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{
    "pk": 47257,
    "title": "Hemothorax from a Thoracic Chalk-Stick Fracture in Ankylosing Spondylitis: A Case Report",
    "subtitle": null,
    "abstract": "<p style=\"line-height: 2;\"><strong>Introduction</strong>: Chalk-stick fractures are transverse spinal injuries seen in patients with ankylosing spondylitis due to chronic inflammation and spinal rigidity. These fractures may result from minor trauma and are associated with potentially fatal complications. While spinal fractures in ankylosing spondylitis are well recognized, thoracic chalk-stick fractures complicated by hemothorax from vascular injury remain exceedingly rare. We present a case of an elderly male with ankylosing spondylitis who sustained a thoracic chalk-stick fracture following a ground-level fall, complicated by hemothorax and hemorrhagic shock. This case highlights a rarely reported but life-threatening complication and emphasizes the importance of early imaging and high clinical suspicion in this high-risk population—even after minor trauma.</p>\n<p style=\"line-height: 2;\"><strong>Case Report: </strong>A 90-year-old male with known history of ankylosing spondylitis presented to the emergency department after a ground-level fall associated with syncope. He had thoracic back pain, dyspnea, and hypotension. Computed tomography revealed a thoracic vertebra 11 chalk-stick fracture with interspinous vascular injury and a large, right-sided hemothorax. The patient underwent emergent chest tube placement, blood transfusion, and vasopressor support, which initially stabilized his condition. However, his hospital course was complicated by multiple comorbidities, and he ultimately died after prolonged critical care.</p>\n<p style=\"line-height: 2;\"><strong>Conclusion</strong>: This case illustrates the potential for catastrophic vascular complications from minor trauma in patients with ankylosing spondylitis. Thoracic chalk-stick fractures may result in life-threatening hemothorax and hemorrhagic shock. Emergency physicians should maintain a high index of suspicion and obtain early radiographic imaging to facilitate timely diagnosis and intervention in this high-risk population.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ankylosing spondylitis"
        },
        {
            "word": "hemothorax"
        },
        {
            "word": "chalk-stick fracture"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/1gc895jz",
    "frozenauthors": [
        {
            "first_name": "Armin",
            "middle_name": "Akbarpur",
            "last_name": "Dehkordi",
            "name_suffix": "",
            "institution": "Arkansas College of Osteopathic Medicine at Arkansas Colleges of Health Education, Fort Smith, Arkansas",
            "department": ""
        },
        {
            "first_name": "Daniel",
            "middle_name": "Michael",
            "last_name": "Aloise",
            "name_suffix": "",
            "institution": "Mount Sinai Medical Center Miami Beach, Department of Emergency Medicine, Miami Beach, Florida",
            "department": ""
        },
        {
            "first_name": "Eric",
            "middle_name": "",
            "last_name": "Scheppke",
            "name_suffix": "",
            "institution": "Mount Sinai Medical Center Miami Beach, Department of Emergency Medicine, Miami Beach, Florida",
            "department": ""
        },
        {
            "first_name": "Mary",
            "middle_name": "",
            "last_name": "Christodoulou",
            "name_suffix": "",
            "institution": "Florida International University, Herbert Wertheim College of Medicine, Miami, Florida",
            "department": ""
        },
        {
            "first_name": "Grayson",
            "middle_name": "",
            "last_name": "Gigliotti",
            "name_suffix": "",
            "institution": "Florida International University, Herbert Wertheim College of Medicine, Miami, Florida",
            "department": ""
        },
        {
            "first_name": "Tony",
            "middle_name": "",
            "last_name": "Zitek",
            "name_suffix": "",
            "institution": "Mount Sinai Medical Center Miami Beach, Department of Emergency Medicine, Miami Beach, Florida",
            "department": ""
        }
    ],
    "date_submitted": "2025-06-26T20:46:23.456000Z",
    "date_accepted": "2025-10-20T21:29:58.680000Z",
    "date_published": "2026-03-19T21:38:00Z",
    "render_galley": null,
    "galleys": [
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            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/47257/galley/49097/download/"
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}