Splenic herniation causing massive haemothorax after blunt trauma.

tree, which showed no evidence of tears or fresh blood. A left chest drain was inserted with immediate drainage of 1600 ml of blood. The drain was removed after three days, with a chest radiograph before discharge (eight days) showing regression of the mediastinal haematoma and expansion of the lung. In this case, despite the moderate trauma, both the chest radiography and computed tomography revealed considerable mediastinal haemorrhage, and we feel that the underlying pathophysiology may have been a direct blow causing deformation of the sternum without fracture, leading to tearing of mediastinal vessels, possibly the internal mammary vein or artery. Other reported complications of blunt chest trauma include: direct cardiac injury with cardiac rupture, left ventricular aneurysms, or pseudoaneurysms'; valve incompetence2; and damage to the thoracic duct.' Damage to the internal mammary artery has been reported, with the formation of an anterior mediastinal haematoma producing external pericardial compression requiring surgical intervention.4 There is also a small incidence of blunt chest trauma induced cardiac arrest during sports activities (commotio cordis) in young athletes with a relatively poor survival rate due to delayed resuscitation.' We have presented a case of considerable mediastinal haemorrhage after a rugby tackle associated with no bony injuries. This case demonstrates that even if the trauma appears trivial, adequate investigation is the only method for excluding potentially life threatening complications.