Delayed hemothorax in adolescent idiopathic scoliosis 5-year post-spinal fusion

Adolescent idiopathic scoliosis (AIS) is commonly managed with posterior spinal fusion (PSF) and thoracic pedicle screw fixation. While vascular complications are typically acute, delayed hemothorax occurring years after surgery is exceedingly rare. This report describes a unique case of delayed hemothorax secondary to thoracic pedicle screw proximity to the descending thoracic aorta.

An 18-year-old female presented with chest pain and dyspnea 5 years after T4-L3 posterior thoracic fusion for AIS. Computed Tomography Angiography (CTA) revealed a large left pleural effusion, and thoracentesis confirmed hemothorax. Detailed imaging review demonstrated a left T6 pedicle screw tip contacting the posterior wall of the descending aorta. A multidisciplinary surgical team performed thoracoscopic evaluation followed by elective hardware removal.

Thoracoscopy showed localized inflammatory changes without active extravasation. Under controlled conditions, the left T4-L3 instrumentation was safely removed, including the high-risk T6 screw.

This case illustrates an exceptionally delayed vascular complication after thoracic spinal instrumentation. Long-term surveillance and thorough imaging review should be considered in patients with late-onset thoracic symptoms, even years after fusion.