CTICasesChest Wall Hematoma with Active Extravasation
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[...]. Chest Wall Hematoma with Active Extravasation. CTICases. Published July 17, 2014. https://str-case-explorer.pages.dev/c/6mfct
Imaging findings
Chest radiograph demonstrates asymmetric density across the entire left hemithorax. Contrast-enhanced chest CT reveals an extremely large hematoma in the left lateral and posterior chest wall with foci of active arterial extravasation, a small hemothorax, and dependent atelectasis. Angiography confirms active bleeding from intercostal and chest wall arteries, which were successfully embolized.
Key takeaways
Massive chest wall hematomas can occur after minor trauma in patients who are super-therapeutic on anticoagulants (such as warfarin, with an INR of 9.9 in this case). On a chest radiograph, this can present as a diffuse asymmetric hemithorax opacity that mimics a large pleural effusion or parenchymal process; CT is essential to identify the chest wall origin and any active arterial extravasation amenable to transcatheter embolization.
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