CTICasesExtrapleural Hematoma and Esophageal Rupture
Imaging findings
Initial chest radiograph demonstrates a massive left apical cap and right paratracheal stripe thickening in a patient status post blunt trauma from a motor vehicle collision. Contrast-enhanced chest CT reveals bilateral hemothoraces, mediastinal hemorrhage, and a massive, progressing left extrapleural hematoma likely arising from a branch of the subclavian artery. Notably, pneumomediastinum is present, and a 'parfait sign' is demonstrated in the left pleural space, showing distinct layers of extrapleural blood, extrapleural fat, pleural fluid, and adjacent collapsed lung.
Key takeaways
Esophageal rupture from blunt trauma is highly uncommon and usually difficult to diagnose in the acute setting due to the tamponade effect of co-existing mediastinal hematomas. When evaluating extrapleural hematomas, the presence of a fat stripe between the fluid collection and the lung (the 'parfait sign') helps distinguish an extrapleural hematoma from a standard hemothorax.
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