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This case report describes massive hemothorax occurring 67 days after right rib fractures caused by rupture of a right IPA pseudoaneurysm. A 73-year-old man presented in shock with right hypochondrial pain, underwent non-contrast and contrast CT, and had angiography confirming active extravasation. Transcatheter arterial embolization achieved hemostasis, followed by ICU care, transfusion, drainage of residual hematoma, and rehabilitation transfer.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/delayed-hemothorax-due-to-rupture-of-a-right-inferior-phrenic-artery-pseudoaneurysm-67-days-after-rib-fractures-case-report/454264/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/delayed-hemothorax-due-to-rupture-of-a-right-inferior-phrenic-artery-pseudoaneurysm-67-days-after-rib-fractures-case-report/454264.png","ImageObject",300,407,{"name":92,"@type":93},"Sophia Brooks","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"When does delayed hemothorax usually develop after blunt chest trauma, and what is unusual in this case?","Question",{"text":112,"@type":113},"Delayed hemothorax after blunt chest trauma usually develops within seven days. In this case, hemothorax occurred 67 days after rib fractures, which is much later than typical onset.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What diagnostic methods confirmed the cause of the hemothorax?",{"text":117,"@type":113},"Non-contrast CT showed massive right hemothorax and multiple rib fractures, while contrast-enhanced CT demonstrated contrast extravasation near the right 10th rib with a pseudoaneurysm-like saccular lesion. Angiography identified a pseudoaneurysm with active extravasation in a distal dorsal branch of the right inferior phrenic artery.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the bleeding treated and what was the clinical outcome?",{"text":121,"@type":113},"Transcatheter arterial embolization was performed and achieved successful hemostasis. The patient was managed in the ICU with transfusion, received drainage for residual hematoma, and was later transferred to a rehabilitation hospital after stabilization.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},454264,1790794549,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962084925636,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Review began 11/27/2025  \nReview ended 12/02/2025  \nPublished 12/07/2025  \n© Copyright 2025  \nKubota et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98612  \nOpen Access Case Report  \nDelayed Hemothorax Due to Rupture of a Right Inferior Phrenic Artery Pseudoaneurysm 67 Days After Rib Fractures: A Case Report  \nAkito Kubota 1, Momoko Sugiyama 1 , Yasumasa Ode 1, Kenji Iwata 2, Asako Matsushima 1  \n1. Department of Emergency and Critical Care, Nagoya City University, Graduate School of Medical Sciences, Nagoya, JPN 2. Department of Diagnostic Radiology, Nagoya City University East Medical Center, Nagoya, JPN  \nCorresponding author: Akito Kubota, [a.kubota0804@gmail.com](a.kubota0804@gmail.com)  \nAbstract  \nDelayed hemothorax after blunt chest trauma usually develops within seven days, and the inferior phrenic artery (IPA) is a rare culprit vessel. We report a case of massive hemothorax that occurred 67 days after rib fractures due to rupture of an IPA pseudoaneurysm. A 73-year-old man was transported in shock with a fiveday history of right hypochondrial pain. Non-contrast CT revealed a right pleural effusion with attenuation consistent with blood and multiple fractures of the right 8th-12th ribs, while contrast-enhanced CT demonstrated contrast extravasation adjacent to the right 10th rib. Angiography identified apseudoaneurysm with active extravasation in a distal dorsal branch of the right IPA, and transcatheter arterial embolization was performed with successful hemostasis. He was admitted to the intensive care unit (ICU) and transfused ; after stabilization of his hemodynamics, he was discharged from the ICU on hospital day 2. Percutaneous drainage was subsequently performed for the residual hematoma, and he was transferred to a rehabilitation hospital on hospital day 28. During the course, it was clarified that the multiple right rib fractures had been sustained in a fall 72 days before presentation; therefore, the hemothorax was diagnosed as a delayed hemothorax due to rupture of a right IPA pseudoaneurysm. We experienced a case of delayed hemothorax that developed on day 67 after rib fractures. In delayed hemothorax, the medical history should be traced back several months. Although rare, an IPA pseudoaneurysm can be a life-threatening cause of post-traumatic delayed hemothorax; therefore, inpatients with lower rib fractures, an active diagnostic workup is essential.  \nCategories: Emergency Medicine, Trauma  \nKeywords: delayed hemothorax, inferior phrenic artery, rib fractures, thoracic injuries, traumatic pseudoaneurysm  \nIntroduction  \nWith the rapid aging of Japan 's population, traumatic injuries in older adults have become increasingly common [1], and the incidence of blunt thoracic trauma from falls has risen sharply [2] . Delayed hemothoraxis a recognized complication of blunt chest trauma, occurring in approximately 12% of cases [3] . Prior reports indicate that 87% of delayed hemothoraces develop within seven days of injury and 54% within 48 hours [3]; the longest reported interval to onset is 60 days [4] . Intercostal arteries are most frequently implicated as the bleeding source in traumatic hemothorax [5] . In contrast, hemothorax attributable to the inferior phrenic artery (IPA) accounts for only 1.3% of cases yet has been associated with a mortality rate as high as 11%[6] . Here, we report a case of delayed hemothorax due to rupture of an IPA pseudoaneurysm presenting more than two months after the initial injury.  \nCase Presentation  \nA 73-year-old man presented with acute right-sided chest and upper abdominal pain and dyspnea that had progressively worsened over five days after he twisted his torso, 67 days after sustaining right posterolateral fractures ofthe 8th-12th ribs in ","cbCaij1O9kXsYnzf","https://ap.wps.com/l/cbCaij1O9kXsYnzf","pdf",1871368,"English","# Abstract\n# Introduction\n# Case Presentation\n## Imaging and Diagnostic Findings","[{\"question\":\"When does delayed hemothorax usually develop after blunt chest trauma, and what is unusual in this case?\",\"answer\":\"Delayed hemothorax after blunt chest trauma usually develops within seven days. In this case, hemothorax occurred 67 days after rib fractures, which is much later than typical onset.\"},{\"question\":\"What diagnostic methods confirmed the cause of the hemothorax?\",\"answer\":\"Non-contrast CT showed massive right hemothorax and multiple rib fractures, while contrast-enhanced CT demonstrated contrast extravasation near the right 10th rib with a pseudoaneurysm-like saccular lesion. Angiography identified a pseudoaneurysm with active extravasation in a distal dorsal branch of the right inferior phrenic artery.\"},{\"question\":\"How was the bleeding treated and what was the clinical outcome?\",\"answer\":\"Transcatheter arterial embolization was performed and achieved successful hemostasis. The patient was managed in the ICU with transfusion, received drainage for residual hematoma, and was later transferred to a rehabilitation hospital after stabilization.\"}]","Delayed Hemothorax Due to Rupture of a Right Inferior Phrenic Artery Pseudoaneurysm 67 Days After Rib Fractures - Case Report | PDF",1790740413,13]