Another Source of Near-Fatal Bleeding—Late-Onset Hemothorax Six Weeks After Uneventful Minimally Invasive Repair of Pectus Excavatum

Background/Objectives: The minimally invasive repair of pectus excavatum (MIRPE) and its modifications represent the gold standard for surgical repair of chest wall deformities. Severe complications during or after MIRPE are rare but likely underreported in the literature. Methods/Results: We report the case of a 14-year-old adolescent who underwent an uneventful repair of an asymmetric pectus excavatum. Six weeks postoperatively, the patient presented with shortness of breath and dizziness. Clinical examination and imaging revealed a spontaneous massive right-sided hemothorax. Following chest tube placement, an initial 600 mL of bloody pleural fluid was drained. CT angiography demonstrated no active bleeding but raised suspicion of an injury to the right-sided internal mammary artery. After a total drainage of 1600 mL, the patient remained hemodynamically stable, and the chest tube was removed within 24 h. During 32 months of follow-up, the further clinical course was uneventful, and imaging demonstrated no secondary displacement of the implants. Discussion/Conclusions: Accidental injury to the internal mammary or intercostal vessels during pectus surgery is a rare but potentially life-threatening complication. Only a few cases of delayed hemorrhage following MIRPE have been reported, and in many a clear source of bleeding could not be identified. Pectus surgeons should be aware of this rare complication and should report such cases to improve understanding of its incidence and management.