Case report of rare complication: unilateral chest wall hematoma after intracranial aneurysm embolization

Unilateral chest wall hematoma is a rare but life-threatening cause of shock following endovascular procedures. We report a case of refractory hypotension and unilateral chest wall swelling in the post-anesthesia care unit, which was initially suspected to be a tension pneumothorax but was ultimately diagnosed as a contained chest wall hematoma. An 81-year-old male patient developed refractory hypotension and right chest wall swelling 15 min post-procedure. Initial bedside eFAST examination showed no pleural effusion, pneumothorax, or pericardial effusion. Cardiac ultrasound revealed normal wall motion, making myocardial infarction less likely. Physical examination revealed a rock-hard, high-tension mass in the chest wall. Emergency CT and ultrasound confirmed a massive intermuscular hematoma in the right chest wall. The patient received aggressive fluid resuscitation, blood transfusion, and compressive bandaging therapy. Angiography showed no active extravasation. The patient’s hemodynamics stabilized within 24 h, and the hematoma gradually absorbed over the subsequent days. Chest wall hematoma should be considered in the differential diagnosis of postprocedural shock, particularly when eFAST is negative. Physical examination and palpation are critical for identifying a localized tense mass, and prompt CT imaging is key to avoiding misdiagnosis as tension pneumothorax and ensuring correct treatment.