A Case of Obstructive Shock and Respiratory Failure Caused by Chest Wall Hematoma

TL;DR

An elderly dialysis patient developed respiratory failure and obstructive shock due to a large chest wall hematoma after heart surgery.

Contribution

This is the first reported case linking a chest wall hematoma to obstructive shock and respiratory failure.

Findings

A large chest wall hematoma compressed the thoracic cage, causing ventilation disorders.

Emergency surgery to remove the hematoma improved the patient's respiratory and hemodynamic status.

Elderly dialysis patients may have a higher risk of thoracic cage complications after sternotomy.

Abstract

A woman in her 70s undergoing dialysis developed respiratory failure and acute circulatory failure accompanied by bleeding after cardiac surgery. A large chest wall hematoma was found in the right anterior chest, and the CT scan showed that the hematoma was compressing the right thoracic cage. After emergency surgery to stop the bleeding and remove the hematoma, the patient’s respiratory and hemodynamic status improved immediately. In this case, the elderly dialysis patient had undergone a sternotomy, which made the thoracic cage more susceptible to external compression and reduced its ability to expand. The rapidly developing hematoma compressing the thoracic cage caused respiratory failure due to ventilation disorders and obstructive shock. This is the first case report in which compression of the thoracic rib cage by a large chest wall hematoma caused respiratory failure and obstructive shock.

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