{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:44:35Z","timestamp":1787021075967,"version":"build-2736575974"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gen Thorac Cardiovasc Surg Cases"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed hemothorax due to aortic injury is rare, and its delayed diagnosis can be fatal. Herein, we report a case of delayed hemothorax owing to aortic injury following blunt chest trauma, which was successfully treated through emergency surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A woman in her 70s fell on an escalator at a train station and was brought to our emergency department. Initial evaluation with computed tomography (CT) imaging revealed a thoracic vertebral fracture, bilateral lower rib fractures, and a right-sided hemothorax. She was admitted for observation and supportive care, and her condition remained stable for days. On day 9 of hospitalization, the patient suddenly experienced cardiac arrest. A plain chest X-ray showed a massive pleural effusion on the left side, prompting the insertion of a chest tube. The drainage was hemorrhagic, and laboratory tests showed a significant decline in the hemoglobin level to 4.9 g\/dL. Following successful cardiopulmonary resuscitation and the return of spontaneous circulation, a contrast-enhanced CT scan of the chest was performed. However, no active extravasation or apparent source of bleeding was observed. Owing to ongoing hemodynamic instability and the substantial volume of hemothorax, emergency surgery was conducted to identify and control the source of hemorrhage. Intraoperatively, after evacuating a large hematoma from the left thoracic cavity, a small ulcerated hole was identified in the descending thoracic aorta, which appeared tortuous. Pulsatile bleeding was observed from this site. Manual compression was applied to achieve temporary homeostasis. Intraoperative ultrasound showed no evidence of aortic dissection. The bleeding site was sutured directly, and hemostasis was achieved. No additional significant intrathoracic injuries were identified. The aortic injury had resulted from mechanical irritation or penetration by the adjacent fractured lower rib. This represented a case of delayed hemothorax secondary to traumatic aortic injury, a rare but potentially fatal complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In cases of delayed hemothorax following blunt thoracic trauma\u2014particularly with fractures of the lower left posterior ribs, clinicians should maintain a high index of suspicion for aortic injury. Prompt recognition and surgical intervention are critical for patient survival in such cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44215-025-00225-2","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T15:39:04Z","timestamp":1760456344000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Delayed aortic injury following multiple rib fractures: a case report"],"prefix":"10.1186","volume":"4","author":[{"given":"Kei","family":"Nakano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiko","family":"Matsuzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Fujino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Ohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ishihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Matsuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Higeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kie","family":"Maita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Onozawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Tsuboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohiro","family":"Aruga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Masuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"225_CR1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1097\/00000658-198708000-00013","volume":"206","author":"RM Shorr","year":"1987","unstructured":"Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987;206:200\u20135.","journal-title":"Ann Surg"},{"key":"225_CR2","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.ejcts.2004.01.044","volume":"25","author":"P Misthos","year":"2004","unstructured":"Misthos P, Kakaris S, Sepsas E, Athanassiadi K, Skottis I. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg. 2004;25:859\u201364.","journal-title":"Eur J Cardiothorac Surg"},{"key":"225_CR3","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1177\/000313480507100606","volume":"71","author":"OP Sharma","year":"2005","unstructured":"Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg. 2005;71:481\u20136.","journal-title":"Am Surg"},{"key":"225_CR4","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1097\/00005373-198606000-00018","volume":"26","author":"RM Ross","year":"1986","unstructured":"Ross RM, Cardoba A. Delayed life-threatening hemothorax associated with rib fractures. J Trauma. 1986;26:576\u20138.","journal-title":"J Trauma"},{"key":"225_CR5","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.ijscr.2020.10.125","volume":"77","author":"T Muronoi","year":"2020","unstructured":"Muronoi T, Kidani A, Oka K, Konishi M, Kuramoto S, Shimojo Y, et al. Delayed massive hemothorax due to diaphragm injury with rib fracture: a case report. Int J Surg Case Rep. 2020;77:133\u20137.","journal-title":"Int J Surg Case Rep"},{"key":"225_CR6","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/S0020-1383(97)00173-3","volume":"29","author":"K Sugimoto","year":"1998","unstructured":"Sugimoto K, Asari Y, Hirata M, Imai H, Ohwada T. The diagnostic problem associated with blunt traumatic azygous vein injury: delayed appearance of right haemothorax after blunt chest trauma. Injury. 1998;29:380\u20132.","journal-title":"Injury"},{"key":"225_CR7","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s11748-007-0186-7","volume":"56","author":"Y Yanagawa","year":"2008","unstructured":"Yanagawa Y, Kaneko N, Hagiwara A, Kimura T, Isoda S. Delayed sudden cardiac arrest induced by aortic injury with a posterior fracture of the left rib. Gen Thorac Cardiovasc Surg. 2008;56:91\u20132.","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"225_CR8","doi-asserted-by":"publisher","first-page":"406","DOI":"10.5090\/kjtcs.2014.47.4.406","volume":"47","author":"HS Park","year":"2014","unstructured":"Park HS, Ryu SM, Cho SJ, Park SM, Lim SH. A treatment case of delayed aortic injury: the patient with posterior rib fracture. Korean J Thorac Cardiovasc Surg. 2014;47:406\u20138.","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"225_CR9","doi-asserted-by":"publisher","first-page":"4136","DOI":"10.21037\/jtd-22-1359","volume":"14","author":"L Wang","year":"2022","unstructured":"Wang L, Wu W, Guo X, Yang Y. The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury-a case series. J Thorac Dis. 2022;14:4136\u201342.","journal-title":"J Thorac Dis"},{"key":"225_CR10","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1097\/01.TA.0000071292.36248.13","volume":"58","author":"H Ashrafian","year":"2005","unstructured":"Ashrafian H, Kumar P, Sarkar PK, DeSouza A. Delayed penetrating intrathoracic injury from multiple rib fractures. J Trauma. 2005;58:858\u20139.","journal-title":"J Trauma"},{"key":"225_CR11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.ijscr.2020.02.023","volume":"68","author":"Y Goda","year":"2020","unstructured":"Goda Y, Shoji T, Date N, Katakura H. Hemothorax resulting from an initially masked aortic perforation caused by penetration of the sharp edge of a fractured rib: a case report. Int J Surg Case Rep. 2020;68:18\u201321.","journal-title":"Int J Surg Case Rep"},{"key":"225_CR12","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.938","volume":"11","author":"K Tetsumoto","year":"2024","unstructured":"Tetsumoto K, Takayama M, Koyama T, Kayawake H, Saito M, Nakamura K, et al. Penetrating cardiac injury caused by multiple rib fractures following high-energy trauma: usefulness of the exploratory video-assisted thoracoscopic surgery. Acute Med Surg. 2024;11:e938.","journal-title":"Acute Med Surg"},{"key":"225_CR13","volume-title":"Advanced Trauma Life Support (ATLS\u00ae): student course manual","author":"American College of Surgeons Committee on Trauma","year":"2018","unstructured":"American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS\u00ae): student course manual. 10th ed. Chicago: American College of Surgeons; 2018.","edition":"10"},{"key":"225_CR14","first-page":"510","volume":"70","author":"NT Mowery","year":"2011","unstructured":"Mowery NT, Gunter OL, Collier BR, Diaz JJ Jr, Haut E, Hildreth A, et al. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma. 2011;70:510\u20138.","journal-title":"J Trauma"}],"container-title":["General Thoracic and Cardiovascular Surgery Cases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-025-00225-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44215-025-00225-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44215-025-00225-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T02:13:39Z","timestamp":1760494419000},"score":1,"resource":{"primary":{"URL":"https:\/\/gtcscases.biomedcentral.com\/articles\/10.1186\/s44215-025-00225-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["225"],"URL":"https:\/\/doi.org\/10.1186\/s44215-025-00225-2","relation":{},"ISSN":["2731-6203"],"issn-type":[{"value":"2731-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"26 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethics approval was not required as this was a case report. Written informed consent was obtained from the patient for participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient and their family for the publication of this case report and accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"42"}}