Chance fracture-induced rapidly progressive traumatic hemothorax: A rare case report

Background Traumatic hemothorax is a life-threatening condition, mostly caused by chest wall vascular or lung injuries from rib fractures. Chance fractures are typically linked to flexion-distraction trauma and often accompanied by neurological or abdominal injuries, but cases of hemothorax induced by thoracic vertebral Chance fractures are extremely rare. This report highlights this unusual etiology to improve clinical awareness and timely intervention. Case presentation A 64-year-old male was admitted unconscious (Glasgow Coma Scale 2T) and in shock (blood pressure 60/33 mmHg) after a car accident. Emergency computed tomography revealed left multiple rib fractures, massive right hemothorax, small left pleural effusion, and a T9 vertebral fracture. Bilateral chest tube drainage yielded 3700 ml of bloody fluid. Emergency thoracotomy identified a 3-cm transverse fracture on the anterolateral edge of T9 penetrating the parietal pleura as the sole bleeding source. Hemostasis was achieved via packing with multiple hemostatic materials. Intraoperative cardiac arrest occurred, with successful resuscitation after 25 minutes. Postoperatively, the patient developed disseminated intravascular coagulation and refractory hemodynamic instability, leading to death despite intensive care. Conclusions Thoracic vertebral Chance fractures can rarely cause traumatic hemothorax by damaging the parietal pleura, especially in elderly patients with reduced bone density and tissue fragility. For unexplained traumatic hemothorax, vertebral fractures should be considered to promptly locate the bleeding source. Emergency thoracotomy is crucial for hemodynamically unstable patients, but hemostasis remains challenging, emphasizing the need for enhanced clinical recognition of this rare injury pattern.