Villegas Md Katrina, Aiken Md Arielle, Halabiya Md Mohammed, Ismail Md Mourad
Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, New Jersey, USA.
Department of Internal Medicine, St. Joseph's Wayne Medical Center, Wayne, New Jersey, USA.
Case Rep Pulmonol. 2025 Apr 3;2025:7977884. doi: 10.1155/crpu/7977884. eCollection 2025.
Hemothorax, the accumulation of blood in the pleural space, is most frequently linked to chest trauma but can occasionally result from nontraumatic causes such as persistent or forceful coughing. Cough-induced rib fractures are rare, with an even less frequent association with hemothorax. We describe a case involving a 57-year-old male who presented with a worsening cough and left-sided pleuritic chest pain despite prior antibiotic and symptomatic treatment. Initial imaging revealed a minimally displaced 10th rib fracture, left-sided atelectasis, and trace pleural effusion. During his hospital stay, he developed acute respiratory distress and increased chest pain, with repeat imaging revealing a large left-sided hemothorax. Chest tube placement drained 1100 mL of blood, supporting the diagnosis of hemothorax, as evidenced by clinical presentation and imaging, despite the absence of fluid analysis. The patient's condition improved following the intervention, and he was discharged in stable condition without recurrence of hemothorax on follow-up imaging. This case highlights the rare association between cough-induced traumatic rib fractures and delayed development of hemothorax. While rib fractures typically result from blunt trauma, they can also occur from stress or repetitive coughing. Complications such as hemothorax are uncommon but potentially life-threatening. The interval development of hemothorax, as seen in this patient, underscores the importance of serial monitoring in cases of rib fractures with ongoing symptoms. Clinicians should maintain a high index of suspicion for hemothorax in patients presenting with rib fractures and persistent cough, particularly in the context of worsening respiratory symptoms or pleuritic chest pain. Early recognition and timely intervention are critical to optimizing outcomes and mitigating the risks of rapid clinical deterioration.
血胸是指血液在胸腔内积聚，最常见于胸部创伤，但偶尔也可能由非创伤性原因引起，如持续性或剧烈咳嗽。咳嗽引起的肋骨骨折很少见，与血胸同时出现的情况则更为罕见。我们报告一例57岁男性患者，尽管之前接受了抗生素治疗和对症治疗，但咳嗽仍加重，伴有左侧胸膜炎性胸痛。初始影像学检查显示第10肋骨轻度移位骨折、左侧肺不张和微量胸腔积液。在住院期间，他出现了急性呼吸窘迫，胸痛加重，复查影像学检查发现左侧大量血胸。放置胸腔引流管引出1100毫升血液，结合临床表现和影像学检查，支持血胸的诊断，尽管未进行液体分析。干预后患者病情好转，出院时情况稳定，随访影像学检查未发现血胸复发。该病例突出了咳嗽引起的创伤性肋骨骨折与血胸延迟发生之间的罕见关联。虽然肋骨骨折通常由钝性创伤引起，但也可能由压力或反复咳嗽导致。血胸等并发症并不常见，但可能危及生命。如该患者所见，血胸的延迟发生强调了对有持续症状的肋骨骨折患者进行连续监测的重要性。临床医生对伴有肋骨骨折和持续咳嗽的患者，尤其是在出现呼吸症状恶化或胸膜炎性胸痛的情况下，应高度怀疑血胸。早期识别和及时干预对于优化治疗结果和降低快速临床恶化风险至关重要。
