Sudden exacerbation of a minimal hemothorax during emergence from general anesthesia: diagnosis using lung ultrasound

Minimal traumatic hemothoraces are generally stable but can be exacerbated by physiological shifts during the perioperative period.However, sudden deterioration during emergence from general anesthesia is rarely reported.A 62-year-old man with multiple rib fractures and a small pre-existing hemothorax underwent clavicle fracture fixation.Although hemodynamically stable intraoperatively, he developed severe agitation and forceful inspiratory efforts against airway obstruction during emergence, causing oxygen saturation to drop to 83%.Following airway maneuvers, saturation recovered to 95% and the patient was extubated.However, saturation subsequently declined to 90% despite 100% oxygen supplementation.Lung ultrasound promptly revealed pleural fluid accumulation and absent lung sliding, enabling rapid diagnosis of hemothorax.Chest tube insertion drained a total of 880 mL of blood and stabilized the patient.This case highlights that even a minimal hemothorax can worsen during emergence due to abrupt intrathoracic pressure shifts, and that point-of-care ultrasound enables immediate perioperative diagnosis and intervention.