Successful Management of a Delayed Traumatic Hemothorax by Timely Imaging Re-evaluation in a Hybrid Emergency Room System

Delayed hemothoraces are rare in patients with trauma, and their optimal management has not been well established. We report a well-managed case of delayed hemothorax diagnosed on post-treatment computed tomography (CT) and managed through endovascular intervention in a hybrid emergency room system. A 24-year-old woman presented in shock after falling from a height of 10 meters. With no external signs of trauma, initial whole-body CT revealed an unstable pelvic ring fracture with active extravasation. Following resuscitative endovascular balloon occlusion of the aorta, transarterial embolization was performed for pelvic bleeding 1 h after patient arrival. CT performed immediately after embolization revealed a delayed right hemothorax. Selective angiography revealed a pseudoaneurysm in a lateral upper intercostal artery branch, which was successfully treated via embolization. In cases of severe blunt trauma requiring invasive interventions, post-treatment CT should be considered even in the absence of abnormalities on the initial scan because of the potential for delayed hemothoraces.