Delayed massive hemothorax due to a diaphragmatic laceration caused by lower rib fractures

  • Hitoshi Igai
  • Mitsuhiro Kamiyoshihara
  • Ryohei Yoshikawa
  • Fumi Ohsawa
  • Tomohiro Yazawa
Case Report


A delayed hemothorax requiring surgical treatment is considered a rare minor thoracic injury. We experienced four cases of delayed massive hemothorax due to a diaphragmatic laceration caused by lower rib fractures. A computed tomography scan on admission revealed multiple rib fractures in all patients, and at least one fractured lower rib was severely displaced, which injured the diaphragm. The duration between the injury and the diagnosis were 14 h–30 days. Emergency surgical treatment was performed, and intraoperative findings revealed a diaphragmatic laceration with oozing due to injury caused by the edge of a fractured rib. After the operation, all patients were successfully discharged.


Delayed hemothorax Diaphragmatic laceration Rib fractures 


Compliance with ethical standards

Conflict of interest

Hitoshi Igai has no conflict of interest. Mitsuhiro Kamiyoshihara has no conflict of interest. Ryohei Yoshikawa has no conflict of interest. Fumi Ohsawa has no conflict of interest. Tomohiro Yazawa has no conflict of interest.


  1. 1.
    Emond M, Sirois MJ, Guimont C, et al. Functional impact of a minor thoracic injury. Ann Surg. 2015;262:1115–22.CrossRefGoogle Scholar
  2. 2.
    Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg. 2005;71:481–6.PubMedGoogle Scholar
  3. 3.
    Kim S, Choi WJ, Lee KH, Byu CS, Bae KS, Park IH. The clinical implications of severe low rib fracture in the management of diaphragm injury: a case control study. Int J Surg. 2017;42:178–82.CrossRefGoogle Scholar
  4. 4.
    Chen CL, Chang YL. Delayed massive hemothorax complicating simple rib fracture associated with diaphragmatic injury. Am J Emerg Med. 2014;32:818.e3-4.PubMedGoogle Scholar
  5. 5.
    Chang SW, Ryu KM, Ryu JW. Delayed massive hemothorax requiring surgery after blunt thoracic trauma over a 5-year period: complicating rib fracture with sharp edge associated with diaphragm injury. Clin Exp Emerg Med. 2018;5:60–5.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  1. 1.Department of General Thoracic SurgeryJapanese Red Cross Maebashi HospitalMaebashiJapan

Personalised recommendations