A surgical case of mediastinal hematoma caused by a minor traffic injury
Mediastinal hematoma rarely occurs after a minor traffic injury.
A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery.
It is possible that mediastinal hematoma might be caused by a minor traffic injury.
KeywordsMediastinal hematoma Thyroid bleeding Minor traffic injury
Most massive mediastinal hematomas are associated with great vessel disruption or major injury . There are a few reports of mediastinal hematoma not associated with great vessel disruption or major injury. Additionally, there have been no reports of massive mediastinal hemorrhage after a minor traffic injury. Because massive mediastinal hematoma due to minor injury is very rare, the indication for surgical intervention is controversial [1, 2, 3, 4, 5]. We herein report a very rare surgical case of mediastinal hematoma caused by a minor traffic injury.
Mediastinal hematoma without major thoracic injury is reported to be extremely rare . According to previous reports, various causes have been reported: thyroid gland rupture by blunt neck trauma [2, 3], rupture of the inferior thyroid artery by repetitive Valsalva maneuver , violent coughing , spontaneous rupture of an inferior thyroid artery aneurysm , and hemorrhage in a parathyroid adenoma . The thyroid gland has a rich blood supply, and we could not find bleeding from the inferior thyroid artery and mediastinum. Thus, we speculated this patient’s bleeding could have been caused by neck bleeding from the thyroid gland due to increased venous pressure resulting from the traffic injury. Moreover, it is thought that the blood passed through the retropharyngeal prevertebral space, which is the same root as a deep neck infection .
Lemke et al. reviewed 34 cases of thyroid gland hemorrhage after blunt neck trauma and reported the delayed onset of symptoms due to bleeding from the thyroid gland, even 24 h after neck trauma . In this case, the patient showed remarkable symptoms 2 days after the traffic accident. At first, we did not suspect that the mediastinal hematoma was due to the minor accident. We subsequently realized that the minor traffic injury may have caused massive mediastinal bleeding. Even after a minor traffic injury, patients who complain of a sore throat or chest pain could have mediastinal bleeding. Such patients should be observed to assure that their condition is stable.
The treatment of mediastinal hematoma depends on the cardiorespiratory conditions [1, 2]. Angiography and embolization are less invasive, and embolization is regarded as an option for treatment. On the other hand, if a patient has severe cardiorespiratory problems due to active bleeding, massive hematoma and tracheal compression, surgical intervention and drainage of the mediastinal hematoma may be necessary. If a patient’s general condition is stable, close monitoring and conservative treatment may be appropriate. In this case, although we adopted a wait-and-see strategy after embolization of the right inferior thyroid artery, her general condition was deteriorating, and CT revealed compression of mediastinal organs including the trachea due to the hematoma; therefore, we decided to perform emergent surgery. As a result, she had a good clinical course. The treatment of mediastinal hematoma should be based on the patient’s status.
We described a rare case of mediastinal hematoma following a minor traffic injury. Even though such a case is very rare, it should be kept in mind that a minor traffic injury could cause a mediastinal hematoma due to thyroid bleeding.
We would like to thank Dr. S. Kurabe for angiography and embolization, and Dr. S. Koike, F. Saito, S. Okazaki, and A. Yosida for the surgical procedure of the cervical region.
All authors (KS, SS, KH, ME) performed the surgery and post-operative treatment. KS wrote the manuscript, and SS was correspondence. All authors read and approved the final manuscript.
No funding has been received.
Ethics approval and consent to participate
Consent for publication
Informed consent was obtained from the patient for publication of this case report.
The authors declare that they have no competing interests.
- 5.Heckenkamp J, Aleksic M, Gawenda M, Krueger K, Reichert V, Brunkwall JS. Endovascular treatment of a ruptured aneurysm of the inferior thyroid artery. Case report and literature review. J Cardiovasc Surg. 2007;48:193–6.Google Scholar
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.