Massive Hemothorax Resulting from Blunt Vertebral Fracture

Thoracic and lumbar vertebral fractures are rare causes of hemothorax, and data on the clinical characteristics of patients with massive hemothorax caused by blunt vertebral fractures are limited.

We conducted a literature search using PubMed, Embase, CENTRAL, Web of Science, and Google Scholar for case reports/series on massive hemothorax resulting from blunt vertebral fractures. Descriptive statistics were employed to analyze the study sample, providing a comprehensive understanding of the characteristics of these patients.

Most included cases were older adults and 96.2% patients presented with right hemothorax. The thoracolumbar junction (T10-L2) was the most common site of hemothorax (85.3%). Patients with hemothorax were divided into two groups: group 1, in which bleeding originated from fractured vertebrae, and Group 2, in which bleeding originated from the arteries associated with vertebral fractures. Surgical interventions (68.5%) were the predominant method for controlling bleeding in group 1, whereas endovascular treatments (53.3%) and surgical interventions (46.7%) were the common methods in Group 2. The mortality rate was higher in Group 1 than in Group 2 (26.3% vs. 6.7%). The incidence of massive hemothorax resulting from blunt vertebral fractures is higher in older patients. Massive hemothorax may occur in older patients even following minor traumatic events.

Thoracotomy remains the most reliable method for controlling bleeding caused by vertebral fractures, and transarterial embolization is an effective approach for managing arterial bleeding associated with vertebral fractures. Surviving patients often require spinal fixation after the causative bleeding for hemothorax has been controlled.