An extrapleural hematoma may develop after trauma. The diagnosis may be missed if it is not considered or if imaging findings are ascribed to another cause.
Risk factors for a traumatic extrapleural hematoma:
(1) advanced age
(2) anticoagulation
(3) thoracic surgery or trauma
(4) skeletal spinal deformity (scoliois)
(5) rib fractures
(6) hemothorax
(7) lung contusion
(8) pneumothorax
Clinical findings:
(1) often asymptomatic
(2) small collections may be associated with fever and mild chest pain
(3) large collections may be associated dyspnea, anemia and hypotension
Imaging studies may show:
(1) pleural thickening that does not shift with gravity
(2) costophrenic angle is not obliterated (obliterated angle seen in hemothorax)
(3) displacement of extrapleural fat and the parietal pleura
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