Delayed life-threatening hemothorax following blunt thoracic trauma: A rare and catastrophic evolution in a...

Delayed hemothorax, although infrequent, constitutes a life-threatening complication in the context of blunt thoracic trauma. The temporal dissociation between injury and symptom escalation challenges early detection, and the pathophysiological mechanisms often remain elusive. We present a case of an 18-year-old female who developed massive right-sided hemothorax six days after initial injury, necessitating emergent thoracotomy.

The patient, a victim of a high-energy vehicular collision, presented with multiple rib fractures, bilateral pneumothorax, and vertebral injuries. Following initial stabilization and ICU care, she showed promising neurological recovery. However, on the sixth post-injury day, she experienced sudden cardiovascular collapse, and imaging revealed a large hemothorax. Thoracotomy evacuated approximately 2000 mL of blood. No active bleeding source was found. Postoperatively, the patient faced sepsis, air leak complications, and required tracheostomy. She gradually recovered and was discharged in stable condition.

This case highlights the unpredictable nature of delayed hemothorax and underscores the need for vigilance, especially in patients with displaced rib fractures and concomitant pulmonary or vertebral injuries. Serial imaging, multidisciplinary monitoring, and preparedness for surgical intervention are key to improving outcomes in such scenarios.