Traumatic Mediastinal Hematoma: A Case Report with Literature Review

Introduction: Mediastinal hematoma is a clinically rare condition. Because its imaging manifestations closely resemble those of mediastinal tumors, diagnosis can be challenging, potentially leading to misdiagnosis and delayed treatment. This article reports a case of post-traumatic mediastinal hematoma and reviews the relevant literature. Case Report: The patient was a 48-year-old male with deaf-mutism. He presented with chest pain, chest tightness, dyspnea, and profuse sweating after a fall injury to the chest. After the injury, he was taken to a local hospital. Chest CT imaging suggested: anterior mediastinal lesion, lung shadow, suspected sternal injury. Due to critical condition, he was transferred to our hospital. Admission examination: T 36.0°C, P 119 bpm, R 24 breaths/min, BP 131/99 mmHg. He appeared acutely distressed and in poor spirits. Bilateral jugular vein distension was noted, with tenderness in the right lower anterior chest. Emergency chest contrast-enhanced CT imaging diagnosis: CT diagnosis of an anterior mediastinal space-occupying lesion, possibly hematoma? After admission, he was monitored and treated in the ICU. After his condition stabilized, CT-guided biopsy of the mediastinal lesion was performed. Pathological examination results indicated mediastinal hematoma. Subsequently, he underwent median sternotomy for mediastinal hematoma evacuation. He was discharged after his condition stabilized and improved. Conclusion Mediastinal hematoma often complicates chest trauma. Medical history and CT imaging have suggestive value for diagnosis. When diagnosis is difficult, further investigations such as chest contrast-enhanced CT or angiography can clarify the diagnosis.