Iatrogenic Symptomatic Chest Wall Hematoma After Shoulder Arthroplasty: A Report of Two Cases
Division of Sports Medicine and Shoulder Surgery, the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 08/2006; 88(7):1603-8. DOI: 10.2106/JBJS.E.00500
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ABSTRACT: A 79-year-old female was admitted to our hospital because of the abrupt appearance of a painful tumor in the left anterior thoracic wall. No history of trauma was reported. She had chronic respiratory failure due to pulmonary tuberculosis sequelae and needed mechanical ventilation (SIMV) for eight hours every night. Four months prior to this admission, she had an attack of cerebral infarction, and since then she had been on aspirin (100 mg per day). On admission she could not breather herself due to strong acute pain, and required mechanical ventilation all day. Aspirin was discontinued, then the mass slowly disappeared and skin discoloration of subcutaneous hemorrhage followed. Chest X-ray film showed right thorax deformation due to thoracoplasty, and soft tissue enlargement on the left thoracic wall. Chest plain CT revealed a mass in the site of the left smaller pectoral muscle containing an irregular high density area. Contrast enhanced CT revealed a blood vessel and small pooling of contrast material in the mass. Therefore, it was diagnosed as a thoracic wall hematoma. She did not consent to additive examinations including angiography and re-examination of CT. The cause of this acute hematoma is unknown. Trauma and chronic expanding hematoma were eliminated, but vessel abnormality and angiogenic tumor could not be excluded. Attention should be paid to the possibility that thoracic wall hematoma could cause exacerbation of chronic respiratory failure.
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