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Case of the month: Intrathoracic rupture of a pectoral muscle haematoma
  1. P A R Armstrong,
  2. G W McNaughton
  1. Emergency Department, Inverclyde Royal Hospital, Greenock, UK
  1. Correspondence to:
 Dr P Armstrong
 peter.armstrong{at}tuht.scot.nhs.uk

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Blunt chest wall trauma is a common reason for patients attending emergency departments. It may be the result of assault, falls, or motor vehicle accidents. Injuries sustained range from minor soft tissue damage and uncomplicated rib fractures to life threatening thoracic insults. Pectoral muscle haematomas following rib fractures are rare. We report such a case and discuss the subsequent clinical course and management.

CASE REPORT

A 31 year old male intravenous drug user, presented to our emergency department two weeks following a blunt trauma assault, during which he sustained a right sided chest injury. His complaint of right anterior chest pain exacerbated by deep inspiration, coughing, and movement, was associated with pyrexial episodes and night sweats. He was not taking any medication at the time, but was smoking 10–15 cigarettes per day.

Clinical examination revealed right sided bronchial breathing, confirmed by the radiographic presence of right middle zone consolidation. In addition, the patient was noted to have a comminuted right third rib fracture. He was pyrexial, tachycardic, and tachypnoeic. A small haematoma was also noted on the right anterior chest wall. He was admitted under the care of the medical receiving team for intravenous antibiotic treatment of his pneumonia and improved over the following days. An echocardiograph, to exclude bacterial endocarditis, showed normal …

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