CTICasesDelayed Mediastinal Hematoma Secondary to Sternal and Spinal Fractures
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Imaging findings
Initial chest radiograph after a motorcycle crash appears normal, with no obvious mediastinal widening or abnormalities of the paratracheal stripe. A subsequent CT scan, performed later, reveals a parasternal hematoma associated with a sternal fracture, as well as a paraspinal hematoma stemming from spine fractures. A later chest radiograph then demonstrates thickening of the paratracheal stripe and a new left apical cap, indicating a delayed presentation of the mediastinal hematoma.
Key takeaways
Mediastinal hematomas following trauma, particularly from sternal and spinal fractures, may have a delayed appearance on plain radiographs, initially appearing normal. Serial imaging is important to detect evolving injuries. An apical cap can be a sign of paratracheal or para-aortic hemorrhage.
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