Hemoptysis On The Pitch: A Soccer Case Study

HISTORY: A 31-year-old professional soccer player (right back) sustained a blunt right sided chest trauma during a game. In the 81st minute he attempted to head a ball by jumping about a foot in the air, turning near belly up and landing on his right side. He felt the “wind knocked out,” of him and noticed he had blood in his mouth. He described pressure in his chest after the trauma and coughed up blood several times. The ATC was called onto the field, followed by the team who evaluated the oropharynx looking for evidence of bleeding. There was no shortness of breath, head trauma, loss of consciousness, nausea/ vomiting, abdominal pain, neck or back pain. He was then sent to the hospital via EMS for further evaluation. PHYSICAL EXAMINATION: Examination on the sidelines revealed no significant oropharyngeal lesions, however hemoptysis was noted. Some tenderness to the posterior right thorax at site of impact. Noted to have normal HR and rhythm as well as normal pulses w/ normal heart sounds. Noted to have normal pulmonary effort, no respiratory distress, and normal breath sounds. There was no stridor, wheezing, rhonchi or rales. Further evaluation in the ED revealed flat, soft abdomen w/o tenderness, no cva tenderness, no tenderness on the chest wall. Spine was nontender w/ no bony stepoffs and normal ROM DIFFERENTIAL DIAGNOSIS: 1. Lung contusion/ Traumatic pneumatocele 2. Hemothorax 3. Arteriovenous malformation 4. Pulmonary Embolism 5. Coagulopathy TEST AND RESULTS: CXR in stadium was normal. CTA Chest w/ contrast- tiny loculated penumothorax or pneumatocele at medial aspect of RUL superior segment measuring 2.5 cm showed a scant internal fluid and surrounding pulmonary hematoma. No fracture. CXR 6 hours later- lungs clear, no pleural effusions or pneumothorax, cardiomediastinal silhouette normal. FINAL WORKING DIAGNOSIS: Pneumatocele w/ pulmonary contusion TREATMENT AND OUTCOMES: 1. While in ED was plated on nasal cannulae 2. Admitted to cardiothoracic surgery and monitored overnight 3. Discharged the following morning and was told to not practice for a week 4. Played all 90 minutes the following game 12 days later with no issues