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Messa GE, Fontenot CJ, Deville PE, Hunt JP, Marr AB, Schoen JE, Stuke LE, Greiffenstein PP, Smith AA. Chest Tube Size Selection: Evaluating Provider Practices, Treatment Efficacy, and Complications in Management of Thoracic Trauma. Am Surg 2024:31348241241735. [PMID: 38557288 DOI: 10.1177/00031348241241735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The standard for managing traumatic pneumothorax (PTX), hemothorax (HTX), and hemopneumothorax (HPTX) has historically been large-bore (LB) chest tubes (>20-Fr). Previous studies have shown equal efficacy of small-bore (SB) chest tubes (≤19-Fr) in draining PTX and HTX/HPTX. This study aimed to evaluate provider practice patterns, treatment efficacy, and complications related to the selection of chest tube sizes for patients with thoracic trauma. METHODS A retrospective chart review was performed on adult patients who underwent tube thoracostomy for traumatic PTX, HTX, or HPTX at a Level 1 Trauma Center from January 2016 to December 2021. Comparison was made between SB and LB thoracostomy tubes. The primary outcome was indication for chest tube placement based on injury pattern. Secondary outcomes included retained hemothorax, insertion-related complications, and duration of chest tube placement. Univariate and multivariate analyses were performed. RESULTS Three hundred and forty-one patients were included and 297 (87.1%) received LB tubes. No significant differences were found between the groups concerning tube failure and insertion-related complications. LB tubes were more frequently placed in patients with penetrating MOI, higher average ISS, and higher average thoracic AIS. Patients who received LB chest tubes experienced a higher incidence of retained HTX. DISCUSSION In patients with thoracic trauma, both SB and LB chest tubes may be used for treatment. SB tubes are typically placed in nonemergent situations, and there is apparent provider bias for LB tubes. A future randomized clinical trial is needed to provide additional data on the usage of SB tubes in emergent situations.
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Affiliation(s)
- Genevieve E Messa
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Cameron J Fontenot
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Paige E Deville
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - John P Hunt
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alan B Marr
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Jonathan E Schoen
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Lance E Stuke
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
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Li X, Xu S, Li Y, Tang Y, Wang K, Lei Y, Ma J, Li J. Spontaneous rupture‑induced life‑threatening mediastinal mixed germ cell tumor: A case report and therapeutic considerations. Oncol Lett 2024; 27:183. [PMID: 38476210 PMCID: PMC10929001 DOI: 10.3892/ol.2024.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Spontaneous rupture and hemorrhage of mediastinal germ cell tumors is a rare occurrence. In the current report, the case of a 20-year-old male patient who was admitted with chest tightness and dyspnea is presented. An urgent chest CT scan revealed a large tumor in the right anterior mediastinum, measuring ~12 cm in diameter, with associated intratumoral hemorrhage. An emergency thoracotomy was performed to excise the lesion, which revealed that the bleeding was caused by a ruptured tumor. Postoperative pathological findings revealed a mediastinal mixed germ cell tumor consisting of four pathological types: Embryonal carcinoma, seminoma, yolk sac tumor and immature teratoma. Postoperatively, the patient showed marked improvement in the symptoms of dyspnea. However, the follow-up outcome was poor, and the patient succumbed 2 months after surgery. To the best of our knowledge, there are no reports of rupture and hemorrhage involving >4 mixed germ cell tumors. In the present report, the experience of the treatment of the patient is summarized, and literature was reviewed to improve clinicians' awareness of the disease.
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Affiliation(s)
- Xiaosong Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Shenghan Xu
- Department of Urology, The People's Hospital of Liupanshui, Liupanshui, Guizhou 553001, P.R. China
| | - Yunbin Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yanping Tang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Kaiying Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Yumeng Lei
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Jian Ma
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Jian Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
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Nakasone K, Mori S, Izawa Y, Imamura K, Takami M, Hirata KI, Fukuzawa K. Left Hemothorax During Pulmonary Vein Isolation. JACC Clin Electrophysiol 2024:S2405-500X(24)00161-0. [PMID: 38573290 DOI: 10.1016/j.jacep.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shumpei Mori
- University of California-Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kimitake Imamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
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4
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Welker E, Mamo E, Hopkins S, Samuels A, Schroeder E, Gardner A. Presentation of a four-year-old Friesian mare to a referral hospital with signs of abdominal pain and thoracic and pericardial effusion. J Am Vet Med Assoc 2024; 262:418-421. [PMID: 38128273 DOI: 10.2460/javma.23.09.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
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5
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Kim YS. Life-threatening hemothorax due to rupture of pulmonary arteriovenous malformation during pregnancy. J Surg Case Rep 2024; 2024:rjae139. [PMID: 38476457 PMCID: PMC10930188 DOI: 10.1093/jscr/rjae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Pulmonary arteriovenous malformation (PAVM) can worsen in pregnant women due to pregnancy-related physiological changes. If a PAVM ruptures, it can become life-threatening. A 24-year-old female patient at 22 weeks of gestation presented to the hospital with chest pain and dyspnea. A simple chest radiograph revealed that the right lung was almost completely collapsed due to massive pleural effusion, and the heart was displaced to the opposite side. Closed thoracostomy was performed and 2 l of blood was drained. Chest CT revealed the presence of a PAVM in the right upper lung. Emergency surgery was performed to resect the PAVM through thoracoscopic pulmonary wedge resection. The patient experienced disseminated intravascular coagulation and acute renal insufficiency after the surgery, but eventually recovered and was discharged without any complications on the sixth postoperative day.
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Affiliation(s)
- Yeon Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Inje University Ilsan Paik Hospital, 170 Juwha-ro, Ilsansu-gu, Goyang-si, Gyeonsgi-Do, 10380, South Korea
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Grimes AD, Stettler GR, Nunn AM. Immediate chest wall stabilization following thoracotomy for hemorrhage in severe blunt thoracic trauma. Trauma Surg Acute Care Open 2024; 9:e001394. [PMID: 38420605 PMCID: PMC10900399 DOI: 10.1136/tsaco-2024-001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Arthur Dinkins Grimes
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory R Stettler
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew M Nunn
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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7
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Özdülger A. Thoracic trauma in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S21-S28. [PMID: 38584786 PMCID: PMC10995687 DOI: 10.5606/tgkdc.dergisi.2024.25746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 04/09/2024]
Abstract
Isolated thoracic trauma is rare in children. Because of their small body size, the trauma often also affects other spaces, such as the abdomen and head, and these coexistences significantly increase the rate of mortality. However, in isolated thoracic traumas, the children can quickly recover if they can survive the initial period of trauma. Pediatric thoracic trauma cases can have a different clinical course compared to adults due to the unique anatomic and physiologic properties of children's thoracic cages. Their ribs are nonossified and are very elastic, and therefore, as their ribs can sustain significant deformation without breaking, some significant intrathoracic injuries can be overlooked. In this review, the most common thoracic injuries, including pulmonary contusion, hemopneumothorax, pulmonary laceration, rib fractures, flail chest, tracheobronchial injuries, traumatic asphyxia, and other less common mediastinal injuries are discussed in detail in regard of clinical presentation and management.
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Affiliation(s)
- Ali Özdülger
- Department of Thoracic Surgery, Mersin University Faculty of Medicine, Mersin, Türkiye
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8
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Intepe OG, Guner Akbiyik A. Single-Center Experience in Cases With Rib Fractures: When To Be Alert? Cureus 2023; 15:e50060. [PMID: 38186497 PMCID: PMC10769462 DOI: 10.7759/cureus.50060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
AIM The aim of this study was to evaluate rib fracture-related complications in blunt chest traumas. METHODOLOGY The study included a cohort of 132 male and 42 female patients, aged between 22 and 89 years, all diagnosed with rib fractures subsequent to blunt chest trauma. The data collection period extended from November 2017 to November 2019. Pulmonary complications, including pneumothorax, hemothorax, pulmonary contusion, flail chest, and the need for mechanical ventilator support, were retrospectively evaluated based on age, gender, trauma history, bilateral fractures, the number of fractured ribs, and concomitant traumas in other systems. Patients with one or two fractured ribs were included in Group 1, while those with three or more rib fractures were in Goup 2. RESULTS Patients in Group 2 (n=82) had a significantly higher mean age and complication rate compared to patients in Group 1 (56.24 vs. 51.08; p: 0.033; p=0.000). Falls from height were the most common trauma history. The most frequently broken ribs were the fifth right (n=35) and the ninth right ribs (n=35), followed by the seventh right (n=33) and the seventh left rib (n=32) in order. Pneumothorax was diagnosed in 60 patients (34.4%), hemothorax in 48 patients (27.5%), and pulmonary contusion in 22 patients (12.6%). Seven patients had a flail chest (4.0%) and four required mechanical ventilation support. The number of male patients was significantly higher (p=0.000). Motor vehicle accidents were most correlated with complications in trauma history (p=0.002). Elderly age, bilateral fractures, three or more fractured ribs, and the mechanism of trauma were significantly correlated with complications (p < 0.05). The mortality rate was 0%. CONCLUSION Three or more fractured ribs, bilateral fractures, and high-energy traumas are important risk factors, particularly in the elderly population. For patients meeting these criteria, hospitalization and careful observation are recommended.
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Affiliation(s)
- Omer Giray Intepe
- Thoracic Surgery, Republic of Türkiye Ministry of Health, Ali Osman Sonmez Oncology Hospital, Bursa, TUR
| | - Ayten Guner Akbiyik
- Thoracic Surgery, Republic of Türkiye Ministry of Health, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, TUR
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9
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Ribeiro S, Pombo A, Lages N, Correia C, Teixeira C. Hemothorax After Retroclavicular Approach to the Infraclavicular Region in a Critically Ill Patient: A Case Report. Cureus 2023; 15:e49876. [PMID: 38169999 PMCID: PMC10760985 DOI: 10.7759/cureus.49876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
The retroclavicular approach to the infraclavicular region (RAPTIR) is a recently described locoregional technique for upper limb analgesia that offers advantages over the classic infraclavicular block. RAPTIR is considered an effective and easy-to-perform block associated with few complications and better patient comfort. We present a case of a critically ill patient with thoracic and upper limb trauma. Despite multimodal analgesia, the patient developed delirium and experienced suboptimal pain control. An ultrasound-guided continuous RAPTIR block was performed, resulting in improved pain scores and delirium control. Twenty-four hours post block, the patient presented with dyspnea and chest pain, leading to the diagnosis of hemothorax. Chest computed tomography angiography revealed no vascular damage. The perineural catheter was removed 48 hours after its placement and the patient had a satisfactory recovery without long-term complications. The RAPTIR requires the needle to pass underneath the clavicle's acoustic shadow, putting the structures beneath the clavicle at risk of injury. Cadaver studies have raised concerns about potential vascular complications of the RAPTIR in a noncompressible location. This case highlights, for the first time, a rare but serious complication of the RAPTIR, demonstrating the potential risks of passing the needle through a blind spot.
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Affiliation(s)
- Sara Ribeiro
- Anesthesiology, Intensive Care and Emergency Department, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - André Pombo
- Anesthesiology, Intensive Care and Emergency Department, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Neusa Lages
- Anesthesiology, Intensive Care and Emergency Department, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Carlos Correia
- Anesthesiology Department, Hospital Narciso Ferreira, Santa Casa da Misericórdia de Riba de Ave, Braga, PRT
| | - Carla Teixeira
- Anesthesiology, Intensive Care and Emergency Department, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Hernandez-Torres SI, Bedolla C, Berard D, Snider EJ. An extended focused assessment with sonography in trauma ultrasound tissue-mimicking phantom for developing automated diagnostic technologies. Front Bioeng Biotechnol 2023; 11:1244616. [PMID: 38033814 PMCID: PMC10682760 DOI: 10.3389/fbioe.2023.1244616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Medical imaging-based triage is critical for ensuring medical treatment is timely and prioritized. However, without proper image collection and interpretation, triage decisions can be hard to make. While automation approaches can enhance these triage applications, tissue phantoms must be developed to train and mature these novel technologies. Here, we have developed a tissue phantom modeling the ultrasound views imaged during the enhanced focused assessment with sonography in trauma exam (eFAST). Methods: The tissue phantom utilized synthetic clear ballistic gel with carveouts in the abdomen and rib cage corresponding to the various eFAST scan points. Various approaches were taken to simulate proper physiology without injuries present or to mimic pneumothorax, hemothorax, or abdominal hemorrhage at multiple locations in the torso. Multiple ultrasound imaging systems were used to acquire ultrasound scans with or without injury present and were used to train deep learning image classification predictive models. Results: Performance of the artificial intelligent (AI) models trained in this study achieved over 97% accuracy for each eFAST scan site. We used a previously trained AI model for pneumothorax which achieved 74% accuracy in blind predictions for images collected with the novel eFAST tissue phantom. Grad-CAM heat map overlays for the predictions identified that the AI models were tracking the area of interest for each scan point in the tissue phantom. Discussion: Overall, the eFAST tissue phantom ultrasound scans resembled human images and were successful in training AI models. Tissue phantoms are critical first steps in troubleshooting and developing medical imaging automation technologies for this application that can accelerate the widespread use of ultrasound imaging for emergency triage.
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Affiliation(s)
| | | | | | - Eric J. Snider
- Organ Support and Automation Technologies Group, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
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Yeon SK, Ahn Y, Shin JH, Oh SY, Kim GH. Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy. Diagn Interv Radiol 2023; 29:819-825. [PMID: 37650514 PMCID: PMC10679561 DOI: 10.4274/dir.2023.232253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB). METHODS A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality. RESULTS All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed. CONCLUSION The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.
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Affiliation(s)
- Su Kyeong Yeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Morales LC, Cardona Ortegón JD, Pinzón Valderrama BA, Jiménez Uribe AM, Mora Bendeck NG, Fierro Ávila F. Osteochondroma of the Rib: A Potentially Life-Threatening Benign Tumor. Cureus 2023; 15:e45449. [PMID: 37859900 PMCID: PMC10583481 DOI: 10.7759/cureus.45449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Osteochondroma is the most common benign bone tumor. It can be classified as isolated or multiple. While the majority of osteochondromas are asymptomatic and found incidentally, they can become symptomatic during adolescence or adulthood due to mechanical irritation, nerve compression, spinal cord compression, or vascular injury. In this article, we present a case of a 14-year-old patient who experienced spontaneous hemothorax caused by bleeding from a diaphragmatic laceration incurred by a costal exostosis on the right eighth rib. A preoperative chest CT scan revealed a bony projection from the rib and bloody effusion in the thoracic cavity, highlighting the possibility of bloody pleural effusion due to costal exostosis. It is important to note that costal osteochondromas are a rare cause of thoracic injury and can lead to laceration of the lung, diaphragm, and/or pericardium. Surgical intervention should be considered for symptomatic rib osteochondroma, and we advocate for prophylactic surgical removal of intrathoracic exostosis even in asymptomatic patients, in order to prevent potential complications.
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Affiliation(s)
- Laura C Morales
- Radiology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, COL
| | | | | | - Ana M Jiménez Uribe
- Pediatric Surgery, University Hospital Fundación Santa Fe de Bogotá, Bogotá, COL
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Bellegarde SB, Gibson V, Andaz S, Huang L, Robinson E, Turi G, Tofuah D, Ekhator C, Bardarov S. Massive Hemorrhage Following Spontaneous Mediastinal Inflammatory Myofibroblastic Tumor Rupture: A Case Report. Cureus 2023; 15:e45833. [PMID: 37750062 PMCID: PMC10518044 DOI: 10.7759/cureus.45833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 09/27/2023] Open
Abstract
A 45-year-old male in a hypertensive emergency was admitted with complaints of frontal headache, progressive chest discomfort, shortness of breath, dysphagia, and right upper quadrant abdominal pain radiating across the epigastrium and to the back that increases in intensity with deep inspiration. He denied any history of abdominal pain, vomiting, dyspnea, nausea, and weight loss. A computed tomography (CT) scan of the chest showed a posterior mediastinal mass between the esophagus and descending aorta. A magnetic resonance imaging (MRI) scan revealed a non-enhancing posterior mediastinal mass possibly compressing both the esophagus and the airway. A 30-degree thoracoscope was inserted in the chest cavity revealing a large hemothorax from a possibly ruptured inflammatory myofibroblastic tumor (IMT) encompassing nearly the entire pleural space with both fresh and clotted blood. Two liters of fresh blood was removed via a right thoracotomy procedure. Once removed, a large fibrinous clot-filled mass was resected entirely and sent to pathology. Postoperative recovery was uneventful; dysphagia and shortness of breath resolved. The patient gradually resumed his regular diet.
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Affiliation(s)
- Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
- Cardiothoracic Surgery, Mount Sinai South Nassau, Oceanside, USA
| | - Vanessa Gibson
- Thoracic Surgery, Mount Sinai South Nassau, Oceanside, USA
| | | | - Lillian Huang
- Cardiothoracic Surgery, Mount Sinai South Nassau, Oceanside, USA
| | | | - George Turi
- Surgery, Mount Sinai South Nassau, Oceanside, USA
| | - Donald Tofuah
- Surgery, Mount Sinai South Nassau, Oceanside, USA
- Cardiothoracic Surgery, American University of Antigua, St. John's, ATG
| | - Chukwuyem Ekhator
- Neuro-oncology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Svetoslav Bardarov
- Pathology and Laboratory Medicine, Richmond University Medical Center, Staten Island, USA
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Agossou M, Sanchez BG, Alauzen PH, Olivier M, Cécilia-Joseph E, Chevallier L, Jean-Laurent M, Aline-Fardin A, Dramé M, Venissac N. Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island. J Clin Med 2023; 12:5578. [PMID: 37685644 PMCID: PMC10488738 DOI: 10.3390/jcm12175578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. OBJECTIVE The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. PATIENTS AND METHODS We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. RESULTS During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). CONCLUSIONS We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bruno-Gilbert Sanchez
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Paul-Henri Alauzen
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maud Olivier
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Elsa Cécilia-Joseph
- Department of Medical Information, CHU of Martinique, 97261 Fort-de-France, France;
| | - Ludivine Chevallier
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Mehdi Jean-Laurent
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Aude Aline-Fardin
- Department of Pathology, CHU of Martinique, 97261 Fort-de-France, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, CHRU of Lille, 59000 Lille, France;
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K A, S B, Govindarajalou R, Saya GK, Tp E, Rajendran G. Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study. Cureus 2023; 15:e44456. [PMID: 37791184 PMCID: PMC10544157 DOI: 10.7759/cureus.44456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Background Thoracic trauma accounts for 20-25% of all traumas and is the third most frequent cause of death, after abdominal injury and head trauma. In the Emergency Department (ED), shifting an unstable patient to the X-ray room for detecting pneumothorax and hemothorax is always risky and bedside X-ray causes radiation exposure not only to the particular patient but also to the surrounding patients in a congested and busy ED. This can be avoided by using bedside ultrasonography (USG) as the initial imaging modality in chest trauma patients. Objective To compare the sensitivity and specificity of ultrasonography and chest radiography in detecting pneumothorax and hemothorax in chest trauma patients. Methods This cross-sectional diagnostic study was conducted for a period of one year at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, a tertiary care centre. All consecutive patients (n=255) with a suspected history of chest trauma were included in the study. The patients were evaluated bedside using USG by point of care ultrasonography trained emergency medicine physician and subsequently underwent chest radiography for documentation of pneumothorax and hemothorax. Sensitivity and specificity were calculated for ultrasonography and chest X-ray (CXR) compared with the composite gold standard (chest radiography and computed tomography thorax). Results Of the 255 patients, 89% were males. The mean age of the patients was 43.46 (standard deviation 16.3). Road traffic accident (RTA) was the most common mode of injury (81%). The median (interquartile range) time interval between injury and arrival at the hospital was four hours (2.5-7). About 16.1% of the patients had subcutaneous emphysema. About 88.2% of the patients were hemodynamically stable and 78% of the patients had associated other system injuries. The sensitivity and specificity of USG in detecting pneumothorax were 85.7% and 95.3% respectively and that of CXR were 71.4% and 100% respectively. Our study found that the sensitivity and specificity of USG in detecting hemothorax were 79% and 97.9% respectively and that of CXR were 62.9% and 100% respectively. Even in the subset of patients in whom a computed tomography scan was done, the sensitivity of USG was higher than that of CXR in detecting pneumothorax and hemothorax. The specificity of USG in detecting pneumothorax was the same as that of CXR and the specificity of USG in detecting hemothorax was higher than that of CXR in that subset of patients. Conclusion The sensitivities of USG in detecting pneumothorax and hemothorax were higher than that of CXR. The specificities of USG in detecting pneumothorax and hemothorax were comparable to that of CXR. Hence bedside USG performed by emergency physician during resuscitation helps in rapid diagnosis and early management of chest trauma patients.
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Affiliation(s)
- Aswin K
- Emergency Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, IND
| | - Balamurugan S
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ramkumar Govindarajalou
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ganesh Kumar Saya
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Elamurugan Tp
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gunaseelan Rajendran
- Emergency Medicine, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation, Puducherry, IND
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16
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Neff A, Bradby C. Hemothorax after sneezing. J Am Coll Emerg Physicians Open 2023; 4:e13025. [PMID: 37576116 PMCID: PMC10423033 DOI: 10.1002/emp2.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Acute hemothorax is generally known to be a sequela of trauma to the chest, rupture of aortic aneurysm, or aortic dissection. Other causes of hemothorax have been attributed to iatrogenic, vascular, neoplastic, coagulopathy, or infectious processes. Although there has been a single report of spontaneous rupture of intercostal artery after coughing, there have been no reports of the same from sneezing. This rare presentation highlights the importance of a full evaluation for patients who present with viral symptoms such as sneezing or coughing along with a complaint of chest pain because massive hemothorax can be life-threatening.
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Affiliation(s)
- Andrew Neff
- Department of Emergency Medicine, East Carolina UniversityGreenvilleNorth CarolinaUSA
- Department of Internal MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Cassandra Bradby
- Department of Emergency Medicine, East Carolina UniversityGreenvilleNorth CarolinaUSA
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Hoshi Y, Ishii S, Takizawa T, Tamura H. Massive Hemothorax Caused by Removal of Percutaneous Transhepatic Abscess Drainage Tube for Bile Leak After Subtotal Cholecystectomy: A Case Report. Cureus 2023; 15:e43310. [PMID: 37577276 PMCID: PMC10415630 DOI: 10.7759/cureus.43310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
A 59-year-old man with a past medical history of gallstones was diagnosed with acute cholecystitis and received antibiotic treatment. He was discharged after ten days of hospitalization and was due to undergo laparoscopic cholecystectomy. Three months later, however, he had to be readmitted due to a recurrence of acute cholecystitis. Subsequently, laparoscopic reconstituting subtotal cholecystectomy was performed because Inflammation of the gallbladder was severe. At the first postoperative outpatient visit, the patient reported obstructive jaundice, and computed tomography (CT) scan revealed fluid collection in the hepatic bed and a missed common bile duct stone. Percutaneous transhepatic abscess drainage (PTAD) was performed on admission, and endoscopic stone removal was attempted the following day but was challenging due to a periampullary diverticulum. During laparotomy for stone extraction, the patient experienced prolonged shock and CT showed bleeding from the liver and massive right hemothorax. After open chest drainage and hemostasis, transcatheter arterial embolization (TAE) was performed. Such a case has never been reported before, and the PTAD tube should be handled cautiously.
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Affiliation(s)
- Yuki Hoshi
- Surgery, Nasu Red Cross Hospital, Otawara, JPN
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18
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Rometti M, Patti L. Catamenial Pneumothorax in a Patient with Endometriosis: A Case Report. Cureus 2023; 15:e42193. [PMID: 37602109 PMCID: PMC10439767 DOI: 10.7759/cureus.42193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Pelvic pain is a common presentation to the emergency department (ED). For female patients, endometriosis can be difficult to diagnose and can have life-threatening complications if missed. In this case report, we present a case of a patient initially presenting to the ED with a few days of crampy lower abdominal pain. After initial imaging, she was found to have a large pelvic hematoma with concern for active extravasation and a large hemothorax. After further evaluation, she was suspected of having endometriosis leading to thoracic endometriosis and a catamenial pneumothorax. Although endometriosis is not typically an emergent diagnosis, the complications of significant endometrial tissue spread can cause life-threatening impacts. Clinicians should consider complications of endometriosis in females of menstruating age.
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Affiliation(s)
- Mary Rometti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Laryssa Patti
- Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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19
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Jivani HB, Joshi P, Dsouza J. Beyond the Surface: Exploring Chest Trauma With Conventional Radiography and CT. Cureus 2023; 15:e41750. [PMID: 37575706 PMCID: PMC10415853 DOI: 10.7759/cureus.41750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Traumatic injuries to the chest are a frequent cause of mortality among young individuals. Imaging plays a crucial role in the management of thoracic trauma, providing essential details for accurate diagnosis and treatment. OBJECTIVE To assess the respective contributions of radiography and CT in cases of chest trauma. SETTINGS AND DESIGN We assessed 64 subjects, gathering findings from both CT scans and radiographic imaging. The results were organized into a table, considering various variables such as subcutaneous emphysema, rib fractures, clavicular fractures, sternal fractures, scapular fractures, vertebral fractures, pneumothorax, pneumomediastinum, hemothorax, lung contusions, diaphragmatic injuries, and lung herniations. We analyzed the incidence and mode of injury for each variable. Additionally, we compared the sensitivity and specificity of radiographs to CT scans. RESULTS The leading cause of chest trauma was road traffic accidents (RTAs) (67.2%). The most common age groups affected were 18-30 years (31.3%) and 30-40 years (25%). Rib fractures (73.4%), contusions (70.3%), and hemothorax (62.5%) were the most frequently observed findings. Comparing the detection rates of contusions, rib fractures, hemothorax/pleural effusions, pneumothorax/pneumomediastinum, radiographs exhibited lower sensitivity than CT scans (p-value < 0.05 for all comparisons). CONCLUSIONS In the assessment of trauma patients, chest radiographs continue to serve as the primary screening method, while CT scans are the preferred imaging technique. CT scans are preferable to radiographs in subjects who are clinically stable, providing valuable information. However, for subjects who are unstable, CT scans become even more indispensable, as they offer critical insights into their condition.
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Affiliation(s)
- Hit B Jivani
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - Priscilla Joshi
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
| | - John Dsouza
- Radiology, Bharati Vidyapeeth DTU (Deemed to be University) Medical College and Hospital, Pune, IND
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20
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Rezkalla J, Alkhouli M. Atrial Back Wall Support to Facilitate Antegrade Closure of Complex Mitral Paravalvular Leaks. JACC Case Rep 2023; 15:101864. [PMID: 37283838 PMCID: PMC10240271 DOI: 10.1016/j.jaccas.2023.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Transapical puncture for transcatheter treatment of mitral-paravalvular leak (PVL) is associated with increased risks even when the apical tract is closed with vascular plugs. A novel technique that leverages back wall support from the right or left atrium can be used to facilitate transcatheter closure of mitral PVL through an antegrade approach. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | - Mohamad Alkhouli
- Address for correspondence: Dr Mohamad Alkhouli, Department of Cardiovascular Diseases, Mayo College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA. @adnanalkhouli
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21
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Warhadpande S, Liles A, Kirkpatrick D. Intercostal Artery Laceration after Adrenal Mass Cryoablation. Semin Intervent Radiol 2023; 40:286-289. [PMID: 37484442 PMCID: PMC10359126 DOI: 10.1055/s-0043-1769766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
We present a case of a 69-year-old male with profound Cushing's syndrome and hypercortisolemia secondary to a cortisol-secreting adrenocortical carcinoma. Patient was not a surgical candidate and subsequently underwent a successful posterior approach tumor cryoablation. The procedure was complicated by a T11 intercostal artery injury and hemothorax. The detection of the culprit injury was almost immediate and the quick response time, and treatment of the injury via an intercostal artery embolization was critical to limiting the patient's morbidity and mortality. This case discusses the technical challenges of a posterior-approach ablation, the pitfalls to avoid, and the importance of attaining rapid hemostasis.
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Affiliation(s)
- Shantanu Warhadpande
- Department of Vascular and Interventional Radiology, University of Michigan Medical Center, Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Amber Liles
- Department of Vascular and Interventional Radiology, University of Michigan Medical Center, Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Daniel Kirkpatrick
- Department of Vascular and Interventional Radiology, University of Michigan Medical Center, Frankel Cardiovascular Center, Ann Arbor, Michigan
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22
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Rüttermann V. [Bruise or fracture? The rib in focused ultrasound]. MMW Fortschr Med 2023; 165:54-56. [PMID: 36894858 DOI: 10.1007/s15006-023-2389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Viktor Rüttermann
- Gemeinschaftspraxis, Nordholter Weg 10, 48317, Drensteinfurt, Deutschland.
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23
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Lin ZX, Weiss A, Li B, Pais S. Intramural Esophageal Hematoma With Associated Hemothorax. ACG Case Rep J 2023; 10:e00957. [PMID: 36699187 DOI: 10.14309/crj.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/09/2022] [Indexed: 01/27/2023] Open
Abstract
Intramural esophageal hematoma (IEH) is a rare manifestation of esophageal wall injury with nonspecific symptoms. It may be caused by trauma or occur spontaneously. IEH is often discovered on computed tomography or esophagogastroduodenoscopy and is typically managed conservatively with supportive care to allow healing. It is frequently an isolated finding in the esophagus and seldom involves any other organ. We report a rare case of a patient discovered to have an obstructing IEH with associated hemothorax after an unrelated surgical admission.
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AlQatari AA, Ahmed A, AlHije F, Sabry M, Elbawab H. Primary Pulmonary Synovial Sarcoma with Hemothorax: a Case Report. Med Arch 2023; 77:496-499. [PMID: 38313103 PMCID: PMC10834050 DOI: 10.5455/medarh.2023.77.496-499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024] Open
Abstract
Background Synovial sarcoma is a rare and aggressive soft tissue malignancy most commonly arises from periarticular tissue of the extremities. Although several cases in the literature have reported different origins, primary pulmonary synovial sarcoma (PPSS) is an exceedingly rare and underrecognized entity, accounting for 0.5% of all lung malignancies. Clinical presentation includes chest pain, dyspnea, cough, and hemoptysis. The finding of hemothorax is a rare presentation and was barely reported in the literature. Due to its rarity and aggressive nature, the optimal treatment is unclear, while the mainstay remains surgical resection with chemo- and/or radiation therapy. Objective To report a case of hemorrhagic effusion subsequently diagnosed with primary pulmonary synovial sarcoma with the main objective of enriching the literature regarding this rare malignancy. Case report A 52-year-old male smoker with a background of coronary artery disease, hypertension, and diabetes mellitus was referred to our hospital. The patient presented with a history of chest pain, dyspnea, and massive right-sided pleural effusion. Laboratory investigations were unremarkable except for anemia. Chest x-ray showed a complete opacity on the right lower zone with right-sided pleural effusion. Thoracentesis was done and revealed hemorrhagic exudative effusion. Computed tomography (CT) scan showed a right heterogeneous lung mass compressing the medial segment of the middle lobe. Subsequently, the patient underwent bronchoscopy, which showed compression and edema on the right middle lobe bronchus with traces of blood coming from the right lower lobe. The patient underwent a right posterolateral thoracotomy, a fungating mass eroding the medial segment of the middle lobe was resected that was diagnosed as high-grade primary pulmonary synovial sarcoma. Radiotherapy was instituted. The patient died after two years due to recurrence. Conclusion PPSS is an aggressive disease with poor prognostic outcomes, and Its presentation is almost similar to other lung malignancies. Meanwhile, there is no definitive management guideline, and most management depends on surgical resection if feasible with adjuvant chemo-radiation therapy.
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Affiliation(s)
- Abdullah Abdulaziz AlQatari
- Thoracic Surgery Division, Department of General Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayesha Ahmed
- Department of Pathology, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatima AlHije
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Sabry
- Associate consultant Thoracic surgery, King Fahad Hospital University, Imam Abdulrahman Bin Faisal University. Assistant Professor of Cardiothoracic Surgery Faculty of Medicine, Menoufia University
| | - Hatem Elbawab
- Thoracic Surgery Division, Department of General Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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25
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Anderson DE, Kocik VI, Rizzo JA, Fisher AD, Mould-Millman NK, April MD, Schauer SG. A Narrative Review of Traumatic Pneumothorax Diagnoses and Management. Med J (Ft Sam Houst Tex) 2023;:3-10. [PMID: 36580518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Correct identification and rapid intervention of a traumatic pneumothorax is necessary to avoid hemodynamic collapse and subsequent morbidity and mortality. The purpose of this clinical review is to summarize the evaluation and best treatment strategies to improve outcomes in combat casualties. Blunt, explosive, and penetrating trauma are the 3 etiologies for causing a traumatic pneumothorax. Blunt trauma tends to be more common, but all etiologies require similar treatment. The current standard to diagnose pneumothorax is through imaging to include ultrasound, chest x-ray, or computed tomography. A physical exam aids in the diagnosis especially when few other resources are available. Recent studies on the treatment of a small, closed pneumothorax involve conservative care, which includes close observation of the patient and monitoring supplemental oxygen. For a large, closed pneumothorax, conservative treatment is still a possible option, but manual aspiration may be required. Less often, a needle or tube thoracostomy is needed to reinflate the lung. Large, open pneumothoraxes require the most invasive treatment with current guidelines recommending tube thoracostomy. More invasive management options can result in higher rates of complications. Given the significant variability in practice patterns, most notable in resource limited settings, the areas for potential research are presented.
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26
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Anderson DE, Kocik VI, Rizzo JA, Fisher AD, Mould-Millman NK, April MD, Schauer SG. A Narrative Review of Traumatic Pneumothorax Diagnoses and Management. Med J (Ft Sam Houst Tex) 2023:3-10. [PMID: 36607292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Correct identification and rapid intervention of a traumatic pneumothorax is necessary to avoid hemodynamic collapse and subsequent morbidity and mortality. The purpose of this clinical review is to summarize the evaluation and best treatment strategies to improve outcomes in combat casualties. Blunt, explosive, and penetrating trauma are the 3 etiologies for causing a traumatic pneumothorax. Blunt trauma tends to be more common, but all etiologies require similar treatment. The current standard to diagnose pneumothorax is through imaging to include ultrasound, chest x-ray, or computed tomography. A physical exam aids in the diagnosis especially when few other resources are available. Recent studies on the treatment of a small, closed pneumothorax involve conservative care, which includes close observation of the patient and monitoring supplemental oxygen. For a large, closed pneumothorax, conservative treatment is still a possible option, but manual aspiration may be required. Less often, a needle or tube thoracostomy is needed to reinflate the lung. Large, open pneumothoraxes require the most invasive treatment with current guidelines recommending tube thoracostomy. More invasive management options can result in higher rates of complications. Given the significant variability in practice patterns, most notable in resource limited settings, the areas for potential research are presented.
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Affiliation(s)
- David E Anderson
- University of Incarnate Word School of Osteopathic Medicine, San Antonio, TX
| | - Veronica I Kocik
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Julie A Rizzo
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Andrew D Fisher
- University of New Mexico Hospital, Albuquerque, NM; and Texas Army National Guard, Austin, TX
| | | | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD; and 40th Forward Resuscitative Surgical Detachment, Fort Carson, CO
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Texas Army National Guard, Austin, TX
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27
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Chen J, Zhang B. Application of contrast-enhanced ultrasound in hemothorax of hereditary hemorrhagic telangiectasia: A case report and literature review. Clin Hemorheol Microcirc 2022; 83:273-278. [PMID: 36565108 DOI: 10.3233/ch-221646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant hereditary disease, which can lead to abnormal angiogenesis. We performed contrast-enhanced ultrasound (CEUS) in a patient with HHT represented with hemothorax. After targeted embolization, the condition of hemothorax improved. In this case, we explore the use of CEUS to locate the responsible vessel of hemothorax, and found that CEUS could be used as a complementary preoperative method of localization with Computed tomography angiography (CTA).
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Affiliation(s)
- Jie Chen
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
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Freeman JJ, Asfaw SH, Vatsaas CJ, Yorkgitis BK, Haines KL, Burns JB, Kim D, Loomis EA, Kerwin AJ, McDonald A, Agarwal, S, Fox N, Haut ER, Crandall ML, Como JJ, Kasotakis G. Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open 2022; 7:e000886. [PMID: 36312819 PMCID: PMC9608538 DOI: 10.1136/tsaco-2022-000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/02/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube thoracostomy (TT) for traumatic hemothorax or pneumothorax should receive antibiotic prophylaxis. METHODS Published literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Cochrane Central Register of Controlled Trials (via Wiley), Web of Science and ClinicalTrials.gov databases by a professional librarian. The date ranges for our literature search were January 1900 to March 2020. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology. RESULTS Fourteen relevant studies were identified and analyzed. All but one were prospective, with eight being prospective randomized control studies. Antibiotic prophylaxis protocols ranged from a single dose at insertion to 48 hours post-TT removal. The pooled data showed that patients who received antibiotic prophylaxis were significantly less likely to develop empyema (OR 0.47, 95% CI 0.25 to 0.86, p=0.01). The benefit was greater in patients with penetrating injuries (penetrating OR 0.25, 95% CI 0.10 to 0.59, p=0.002, vs blunt OR 0.25, 95% CI 0.06 to 1.12, p=0.07). Administration of antibiotic prophylaxis did not significantly affect pneumonia incidence or mortality. DISCUSSION In adult trauma patients who require TT insertion, we conditionally recommend antibiotic prophylaxis be given at the time of insertion to reduce incidence of empyema. PROSPERO REGISTRATION NUMBER CRD42018088759.
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Affiliation(s)
- Jennifer J Freeman
- Surgery, Texas Christian University Burnett School of Medicine, Fort Worth, Texas, USA
| | - Sofya H Asfaw
- General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Cory J Vatsaas
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian K Yorkgitis
- Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Krista L Haines
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - J Bracken Burns
- Surgery, East Tennessee State University, Johnson City, Tennessee, USA
| | - Dennis Kim
- Surgical Critical Care, Los Angeles County Harbor–UCLA Medical Center, Torrance, California, USA
| | | | - Andy J Kerwin
- Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Amy McDonald
- Surgery, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - Suresh Agarwal,
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicole Fox
- Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | | | - Marie L Crandall
- Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - John J Como
- Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - George Kasotakis
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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Nascimento IKDO, Morad HM, Perlingeiro JAG, Parreira JG, Assef JC. Predictors of pleural complications in trauma patients undergoing tube thoracostomy: A prospective observational study. Rev Col Bras Cir 2022; 49:e20223300. [PMID: 36000682 PMCID: PMC10578792 DOI: 10.1590/0100-6991e-20223300-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/14/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries. METHOD we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p<0.05 as significant. RESULTS we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p<0,001) and the necessity of relocation (p<0,001) of the drain. CONCLUSION the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.
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Affiliation(s)
| | - Helena Machado Morad
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Jacqueline Arantes Gianninni Perlingeiro
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - José Gustavo Parreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
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30
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Piastra M, Ferrari V, Morena TC, Picconi E, Conti G. Delayed tension hemothorax after chest trauma in children. Pediatr Pulmonol 2022; 57:1818-1819. [PMID: 35502123 DOI: 10.1002/ppul.25947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/06/2022]
Abstract
Blunt chest injury is commonly observed in the Pediatric Emergency Department and Intensive Care Unit since up to 30% of children with traumatic injury sustain injury to the thorax. Differently from adults, who present with concomitant rib or sternoclavicular fractures in 70% of cases, more than half of childhood chest injuries occur without any bone fracture, mostly causing lung contusions. This lower rate of rib fractures and near absence of flail chest in children may be due to greater elasticity of the pediatric cartilaginous and bony skeleton. Whenever a rib fracture is present, underlying complications should be evaluated carefully (i.e., air leaks or blood effusions). Depending on the trauma mechanism, even minor injuries should raise the suspicion of pathologic bone fractures.
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Affiliation(s)
- Marco Piastra
- Pediatric ICU and Trauma Center, A. Gemelli Hospital, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | | | - Tony C Morena
- Pediatric ICU and Trauma Center, A. Gemelli Hospital, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Enzo Picconi
- Pediatric ICU and Trauma Center, A. Gemelli Hospital, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, A. Gemelli Hospital, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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Mukaihata T, Shiga Y, Inage K, Eguchi Y, Ohtori S, Orita S. Anterior Spinal Surgery Requiring Thoracotomy for Post-Operative Hematoma Removal: Two Case Reports. J Orthop Case Rep 2022; 12:75-78. [PMID: 36659895 PMCID: PMC9826674 DOI: 10.13107/jocr.2022.v12.i07.2924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/20/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction We report two cases that required revision surgery with thoracotomy for massive hematoma after anterior kyphorectomy surgery. Case Report A woman with significant thoracolumbar kyphosis due to L1 vertebral fracture showed associated vertebral instability and pain resistant to conservative treatment.She underwent surgery for a one-stage anterior kypholectomy with spinal fusion. We performed an extrapleural approach. On the 4th post-operative day, the patient developed respiratory distress with decreased SpO2. Contrast-enhanced computed tomography (CT) revealed a left hemothorax with active bleeding. Revision surgery was performed to arrest the bleeding, and a large hematoma in the thoracic cavity was observed around the intercostal artery just below the skin incision, not around the surgical site.A man suffered from impaired activities of daily living caused by postural abnormalities due to severe kyphosis from vertebral fractures at the L1 and L2 vertebrae. Thus, we performed two-stage kypholectomy surgery. First, we performed posterior fixation with posterior facet resection. Then, corpectomy of the 1st and 2nd lumbar vertebrae through an anterior extrathoracic approach was performed. A CT scan on the 2nd post-operative day showed a massive hemopneumothorax, indicating persistent bleeding, and we performed a revision surgery to open the chest for additional hemostasis. Intraoperative findings showed a large hematoma, including reactive pleural effusion in the subcutaneous, retroperitoneal, and intrathoracic cavities. Conclusion We experienced two patients who required thoracotomy hematoma removal after anterior spinal surgery. Intraoperative patronage and adequate hemostasis are necessary to avoid post-operative complications such as hemothorax and hemopneumothorax.
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Affiliation(s)
- Tomohito Mukaihata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan,Address of Correspondence: Dr. Tomohito Mukaihata, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. E-mail:
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan,Department of Orthopaedic, Chiba University Center for Frontier Medical Engineering 1-33 Yayoi-cho, CFME room#B201, Inage-ku, Chiba, 263-8522, Japan
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Drosos V, Durak K, Autschbach R, Spillner J, Nubbemeyer K, Zayat R, Kalverkamp S. Video-Assisted Thoracoscopic Surgery Management of Subacute Retained Blood Syndrome after Cardiac Surgery. Ann Thorac Cardiovasc Surg 2022; 28:146-153. [PMID: 34690218 PMCID: PMC9081459 DOI: 10.5761/atcs.oa.21-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Blood loss along with inadequate evacuation after cardiac surgery leads to retained blood syndrome (RBS) in the pleural and/or pericardial cavity. Re-sternotomy is often needed for clot evacuation. Video-assisted thoracoscopic surgery (VATS) evacuation is a less-invasive procedure. However, sufficient evidence on safety and outcomes is lacking. METHODS Thirty patients who developed hemothorax and/or hemopericardium after cardiac surgery and underwent VATS evacuation between April 2015 and September 2020 were included in this retrospective single-center analysis. RESULTS The median patient age was 70 (interquartile range: IQR 62-75) years, body mass index (BMI) was 24.7 (IQR 22.8-29) kg/m2, time between initial cardiac surgery and VATS was 17 (IQR 11-21) days, 30% of the patients were female, 60% resided in the ICU, and 17% were nicotine users. Coronary artery bypass graft was the most frequent initial cardiac procedure. Median operation time was 120 (IQR 90-143) min, 23% of the patients needed an additional VATS, and the median length of hospital stay after VATS was 8 (IQR 5-14) days. All patients survived VATS, and we experienced no mortality related to the VATS procedure. CONCLUSION In our study, VATS for evacuation of RBS after cardiac surgery was a feasible, safe, and efficient alternative approach to re-sternotomy in selected patients.
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Affiliation(s)
- Vasileios Drosos
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Koray Durak
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Rüdiger Autschbach
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Katharina Nubbemeyer
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
| | - Sebastian Kalverkamp
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany
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Ota K, Katagiri Y, Katakura M, Maemura T, Takahashi T, Morita M. Porous diaphragm syndrome presenting as hemothorax secondary to hemoperitoneum after laparoscopic myomectomy: A case report and literature review. J Obstet Gynaecol Res 2022; 48:1039-1045. [PMID: 35168301 DOI: 10.1111/jog.15175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/16/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
Porous diaphragm syndrome includes all pleural cavity conditions, including pleural effusion, hemothorax, or pneumothorax, that occur secondary to peritoneal cavity disorders through defects in the diaphragm. In this report, we describe the first known case of porous diaphragm syndrome presenting as hemothorax after laparoscopic myomectomy. A 46-year-old nulliparous woman underwent laparoscopic myomectomy for multiple fibroids. Eight hours after surgery, the patient developed exertional dyspnea followed by hemoptysis. Radiological diagnosis revealed massive hemothorax in the right thoracic cavity. Thoracoscopic findings showed the presence of small fenestrae at the center of the right diaphragm, which were repaired thoracoscopically. Hence, quick postoperative diagnosis resulted in successful treatment. In this case, porous diaphragm syndrome is believed to be caused by retention of intraoperative bleed and saline from intra-abdominal lavage, in the abdominal cavity. Porous diaphragm syndrome is a potential life-threatening condition that gynecological surgeons should consider in this era of laparoscopic surgery.
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Affiliation(s)
- Kuniaki Ota
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Yukiko Katagiri
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Masafumi Katakura
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | | | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
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Rovida S, Orso D, Naeem S, Vetrugno L, Volpicelli G. Lung ultrasound in blunt chest trauma: A clinical review. Ultrasound 2022; 30:72-79. [PMID: 35173781 PMCID: PMC8841950 DOI: 10.1177/1742271x21994604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/24/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. TOPIC DESCRIPTION We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms 'trauma', 'lung contusion', 'pneumothorax', 'hemothorax' and 'lung ultrasound'. The latest articles were reviewed and this article was written using the most current and validated information. DISCUSSION Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. CONCLUSION Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.
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Affiliation(s)
- Serena Rovida
- Department of Emergency Medicine, Royal London Hospital, Barts
Health NHS Trust, London, UK,Serena Rovida, Department of Emergency
Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
| | - Salman Naeem
- Department of Emergency Medicine, Royal London Hospital, Barts
Health NHS Trust, London, UK
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy,Department of Anesthesia and Intensive Care Medicine, “Santa
Maria della Misericordia” Hospital, ASUFC Udine, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University
Hospital, Torino, Italy
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Chen T, Yu J, Zhang N, Chen C, Fu L, Zeng Q. Intralobar Pulmonary Sequestration Presenting as Hemothorax Secondary to Spontaneous Pneumothorax: Case Report and Literature Review. Front Pediatr 2022; 10:937563. [PMID: 35844764 PMCID: PMC9279614 DOI: 10.3389/fped.2022.937563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patients with pulmonary sequestration (PS), a rare congenital lung malformation, are mostly asymptomatic. Recurrent localized infection is a major complication, while sudden hemothorax is extremely rare. We present a case of intralobar PS presenting as hemothorax secondary to spontaneous pneumothorax and comprehensively review the relevant literature. CASE REPORT A 16-year-old male presented with chest pain after strenuous exercise. Chest X-ray showed a moderate pneumothorax. After admission and conservative treatment, he developed dizziness, amaurosis, and urinary incontinence. Bedside chest X-ray suggested a massive pleural effusion, and hemothorax was further identified via catheter drainage. Contrast-enhanced computed tomography was performed, and no abnormal blood vessels or leakage of contrast agent were observed. As the hemoglobin level continued to drop, exploratory thoracoscopic surgery was performed immediately. The abnormal systemic artery supplying the lung tissue was found to be ruptured; therefore, ligation of the abnormal artery with resection of the diseased lung tissue was performed. Pathological examination revealed non-specific manifestations of PS. He was followed up for 1 year without related complications. CONCLUSION Our case suggests that the abnormal supply vessels of PS are unstable, which may cause sudden hemothorax. Therefore, patients with PS should undergo surgery promptly after diagnosis. In patients with hemothorax, we should consider the diagnosis of PS; however, contrast-enhanced computed tomography or angiography cannot confirm the diagnosis in all cases. Surgical intervention is recommended in emergency settings.
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Affiliation(s)
- Tian Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Zhang
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Libing Fu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Sebek J, Vodicka J, Procházková K, Kletecka J, Treska V. Massive intrathoracic haemorrhage as a complication of pulmonary parenchymal haemorrhage and anticoagulant treatment of lung embolization during COVID-19 - two case reports. Rozhl Chir 2022; 101:452-455. [PMID: 36257804 DOI: 10.33699/pis.2022.101.9.452-455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The medical and social interest in the SARS-CoV-2 infection is currently high. This infection can, in severe cases, be accompanied by a series of complications, such as thromboembolic disease or pulmonary parenchymal haemorrhage. CASE REPORTS The paper presents two rare cases of massive intrathoracic haemorrhage caused by pulmonary parenchymal haemorrhage and exacerbated by full anticoagulant treatment of thromboembolic disease. RESULTS In both cases, the haemorrhage originated in the left lower lobe and was life threatening, requiring urgent anatomical lung resection - left lower lobectomy. CONCLUSIONS The combinaion of anticoagulant therapy and thromboembolic events related to COVID-19 can cause, in rare cases, massive pulmonary haemorrhage. This rare complication proved lethal in one out of two of the cases described in this paper. An imminent and adequate reaction is necessary when the first signs of haemorrhage appear.
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Parra MW, Ordoñez CA, Pino LF, Millán M, Caicedo Y, Buchelli VR, García A, González-Hadad A, Salcedo A, Serna JJ, Quintero L, Herrera MA, Hernández F, Rodríguez-Holguín F. Damage control surgery for thoracic outlet vascular injuries: the new resuscitative median sternotomy plus REBOA. Colomb Med (Cali) 2021; 52:e4054611. [PMID: 34908619 PMCID: PMC8634276 DOI: 10.25100/cm.v52i2.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/21/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.
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Affiliation(s)
- Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery. Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
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38
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Atreya A, Menezes RG, Timalsina A, Bashyal G, Gyawali L, Gyawali S. Case Report: Penetrating Thoracic Trauma by A Gunshot Involving the Heart. F1000Res 2021; 10:532. [PMID: 34621511 PMCID: PMC8420887 DOI: 10.12688/f1000research.54428.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Firearm-related mortality is not frequently encountered in a country like Nepal where there are stringent laws prohibiting the buying, selling, carrying or storing of firearms. To possess a firearm a person must have a valid license. Wounds produced by firearms have typical characteristics the knowledge of which helps to identify the type of firearm used, range of fire, the position of the victim, and whether the manner of death was homicidal, suicidal, or accidental. The present case is the first autopsy-based study from Nepal which discusses the wounds produced by firearms with an interpretation of such findings for medicolegal purposes. The present case highlights a social problem where the victim, a psychiatric patient, had no access to prescription medication due to coronavirus disease (COVID-19) related lockdown.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Lumbini, 32500, Nepal
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ashal Timalsina
- Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Lumbini, 32500, Nepal
| | - Geeta Bashyal
- District Hospital, Tansen, Palpa, Lumbini, 32500, Nepal
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39
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Abstract
Spontaneous hemothorax is a rare disorder characterized by pleural fluid hematocrit greater than 50% of the peripheral blood hematocrit without natural or iatrogenic trauma to the lungs or pleural space. Since the first case of COVID-19, more than 85 million cases have been confirmed and most patients have sustained symptoms after more than six months of acute infection. This paper reports the case of a 38-year-old woman without signs of endometriosis and a history of COVID-19 infection who developed spontaneous hemothorax after oocyte retrieval. Three months before undergoing assisted reproductive technology (ART) treatment, the patient had a symptomatic COVID-19 infection with a negative PCR test and a positive IgG test four weeks after the onset of symptoms. Controlled ovarian stimulation and oocyte retrieval were conducted uneventfully. Two hours after oocyte retrieval, the patient developed nausea and mild hypogastric pain. Ten hours after the procedure, the patient went to the emergency department with abdominal pain. Chest computed tomography scans revealed moderate right pleural effusion and laminar left pleural effusion. Since the patient had respiratory symptoms, the choice was made to drain the pleural fluid. Fluid analysis confirmed the patient had right hemothorax (400 mL). After drainage, the patient's clinical and imaging signs improved gradually without complications. The patient was asymptomatic one week after the procedure.
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Affiliation(s)
- Danilo Rahal
- Conceber Centro de Medicina Reprodutiva, Curitiba, Paraná, Brazil
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40
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Hu K, Chopra A, Kurman J, Huggins JT. Management of complex pleural disease in the critically ill patient. J Thorac Dis 2021; 13:5205-5222. [PMID: 34527360 PMCID: PMC8411157 DOI: 10.21037/jtd-2021-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 11/08/2022]
Abstract
Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Although the portable chest X-ray remains the primary modality of diagnosis for pleural disorders in the ICU. It can be nonspecific and may miss subtle findings. Ultrasound has become a useful tool to the bedside clinician to aid in diagnosis and management of pleural disease. The majority of pleural space disorders resolve as the patient’s illness improves. There remain a few pleural processes that need specific therapies. While uncomplicated parapneumonic effusions do not have their own treatments. Those that progress to become a complex infected pleural space can have its individual complexity in therapy. Chest tube drainage remains the cornerstone in therapy. The use of intrapleural fibrinolytics has decreased the need for surgical referral. A large hemothorax or pneumothorax in patients admitted to the ICU represent medical emergencies and require emergent action. In this review we focus on the management of commonly encountered complex pleural space disorders in critically ill patients such as complicated pleural space infections, hemothoraces and pneumothoraces.
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Affiliation(s)
- Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Jonathan Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Terrill Huggins
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
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41
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Abdalazim Dafallah M, Habour E, Ahmed Ragab E. Hemothorax after snake bite. Clin Case Rep 2021; 9:e04874. [PMID: 34584724 PMCID: PMC8457406 DOI: 10.1002/ccr3.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022] Open
Abstract
Hemothorax after snake bite is very rare and unusual presentation. Administration of antivenom with supportive measures and close monitoring can prevent further deterioration. Delays in the transportation of patients to health facilities where antivenom and other therapeutic resources are provided can lead to devastating consequences.
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42
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Abstract
The evolution of pleural disease imaging modalities through the years has helped the scientific community understand and treat various disease states. Ultrasound (US) has been an image modality that has reigned superior to those used in the past such as chest X-ray and computed tomographic scan in terms of cost effectiveness, portability, and reduction in unwarranted radiation exposure to patients. Here we provide a succinct review of US use in pleural disease including imaging techniques, identifying safe pleural space for access, and predicting pleural fluid volume and etiology along with specificities regarding trapped lung identification and pleural mass biopsy. We believe bedside chest US is an adjunct to the physical exam adding superior diagnostic abilities. Further research is warranted in more specific aspects of sonographic use such as in fibrinolytic therapy management, evaluation for trapped lung, and the utility of specific modes like the color flow Doppler.
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43
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Pometlová J, Madeja R, Demel J, Ječmínková R, Procházka V, Kitka M, Pleva L. Tension Hemothorax in Aortic Rupture: A Case Report. Medicina (Kaunas) 2021; 57:790. [PMID: 34440997 DOI: 10.3390/medicina57080790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.
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44
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Brogna B, Romano A, Tibullo L, Montuori M, Nunziata M, Russo G, Musto LA. Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report. Acta Radiol Open 2021; 10:20584601211028149. [PMID: 34367668 PMCID: PMC8326360 DOI: 10.1177/20584601211028149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023] Open
Abstract
Hemothorax (HT) and pulmonary hematoma represent rare complications of anticoagulant therapy. We present a rare case of a 53-year-old man with COVID-19 pneumonia who showed, in a follow-up computed tomography (CT) scan 13 days after hospitalization, a left HT and a small hyperdense area in a subpleural location and compatible with a small subpleural hematoma. This patient was being treated with a subcutaneous administration of low-molecular-weight heparin (100UI/kg/BID). No vascular malformations were visualized on the CT pulmonary angiography. Herein, we report the first case of both a spontaneous HT and a lung subpleural hematoma in a COVID-19 patient, probably caused by anticoagulant therapy.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
- Barbara Brogna, Department of Radiology San Giuseppe Moscati Hospital Avellino, National Speciality Hospital San Giuseppe Moscati Neurology and Stroke Unit, Contrada Amoretta, Avellino 83100, Italy.
| | - Annamaria Romano
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Loredana Tibullo
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Montuori
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Nunziata
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Giuseppe Russo
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Lanfranco A Musto
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
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45
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Aswani Y, Thakkar H, Hira P. Disseminated gestational choriocarcinoma presenting with hepatic and uveal metastases, hook effect, and choriocarcinoma syndrome. Indian J Radiol Imaging 2021; 26:482-486. [PMID: 28104943 PMCID: PMC5201079 DOI: 10.4103/0971-3026.195781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Choriocarcinoma is a human chorionic gonadotrophin (HCG)-secreting tumor that comprises vascular channels. It has a tendency for widespread metastasis, common sites for which include the lung, vagina, brain, liver, bone, intestine, and kidney. We describe a 30-year-old female who presented with hepatitis-like features and bilateral diminution of vision, and subsequently developed hemothorax and hemoperitoneum-all rare and seemingly unrelated manifestations which were finally attributable to metastases from gestational choriocarcinoma. To further complicate the clinical scenario, the serum HCG of the patient was mildly raised (due to a phenomenon called hook effect). Subsequently, the patient developed disseminated intravascular coagulation and succumbed to her illness. In this report, we discuss the imaging findings of choriocarcinoma, its potential sites of metastases, and the hook effect.
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Affiliation(s)
- Yashant Aswani
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Hemangini Thakkar
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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46
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Suoh M, Hagihara A, Kageyama K, Yamamoto A, Enomoto M, Tamori A, Kawada N. Successful Transcatheter Arterial Embolization for Hemothorax from a Spontaneous Rupture of Hepatocellular Carcinoma Metastasis to the Chest Wall in an Elderly Patient. Intern Med 2021; 60:2223-2228. [PMID: 33612670 PMCID: PMC8355405 DOI: 10.2169/internalmedicine.6003-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
An 87-year-old man with hepatocellular carcinoma (HCC) presented with right-sided chest pain. Computed tomography revealed right bloody pleural effusion and an extravasation from an arterially enhanced mass in the right seventh posterior intercostal space. These findings indicated hemothorax from a rupture of HCC metastasis to the chest wall. Angiography of the intercostal arteries confirmed a hypervascular tumor, and transcatheter arterial embolization resulted in hemostasis. He was discharged with palliative care and remains alive after 9 months. Although hemothorax represents an unusual, life-threatening complication of HCC, our case suggests that transcatheter treatment can achieve hemostasis and a favorable survival even in elderly patients.
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Affiliation(s)
- Maito Suoh
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan
| | - Atsushi Hagihara
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Japan
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan
| | - Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan
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47
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Sheaffer K, Hampton S, Barnard E, Patel MN, Kim L, Gendreau JL. Hemothorax and Pneumothorax Secondary to Costal Involvement in Hereditary Multiple Exostoses: A Systematic Review of Reported Cases in the Literature. Cureus 2021; 13:e16326. [PMID: 34395113 PMCID: PMC8356515 DOI: 10.7759/cureus.16326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Hereditary multiple exostoses (HME) are an autosomal dominant skeletal disorder characterized by the development of multiple benign osteochondromas (exostoses) that frequently involve long bones of the body. Less commonly, the ribs are a site of involvement, and long-term friction between an exostosis and pleura can produce a hemothorax or pneumothorax. The purpose of this study is to provide a comprehensive review of existing literature on pneumothorax or hemothorax secondary to costal exostosis in HME patients. We reviewed the databases of PubMed and Embase and included data as current as of February 15, 2021. All case reports included cases of hemothorax or pneumothorax in patients with a known personal or family history of HME. After evaluation for inclusion based on eligibility criteria, 18 cases were included. The average age at presentation was 11.7 years (range: 3-32), and most patients were male (83%). Hemothoraces occurred in 15 cases, while pneumothoraces occurred in three cases. All cases were evaluated using chest X-ray and CT scan, and the majority of the cases were treated with surgical resection of the exostosis, either with video-assisted thoracoscopic surgery (VATS; 61%) or thoracotomy (22%). Outcomes were successful with no cases of recurrence after surgical intervention. Although rare, costal exostosis should be considered as a differential in patients presenting with pneumothorax or hemothorax and past medical history or physical exam findings suggestive of HME. Immediate evaluation and surgical intervention to resect costal exostosis are essential to reduce the risk of recurrent life-threatening injury.
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Affiliation(s)
| | - Sarah Hampton
- School of Medicine, Mercer University, Savannah, USA
| | - Emily Barnard
- School of Medicine, Mercer University, Savannah, USA
| | - Meet N Patel
- School of Medicine, Mercer University, Savannah, USA
| | - Lucas Kim
- School of Medicine, Mercer University, Savannah, USA
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48
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Azimi-Ghomi O, Ramirez M, Brummund D, Gibber M, Mawad MR. Traumatic Pulmonary Arteriovenous Malformation Presenting as Spontaneous Hemothorax. Cureus 2021; 13:e16072. [PMID: 34345554 PMCID: PMC8324253 DOI: 10.7759/cureus.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/07/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVM), also known as pulmonary arteriovenous fistulas, are abnormal connections between the pulmonary arterial and venous systems. The majority occur secondary to the congenital syndrome hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease. Trauma is an extremely rare etiology of PAVM, comprising less than 1% of all reported cases. Trauma can be associated with both immediate and delayed development of PAVM, and present similarly to PAVM associated with HHT. We report a case of a traumatic PAVM that developed in a patient one year following blunt thoracic trauma with a rib fracture. The patient subsequently developed a rupture of the PAVM, resulting in spontaneous hemothorax. She required multi-unit blood transfusion and multiple thoracostomy tube placements. The patient subsequently underwent a failed attempt at angioembolization of the PAVM. She eventually required a thoracotomy for surgical excision of the PAVM. We discuss the traumatic etiologies, clinical presentation, diagnostic assessments, and therapeutic modalities for the management of PAVM.
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Affiliation(s)
| | - Marcela Ramirez
- Department of General Surgery, Kendall Regional Medical Center, Miami, USA
| | - Dieter Brummund
- Department of General Surgery, Kendall Regional Medical Center, Miami, USA
| | - Marc Gibber
- Department of Cardiothoracic Surgery, Aventura Hospital and Medical Center, Aventura, USA.,Department of Cardiothoracic Surgery, Kendall Regional Medical Center, Miami, USA
| | - Maurice R Mawad
- Department of Cardiothoracic Surgery, Kendall Regional Medical Center, Miami, USA.,Department of Cardiothoracic Surgery, Aventura Hospital and Medical Center, Aventura, USA
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49
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García A, Millán M, Ordoñez CA, Burbano D, Parra MW, Caicedo Y, González Hadad A, Herrera MA, Pino LF, Rodríguez-Holguín F, Salcedo A, Franco MJ, Ferrada R, Puyana JC. Damage control surgery in lung trauma. Colomb Med (Cali) 2021; 52:e4044683. [PMID: 34188322 PMCID: PMC8216053 DOI: 10.25100/cm.v52i2.4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
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Affiliation(s)
- Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Daniela Burbano
- Fundación Valle del Lili, Departamento de Urgencias Adultos. Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Maria Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
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50
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Al-Obaidi A, Tuck N, Al-Hadeethi D, Mohammed A, Truong Q. Spontaneous, Loculated, and Massive Hemothorax: An Uncommon Complication of Warfarin Therapy. Cureus 2021; 13:e14923. [PMID: 34123622 PMCID: PMC8189267 DOI: 10.7759/cureus.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Warfarin, a commonly used oral anticoagulant, is associated with several adverse drug reactions, principally bleeding. Of all hemorrhagic complications from warfarin therapy, thoracic hemorrhage accounts for only 3% and is usually related to trauma. Cases of spontaneous hemothorax secondary to anticoagulation therapy are rarely reported in the literature.
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Affiliation(s)
- Ammar Al-Obaidi
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Nicholas Tuck
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Daly Al-Hadeethi
- Internal Medicine/Hospital Medicine, Wesley Medical Center, Wichita, USA
| | - Alaeldin Mohammed
- Internal Medicine, Robert J. Dole Veterans Affairs Medical Center, Wichita, USA
| | - Quoc Truong
- Cancer Center of Kansas, University of Kansas School of Medicine, Wichita, USA
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