Extrapleural hematomas: imaging appearance, classification, and clinical significance

Area of Science:

• Radiology
• Trauma Surgery
• Thoracic Imaging

Background:

• Extrapleural hematomas (EPHs) are collections of blood in the space between the parietal pleura and the endothoracic fascia.
• Understanding their imaging characteristics and clinical associations is crucial for appropriate management.

Purpose of the Study:

• To identify radiologic and clinical findings associated with extrapleural hematomas (EPHs).
• To develop an imaging-based classification system for EPHs.
• To determine factors predicting the need for surgical intervention in EPH cases.

Main Methods:

• Retrospective review of 13 extrapleural hematoma cases.
• Diagnosis and characterization of EPHs using computed tomography (CT).
• Documentation of EPH location, shape, and associated injuries; review of chest radiographs.

Main Results:

• Most EPHs occurred in males (92%) with an average age of 61, predominantly from blunt trauma (85%).
• Rib fractures were common (81%), and all patients had associated injuries.
• Biconvex EPHs were larger (average 4211 mL) and necessitated surgery in 80% of cases, unlike nonconvex EPHs managed conservatively.

Conclusions:

• Extrapleural hematomas are typically associated with high-energy blunt trauma and multiple injuries, especially rib fractures.
• The CT appearance (biconvex vs. nonconvex) is a key differentiator for management.
• Biconvex EPHs often indicate significant bleeding and require surgical intervention, while nonconvex types are usually managed nonoperatively.