Delayed retained hemopneumothorax secondary to rib fracture with pulmonary perforation treated by video-assisted thoracoscopic surgery: a case report

Abstract Retained hemothorax is a complication of thoracic trauma caused by incomplete pleural drainage and early fibrotic organization, potentially progressing to trapped lung and functional impairment if untreated. A 60-year-old man sustained fractures of the eighth, ninth, and tenth right ribs after a fall, one associated with pulmonary injury. Without initial medical care, he presented 15 days later with progressive dyspnea. Chest radiography showed right lung collapse with massive hemopneumothorax. Closed thoracostomy drained 4000 ml of blood, but lung re-expansion failed due to organized hemothorax. Video-assisted thoracoscopic surgery revealed organized clots and pleuropulmonary adhesions causing trapped lung. Complete evacuation, adhesiolysis, and pleural lavage were performed. Postoperative drainage was 180 ml. With intensive respiratory physiotherapy, full lung re-expansion and satisfactory recovery were achieved. In stable patients with delayed retained hemothorax, video-assisted thoracoscopic surgery enables effective resolution, avoiding thoracotomy and restoring pulmonary function through a minimally invasive approach.