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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