A Case of Delayed Hemothorax due to Diaphragmatic Injury by a Fractured Rib

Abstract

A 64-year-old woman who fell from her chair at the entrance of her home suffered trauma on her right chest and was referred to our hospital. Chest radiography and computed tomography showed fractures of the fifth and sixth right ribs. Since continuous injection of pain killers was effective in reducing her pain, she was scheduled to be discharged. However, sudden onset right chest pain developed again on the 11th day after the injury. Computed tomography revealed significant right pleural effusion. Right hemothorax was diagnosed by the insertion of a chest tube. Emergency surgery was performed with thoracoscopic assistance. Several blood clots were observed, occupying the right thoracic cavity. The sharp end of the fractured seventh rib protruding into the thoracic cavity causing laceration of the nearby diaphragm was considered to be the cause of hemothorax. Partial resection of the seventh right rib and suture closure of the injured diaphragm were performed. She was discharged on the 22nd day, without any post-operative complications. It is necessary to consider the delayed possibility of a hemothorax due to diaphragmatic injury in patients with middle or lower rib fractures.