Thoracoscopic evacuation of giant traumatic extrapleural hematomas

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In the setting of blunt thoracic trauma, rib fractures and injuries to the intercostal vessels can lead to the development of giant hematomas within the extrapleural space, bordered by the parietal pleura and the endothoracic fascia, which can mimic a hemothorax and—depending on its size—significantly decrease the total lung capacity.1 Management of an extrapleural hematoma can be challenging if it is large in size or if there is ongoing bleeding from the intercostal vessels. Although this entity has traditionally been reported as individual cases in the literature, one single-center experience suggested that the incidence of traumatic extrapleural hematomas is approximately 7%.2 To date, the successful management of a traumatic extrapleural hematoma using a minimally invasive thoracoscopic-based approach has been reported only once.1–7
We describe our experience in two cases in which giant traumatic extrapleural hematomas were successfully managed with thoracoscopy, subtotal pleurectomy, evacuation of the extrapleural hematoma, and tube thoracostomy. To our knowledge, this is the first report of the successful minimally invasive management of a giant traumatic extrapleural hematoma from North America.
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