Multimodal Surgical Strategy with Preoperative Transcatheter Arterial Embolization Facilitates Safe and Controlled...

Chronic expanding hematoma (CEH) is a slowly enlarging hematoma that persists for more than 1 month after the initial hemorrhagic event. Intrathoracic CEH is rare and often requires technically demanding surgery because of dense adhesions and the risk of massive intraoperative bleeding. We report a case of giant intrathoracic CEH managed using a surgical strategy that included preoperative selective transcatheter arterial embolization (TAE).

A 49-year-old man with a history of tuberculous pleuritis approximately 10 years earlier was referred to our hospital because of a gradually enlarging asymptomatic right intrathoracic mass. Contrast-enhanced CT revealed a 95-mm heterogeneous mass with peripheral enhancement, consistent with CEH. Selective embolization of the right 8th to 11th intercostal arteries was performed on the day before surgery. Through a posterolateral thoracotomy with resection of the 7th and 8th ribs, the hematoma was completely resected with partial resection of the right lower lobe. Additional procedures, including decortication, adhesiolysis, and chest wall plasty, were performed to facilitate lung re-expansion and reduce the residual thoracic cavity. Although prolonged postoperative air leakage required pleurodesis on POD 10, the patient was discharged on POD 12 without major complications. No recurrence has been observed during follow-up.

Preoperative selective TAE, combined with an appropriate surgical strategy, may reduce intraoperative bleeding and enable safe and controlled radical resection of intrathoracic CEH. Careful preoperative planning, including bleeding control and optimization of the surgical approach, is essential for successful treatment.