Mediastinal hematoma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
See also Thoracic aortic injury
Overview
Mediastinal hematomas are usually caused by;
- Thoracic trauma,
- Blunt trauma (more common)
- Rapid deceleration (e.g. motor vehicle accident, fall from great height)
- Crush injury
- Penetrating trauma
- Stab wound
- Gun shot wound
- Blunt trauma (more common)
- Cardiac and great vessel aneurysm or rupture
- Iatrogenic factors associated with invasive procedures and surgery
- Coagulation abnormalities (bleeding diathesis)
- Neoplasms
- Spontaneous
- Sneezing
- Coughing
- Emesis
- Uremia,
- Renovascular hypertension
Diagnosis
The gold standard diagnostic modalities are angiography and surgical exploration.
Chest X-Ray
Echocardiography
Transthoracic Echocardiography (TTE)
Transesophageal Echocardiography (TEE)
Multi Sliced CT
Positron Emission Tomography
Magnetic Resonance Imaging (MRI)
Management
Asymptomatic mediastinal hematomas can be diagnosed by using noninvasive modalities and may be appropriately treated conservatively, with a period of observation for hematoma progression or regression. For uncommon, suspicious, or symptomatic mediastinal hematomas, surgical intervention using median sternotomy for adequate surgical exposure, greater cardiovascular control, and hemostasis is prompt management.
References
- Creasy JD et al. Overview of Traumatic Injury of the Thoracic Aorta, RadioGraphics 1997, Vol 17, 27 – 45
- Kuhlman JE et al. Radiographic and CT Findings of Blunt Chest Trauma: Aortic Injuries and Looking Beyond Them, RadioGraphics 1998, Vol 18, 1085 - 1106
- Culliford AT, Ginsberg GD, Lefleur RS, Acinapura AJ. Spontaneous mediastinal hemorrhage as associated with renovascular hypertension. Arch Surg 1977;112;1500–1.
- Turetz F, Steinberg H, Kahn A. Spontaneous anterior mediastinal hematoma: a complication of heparin therapy. J Am Med Womens Assoc 1979;34:85–8.
- Berry BE, Carpenter PC, Fulton RE, Danielson GK. Mediastinal hemorrhage from parathyroid adenoma simulating dissecting aneurysm. Arch Surg 1972;108:740–1.
- Kuo YC, Wang HC, Chu KA, Lu JY. Chronic myeloid leukemia initially presenting with spontaneous mediastinal hematoma and hemothorax. Zhonghua Yi Xue Za Zhi (Taipei) 2000;63:170–4.
- Stilwell ME, Weisbrod GL, Ilves R. Spontaneous mediastinal hematoma. J Can Assoc Radiol 1981;31:60–1.
- MacDonald RG, Kelly J. Cervico-mediastinal hematoma following sneezing. Anesthesia 1975;30:50–3.
- Neinaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328:1–9.
- Neinaber CA, Spielmann RP, von Kodolitsch Y, et al. Diagnosis of thoracic aortic dissection: magnetic resonance imaging versus transesophageal echocardiography. Circulation 1992;85:434–47.
- Neinaber CA, von Kodolitsch Y, Brockhoff CJ, et al. Comparison of conventional and transesophageal echocardiography with magnetic resonance imaging for anatomical mapping of thoracic aortic dissection. Int J Cardiac Imag 1994;10:1–14.
- Kodolitsch YV, Krause N, Spielmann R, Nienaber CA. Diagnostic potential of combined transthoracic echocardiography and x-ray computed tomography in suspected aortic dissection. Clin Cardiol 1999;22:345–52.
- Ogawa T, Hatazawa J, Inugami A, et al. Carbon-11-methionine PET evaluation of intracerebral hematoma: distinguishing neoplastic from non-neoplastic hematoma. J Nucl Med 1995;36:2175–9