From the Research
The posterior intercostal artery is the most likely artery responsible for hemothorax due to a fracture of the 5th, 6th, and 7th ribs. In this case, the rib fractures have likely damaged the posterior intercostal arteries that run along the inferior border of each rib in the costal groove. These arteries are particularly vulnerable to injury during rib fractures because of their anatomical position. When damaged, they can cause bleeding into the pleural space (hemothorax), which is what has happened in this case. The posterior intercostal arteries are branches of the thoracic aorta and supply the intercostal muscles and parietal pleura.
Some key points to consider:
- The posterior intercostal arteries are more likely to be damaged in lateral rib fractures, as they course directly along the fractured ribs in the described location 1.
- Haemorrhagic shock is a life-threatening complication of trauma, and early recognition of retroperitoneal haemorrhage (RPH) is crucial in preventing deleterious outcomes including mortality 2.
- Injury to the intercostal arteries can result in massive hemothorax, which is one of the most lethal forms of chest trauma 3.
- The other vessels listed (bronchial artery, internal thoracic artery, and external thoracic artery) are less likely to be damaged in this specific injury pattern involving lateral rib fractures, as they don't course directly along the fractured ribs in the described location.
It's worth noting that while other studies discuss different types of injuries and treatments, the most relevant and recent study 4 highlights the importance of early recognition and treatment of intercostal artery injuries in patients with multiple displaced rib fractures.
In terms of management, it's crucial to prioritize early recognition and treatment of hemothorax, as delayed treatment can lead to increased morbidity and mortality. The treatment options may include thoracotomy, transcatheter arterial embolization, and rib fixation, depending on the severity of the injury and the patient's condition 3, 4.