Kuriyama Akira, Kato Yumi, Echigoya Ryosuke
Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan. ak.bellyrub+
Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan.
World J Emerg Surg. 2025 Apr 19;20(1):34. doi: 10.1186/s13017-025-00609-3.
Hemothorax is a common complication of thoracic trauma, often associated with morbidity and mortality. While intercostal and internal mammary arteries are commonly involved, the inferior phrenic artery (IPA) is rarely the source of hemothorax following blunt trauma. We aimed to investigate the prevalence of IPA-related hemothorax by describing a single-center case series and to outline the characteristics and management of hemothorax secondary to IPA injury with a systematic review.
We conducted a chart review of patients with trauma to identify patients with hemothorax due to IPA injury at a Japanese tertiary care hospital between 2013 and 2019. We performed a systematic review of published studies about this condition by searching PubMed, EMBASE, and ICHUSHI from their inception to January 18, 2025, summarizing their clinical characteristics, treatment, and prognosis.
Among 231 patients with hemothorax following blunt trauma, 3 (1.3%) were caused by IPA injury. The systematic review identified published articles for 16 additional reports, yielding 19 reports for analysis. IPA injury was typically diagnosed after 1 day to 3 weeks post-injury, with 94% of patients presenting with shock. Transcatheter arterial embolization (TAE) was the primary treatment, although many patients required additional interventions such as thoracotomy and hematoma evacuation. Complications included pneumonia, and the mortality rate was 11%.
Hemothorax due to IPA injury following blunt trauma may be rare and potentially life-threatening. While endovascular techniques such as TAE were effective in many cases, repeated bleeding and substantial hematoma necessitated repeat interventions or surgical procedures. Despite an overall favorable prognosis, significant risks for complications and mortality remained. Thus, early recognition and increased awareness of IPA injury in patients with trauma are essential for improving outcomes.
血胸是胸部创伤的常见并发症，常与发病率和死亡率相关。虽然肋间动脉和胸廓内动脉常受累，但钝性创伤后膈下动脉（IPA）很少是血胸的来源。我们旨在通过描述一个单中心病例系列来调查IPA相关血胸的患病率，并通过系统评价概述IPA损伤继发血胸的特征和管理。
我们对创伤患者的病历进行了回顾，以确定2013年至2019年期间在一家日本三级护理医院因IPA损伤导致血胸的患者。我们通过检索PubMed、EMBASE和ICHUSHI从创刊到2025年1月18日关于该疾病的已发表研究进行系统评价，总结其临床特征、治疗和预后。
在231例钝性创伤后血胸患者中，3例（1.3%）由IPA损伤引起。系统评价确定了另外16篇报告的已发表文章，产生了19篇报告进行分析。IPA损伤通常在受伤后1天至3周被诊断，94%的患者出现休克。经导管动脉栓塞术（TAE）是主要治疗方法，尽管许多患者需要额外的干预措施，如开胸手术和血肿清除。并发症包括肺炎，死亡率为11%。
钝性创伤后因IPA损伤导致的血胸可能很少见且有潜在生命危险。虽然TAE等血管内技术在许多情况下有效，但反复出血和大量血肿需要重复干预或手术。尽管总体预后良好，但并发症和死亡率的重大风险仍然存在。因此，早期识别和提高对创伤患者IPA损伤的认识对于改善预后至关重要。
