Massive hemothorax following ground-level fall in an older adult: A case report

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Background As the older adult population increases, fall-related ED presentations are increasing, with ground-level falls a leading cause of fatal and non-fatal injuries in this population. Geriatric patients are at high risk for rib fractures, including delayed hemothorax. While delayed presentations typically occur within 14 days of injury, older adults face greater risk of rapid deterioration and mortality. We present a geriatric patient who developed a massive hemothorax following a ground-level fall. Case Report A 75-year-old male with coronary artery disease on aspirin, hypertension, hyperlipidemia, type 2 diabetes, prostate cancer, prior hemorrhagic stroke with ventriculostomy, and aortic root replacement presented after a backward ground-level fall with posterior head trauma and transient loss of consciousness. On ED arrival, he became profoundly hypotensive. FAST and chest x-ray showed a right hemothorax. Trauma activation was initiated, and he underwent rapid ED resuscitation. Despite early identification and aggressive intervention, he remained unstable and required emergent thoracotomy for intercostal arterial bleeding. Imaging later confirmed right 6th–8th rib fractures. His ICU course was complicated by respiratory failure, recurrent infections, and progressive organ dysfunction, ultimately leading to transition to comfort care. Why should an emergency physician be aware of this This case illustrates how a seemingly minor fall can result in rapid, life-threatening thoracic hemorrhage in older adults despite prompt ED management. It highlights the need for continuous reassessment, early repeat imaging, and a low threshold for surgical consultation when geriatric patients with rib fractures show early signs of instability.

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