Delayed hemothorax resulting from stab wounds to the internal mammary artery

Massive delayed hemothorax as a result of stab wounds to the internal mammary artery have not recently been reported. A patient who died after such an injury prompted a 10-year retrospective review. During that time period, 88 patients with stab wounds to the chest were identified. Thirty-five of these involved injuries to the parasternal region. This region is described as being located below the clavicles, between the midclavicular lines, and above the costal margins. We identified 5 patients with internal mammary artery injuries: 4 had massive delayed bleeding and 2 died. Our current recommendations for managing stable patients with parasternal stab wounds include maintaining a high index of suspicion, intensive care monitoring, and placement of chest tubes for monitoring. Should delayed bleeding occur, a prompt thoracotomy is mandatory.