The patient was a 67-year-old man who showed right massive haemothorax after being run over by a low-speed vehicle. In the ambulance, his Glasgow Coma Scale score was 15/15 (eyes: 4; verbal: 5; motor: 6) and he was able to speak. However, he went into cardiopulmonary arrest during transportation. On admission to our hospital 40 min after arrest, right massive haemothorax was detected. The haemothorax could not be controlled and he died. Autopsy imaging was subsequently performed, which revealed movement of the renal parenchyma, collecting system and vasculature into the intrathoracic space (figure 1A), extravasation in the retroperitoneum (figure 1B), and no extravasation in the lung. In general, the estimated incidence of renal artery injury among blunt trauma patients is only 0.08%,1 and massive haemorrhage from injured lung parenchyma is the most common cause of haemothorax in these patients. Moreover, traumatic diaphragmatic rupture more commonly affects the left side than the right, and complete avulsion of the right kidney into the thorax through a ruptured diaphragm is extremely rare.

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Figure 1

Coronal reformation CT shows intrathoracic migration of the right kidney (A, arrow). Extravasation was detected in the retroperitoneum (B, arrowhead).

This case presents two findings. First, massive haemothorax may originate from the retroperitoneum. Second, autopsy imaging using contrast-enhanced computer tomography can clearly reveal the cause of death in such cases.