Giant solitary fibrous tumor of the thoracic cavity presenting with sudden circulatory failure after blunt trauma: a case report.

BACKGROUND: Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm primarily arising from the pleura. While the majority exhibit benign biological behavior, their clinical presentation is often indolent. Solitary fibrous tumor of the pleura (SFTP) is frequently an incidental finding during physical examinations or imaging for unrelated conditions, as patients are often asymptomatic in the early stages.

CASE PRESENTATION: A 37-year-old previously healthy male, a delivery driver, suffered blunt chest and abdominal trauma following an electric bike accident with right-sided chest and abdominal pain rapidly progressing to altered consciousness and circulatory failure. On arrival, he was in hemorrhagic shock (blood pressure 70/40 mmHg, heart rate 120 beats/min). Bedside ultrasonography demonstrated a large right pleural effusion. Emergency tube thoracostomy drained >1000 mL of bright red blood. and subsequent chest computed tomography revealed massive right pleural effusion and a giant heterogeneous mass (approximately 16.4 ×14.5×15.6 cm) in the right lower hemithorax adjacent to the mediastinum, with marked mediastinal shift and cardiac compression. Given ongoing shock and suspected rupture of an intrathoracic lesion, emergent right thoracotomy was performed. A pedunculated giant tumor (20×15×12cm) arising from the right diaphragmatic pleura had partially torn with active bleeding from the pedicle; the mass was completely resected. Despite aggressive resuscitation, including open pericardium and direct cardiac massage for intraoperative cardiac arrest, the patient died postoperatively from multiple organ failure following massive blood loss and prolonged low-flow time. Histopathology and immunohistochemistry (CD34+, STAT6+) supported the diagnosis of SFT.

CONCLUSIONS: SFTP may remain clinically silent even when extremely large. Blunt trauma may cause catastrophic tumor vessel rupture and fatal hemothorax,accompanied by sudden circulatory failure.In unstable patients with massive hemothorax and an intrathoracic mass, rupture of a hypervascular pleural tumor including SFTP should be considered, We review the relevant literature to enhance clinical recognition and management strategies for giant SFTPs with atypical presentations.