Tuesday, October 22, 2013

Case review 8: Loculated Hematoma


History
An elderly man fell from his motorbike 2 weeks ago. He was admitted to hospital and a chest tube was inserted. After a week, he was discharged and consulted his GP who did an x-ray.

X-ray findings
The x-ray showed multiple right rib fractures and fracture mid shaft of his right clavicle.
In addition, there is a homogenous opacity in the right mid upper zone. 
The medial and lower borders are well defined while the upper border is hazy.
The lower border makes an obtuse angle with the lateral chest wall indicating that it is a pleural based lesion. These are strongly suggestive of loculated hematoma. The most likely cause would be complication from his chest tube.
Residual effusion/hematoma is also seen in the lower zone.

Further management

He should be referred back to the hospital as the hematoma may complicates to abscess formation later.

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