Delayed Hemothorax due to Thoracic Aortic Injury after Rib Fracture

Abstract

A 72-year-old man fell down a steep slope on a mountain and had a left 9-11 rib fracture with slight traumatic hemopneumothorax. The next morning, he vomited, and his blood pressure dropped. Computed tomography revealed an increase in hemothorax, and more than 2,000 ml of blood was drained from his left thoracic cavity. We performed emergency surgery and found a pinhole-sized bleeding point in the descending aorta. The aortic injury was thought to have been caused by a nearby rib fracture tip. After suturing, the bleeding hemodynamics stabilized. The patient was discharged 14 days after the injury. Hemothorax following chest trauma is commonly associated with intercostal artery damage caused by rib fractures. It is rare that the cause is aortic injury, as in this case. However, delayed treatment can lead to death. Therefore, in cases of hemothorax after chest trauma, especially after rib fracture of the left back, it is important to exclude aortic injury.