Mediastinal Hematoma

Mediastinal Hematoma

David Ray Velez, MD

Table of Contents

Background
Presentation
Diagnosis
Management

Background

Definition: The Presence of Blood within the Mediastinum as it Dissects Fascial Planes

Small Venous Injury is the Most Common Cause in Blunt Thoracic Trauma

Causes

  • Penetrating Injury
  • Aortic Injury
  • Mediastinal Vascular Injury (Internal Thoracics, Intercostals)
  • Sternal Fracture
  • Rib Fracture
  • Vertebral Fracture
  • Esophageal Injury
  • Misplaced Central Venous Catheters

Can Also Be Caused by Nontraumatic or Iatrogenic Causes: Non-Traumatic Aortic Rupture, Secondary Hemorrhage into Associated Masses, Valsalva Maneuver, Sever Vomiting, etc.

Bleeding Disorders and Anticoagulation Can Increase the Risk

Mediastinal Hematoma Associated with Sternal Fracture

Presentation

Symptoms

  • Dyspnea – The Most Common Symptom
  • Airway Obstruction/Respiratory Failure
  • Chest Pain
  • Neck Pain
  • Dysphagia
  • Fatigue
  • Neck/Chest Wall Hematoma

Can Cause Significant Hemorrhage and Extrapericardial Tamponade

Diagnosis

Primarily Diagnosed by CT or CTA

May See a Widened Mediastinum on Initial Plain Film Radiography (Low Sensitivity/Specificity)

Can Also Be Diagnosed by Echocardiography but is Easily Missed by a Traditional FAST with Subxiphoid View (Echocardiography is Also Unable to Clearly Differentiate Etiology Alone)

Management

Management is Primarily Directed by the Etiology and Stability

Often Managed Conservatively with Close Observation if Stable and Not Actively Bleeding

Additional Options as Appropriate

  • Transcatheter Arterial Embolization (TAE)
  • Open Surgical Intervention (Sternotomy vs Thoracotomy)
  • Video-Assisted Thoracoscopic Surgery (VATS)