1
|
Kaewlai R, Chatpuwaphat J, Butnian K, Thusneyapan K, Panrong N, Lertpipopmetha W, Wongpongsalee T. Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation. Tomography 2022; 8:2772-2783. [PMID: 36412690 PMCID: PMC9680416 DOI: 10.3390/tomography8060231] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. METHODS This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. RESULTS Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. CONCLUSIONS Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.
Collapse
Affiliation(s)
- Rathachai Kaewlai
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Jitti Chatpuwaphat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Krittachat Butnian
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Kittipott Thusneyapan
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Nutthanun Panrong
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Wanicha Lertpipopmetha
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
| | - Thongsak Wongpongsalee
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkok Noi, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-86-015-5915
| |
Collapse
|
2
|
Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Rodríguez-Holguín F, Serna JJ, Salcedo A, García A, Orlas C, Pino LF, Del Valle AM, Mejia D, Salamea-Molina JC, Brenner M, Hörer T. REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients. Colomb Med (Cali) 2020; 51:e4064506. [PMID: 33795901 PMCID: PMC7968426 DOI: 10.25100/cm.v51i4.4422.4506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
Collapse
Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, 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
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Claudia Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, USA.,Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | | | - David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Juan Carlos Salamea-Molina
- Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery. Cuenca, Ecuador.,Universidad del Azuay, Escuela de Medicina. Cuenca, Ecuador
| | - Megan Brenner
- University of California, Department of Surgery Riverside University Health Systems. Riverside, CA, USA
| | - Tal Hörer
- 15 Örebro University Hospital, Faculty of Medicine, Department of Cardiothoracic and Vascular Surgery, Örebro, Sweden
| |
Collapse
|
3
|
Abstract
Aortic valve rupture is a rare manifestation in comparison to cardiac rupture or contusion following blunt chest trauma. We report a case of aortic valve leaflet rupture with severe aortic regurgitation after a fall from a ladder. The aortic valve rupture had been missed in the emergency ultrasound and was only detected on comprehensive echocardiography after failure of weaning from a mechanical ventilator. The patient underwent aortic bioprosthetic valve replacement that dramatically changed the clinical course.
Collapse
Affiliation(s)
- Nguyen Hoang Bac
- University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Dinh
- University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Truong Quang Binh
- University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Minh Khoi
- University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| |
Collapse
|
4
|
Abstract
Background Tracheobronchial injury is a rare and serious outcome of thoracic trauma. The aim of this study was to describe our experience in the management of tracheobronchial injuries. Methods We reviewed the presentation, line of management, and results of all 23 patients (17 males and 6 females) with a mean age of 27.87 years, who presented with traumatic tracheobronchial injuries and were admitted to the level 3 trauma center of our university emergency hospital over an eight-year period. Results Blunt trauma was the leading cause (73.9%) of injury. Bronchoscopy was routinely performed. A right thoracotomy was carried out in 73.9% of patients. The right main bronchus was the most common site of injury (30.4%), followed by the trachea in 26.1%. Pulmonary resection was undertaken in 5 cases. Three operative mortalities were recorded. Conclusion Tracheobronchial injuries can be treated conservatively or ideally by surgical repair which is the core line of treatment. Surgery has excellent outcomes depending on skillful use of bronchoscopy and the surgeon’s experience of the surgical approach and technique.
Collapse
Affiliation(s)
| | - Hatem Beshir
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt.,Department of Cardiothoracic Surgery, Egypt Ministry of Health and Population, Alexandria Directorate, Egypt
| | - Walid H Mohammed
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Mohammed Sanad
- Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Egypt
| |
Collapse
|
5
|
Abstract
We report a case of isolated traumatic rupture of the azygous vein. A 33-year-old female suffered blunt chest injury from the airbag explosion in a car accident. Initial examination revealed decreased breath sounds in the right chest. Computed tomography showed a massive right hemothorax without evidence of rib fracture or great vessel injury. An emergency exploratory thoracotomy was performed due to massive hemothorax with unstable vital signs. A laceration in the anterior wall of the azygos vein was identified. Bleeding was controlled by double ligation at the injury site. The patient was discharged on postoperative day 7 without any sequelae.
Collapse
Affiliation(s)
- Sira Laohathai
- Cardiothoracic Surgery Unit, Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| |
Collapse
|
6
|
Richhariya D, Verm V, Mehta Y. An Interesting Case of Isolated Pancreatic Transection Following Blunt Abdominal Trauma in Emergency Department. Adv J Emerg Med 2018; 2:e48. [PMID: 31172111 DOI: 10.22114/AJEM.v0i0.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Traumatic injury to the pancreas is not common, but if the diagnosis is delayed or misdiagnosed in the emergency department (ED), the condition is associated with high morbidity and mortality and raises a question about the quality of emergency care. Here, we describe a rare case of blunt abdominal trauma resulted in isolated pancreas injury. Case presentation: A 25-year-old young male came to our emergency room (ER) in a conscious, anxious state from a nearby town with a history of roadside trauma. Further investigations revealed an isolated pancreatic injury due to trauma with no other major injuries, which occurred due to a sudden high-speed impact of the steering wheel to the epigastrium of a driver while driving the car, severely compressing the pancreas between the backbone and steering wheel. The patient was admitted to the intensive care unit for close observation and monitoring. He was managed conservatively on intravenous fluids, antibiotics, analgesics, and vasopressors. He was discharged after five days in a hemodynamically stable and afebrile condition, on a normal diet. Conclusion: Isolated pancreatic injury following blunt abdominal trauma is rare, and the symptoms are difficult to analyze early due to its retroperitoneal anatomy. Early detection and early intervention are important in the ED, and if left unrecognized, could result in a poor outcome.
Collapse
|
7
|
Abstract
Background An emergency thoracotomy can be performed either immediately at the site of trauma or in the emergency department or operating room for resuscitation of patients in extremis or life-saving treatment for patients with thoracic injury. It remains a procedure associated with high mortality rates, and there is a paucity of data from Asia. This study analyzed our six-year experience of emergency trauma thoracotomy in an acute general hospital in Singapore. Methods This retrospective analysis was based on experience in a single institution with all emergency trauma thoracotomies performed by general surgeons. All patients who underwent an emergency trauma thoracotomy in Khoo Teck Puat Hospital between January 2011 and December 2016 were studied. Data collected included patient demographics, mechanism of injury, Injury Severity Scores, surgical approach, and postoperative outcomes. Results Twenty-three patients underwent an emergency thoracotomy, 8 in the emergency department and 15 in the operating room. The mechanism of injury was blunt in 20 (87%) patients and penetrating in 3 (13%), with road traffic accidents the most common cause (70%). Six (40%) patients who underwent an emergency thoracotomy in the operating room survived beyond 24 h, and 4 (27%) survivors were eventually discharged from the hospital with no neurological deficit. No patient who underwent a thoracotomy in the emergency department survived beyond 24 h. Conclusions Emergency thoracotomy is associated with high mortality rates, especially when required in the emergency department or for blunt trauma. Nevertheless, it is a potentially life-saving procedure that offers a chance of survival in selected patients.
Collapse
Affiliation(s)
| | - Gregory Heng
- 2 Department of Surgery, 371018 Khoo Teck Puat Hospital , 90 Yishun Central, Singapore 768828
| | - Sachin Mathur
- 3 Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608
| | - Woan Wui Lim
- 2 Department of Surgery, 371018 Khoo Teck Puat Hospital , 90 Yishun Central, Singapore 768828
| | - Tiong Thye Goo
- 2 Department of Surgery, 371018 Khoo Teck Puat Hospital , 90 Yishun Central, Singapore 768828
| |
Collapse
|
8
|
Zemp L, Mann U, Rourke KF. Perinephric Hematoma Size is Independently Associated with the Need for Urological Intervention in Multisystem Blunt Renal Trauma. J Urol 2018; 199:1283-1288. [PMID: 29360530 DOI: 10.1016/j.juro.2017.11.135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/24/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE We examined radiographic predictors of intervention for blunt renal trauma independent of AAST-OIS (American Association for the Surgery of Trauma-Organ Injury Scale). MATERIALS AND METHODS A total of 328 patients with blunt renal trauma from October 2004 to December 2014 were identified for analysis. Hospital records and diagnostic imaging were reviewed to identify the need for urological intervention, including angiographic embolization, nephrectomy, renorrhaphy, ureteral stenting or percutaneous drainage. Factors examined included patient age, gender, length of stay, ISS (Injury Severity Score), AAST-OIS, laceration location, length and number, perinephric hematoma characteristics, intravascular contrast extravasation and devitalized segment status. Descriptive statistics and binary logistic regression were performed as appropriate. RESULTS Mean patient age was 37.0 years and mean ISS was 31.7. A total of 31 urological interventions were required in 27 patients (8.2%), including ureteral stenting in 38.7%, angiographic embolization in 32.3%, nephrectomy in 22.6%, renorrhaphy in 3.2% and percutaneous drainage in 3.2%. On univariate analysis AAST-OIS, hematoma diameter, hematoma area, intravascular contrast extravasation, laceration length, laceration number, degree of devitalization and devitalized fragment presence were associated with the need for intervention (each p <0.001). On multivariate analysis only AAST-OIS grade (OR 69.4, 95% CI 6.4-748.3, p <0.001) and hematoma diameter (OR 1.5, 95% CI 1.1-1.9, p = 0.004) or area (OR 1.03, 95% CI 1.01-1.06, p = 0.012) remained associated with urological intervention. CONCLUSIONS Although AAST-OIS is strongly associated with the need for urological intervention, perinephric hematoma size is also independently associated with this occurrence. Perinephric hematoma diameter should be considered during clinical decision making and incorporated into a revised injury grading system.
Collapse
Affiliation(s)
- Logan Zemp
- Division of Urology, Northern Alberta Urology Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Uday Mann
- Division of Urology, Northern Alberta Urology Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Northern Alberta Urology Centre, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
9
|
Richhariya D, Verma V, Mehta Y. Blunt, Penetrating and Strangulating; Suicidal, Homicidal, Accidental and Sport-Related Neck Injuries: a Case Series and Literature Review. Adv J Emerg Med 2018; 2:e33. [PMID: 31172096 DOI: 10.22114/AJEM.v0i0.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Presentation of neck injuries in ER can be with or without neurological deficit. Trauma victims with multiple injuries should be examined for neck injuries as these injuries are potentially life threatening. Further neck movement should be restricted by applying the cervical collar until further radiological investigations rule out the spine injury. Early identification and treatment of neck injuries whether spine, vascular, or muscular injury improve the morbidity and mortality in polytrauma patients. Case presentation: In a series of case presentations of neck injuries through various modes, the first case of neck injury was related to road traffic accident presented with neck pain and paraplegia. In the second case, neck injury was due to suicidal hanging presented with ligature mark over the neck. Third case was related to Indian traditional sport-related neck injury presented with severe neck pain stiffness. In the fourth case, neck injury was due to gunshot and presented with bullet entry wound and quadriparesis. Conclusion: Neck injury in the absence of associated injuries is rarely seen after blunt and penetrating trauma, but can result in devastating outcomes if left unrecognized. A high index of suspicion and early intervention are critical.
Collapse
|
10
|
Ghafourian N, Mahdizadeh F, Zavareh M, Ahmadi M, Askarzadeh MH, Jalili F. Post-Traumatic Pulmonary Pseudocyst following Blunt Chest Trauma; a Case Report. Emerg (Tehran) 2018; 6:e29. [PMID: 30009231 PMCID: PMC6036524] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic pulmonary pseudocyst is a rare complication of chest trauma that has been poorly documented and usually resolves without specific treatment. Here, we present a case of pulmonary pseudocyst in a child with chest trauma without obvious symptoms. It is important to consider this diagnosis in patients with chest trauma to avoid unnecessary invasive procedures.
Collapse
Affiliation(s)
- Nasim Ghafourian
- Department of Emergency Medicine, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Fatemeh Mahdizadeh
- Department of Emergency Medicine, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Mina Zavareh
- Department of Emergency Medicine, Pastornou Hospital, Tehran, Iran
| | - Mitra Ahmadi
- Department of Emergency Medicine, Pastornou Hospital, Tehran, Iran
| | - Mohammad Hossein Askarzadeh
- Department of Emergency Medicine, Afshar Educational Hospital, Yazd University of Medical Sciences, Yazd, Iran
| | - Fatemeh Jalili
- Department of Emergency Medicine, Hasheminejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
11
|
Akhgar A, Talebian MT, Ashouri M, Ghorbani S, Mirfazaelian H. Jejunal Perforation Following Blunt Abdominal Trauma; a Case Report. Adv J Emerg Med 2017; 1:e9. [PMID: 31172061 DOI: 10.22114/AJEM.v1i1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The possibility of intestinal injury for all patients presenting to emergency department (ED) with blunt abdominal trauma, despite minimal physical signs should be considered. To highlight the patient management, hear, we report a case of hollow viscus injuries resulting from blunt abdominal trauma referring to a teaching hospital in Tehran, Iran. Case presentation: A 30-year-old man presented to the ED after “falling into a hole” with his back and had direct blunt abdominal trauma by a heavy bag of cement. In physical examination, there was a mild abdominal tenderness on right upper quadrant. On bedside ultrasonography, there was small free fluid in his Morison’s pouch without hypotension. So abdominal CT scan was performed which revealed free fluid in pelvic, perihepatic, and perisplenic spaces. Mural hematoma of proximal part of jejunum with mural wall hypodensity in mid jejunal loop were also revealed. The patient underwent surgery, and there was damage to the colon serosa and jejunal perforation which was primarily repaired. Conclusion: The presented case highlights the importance of obtaining history and physical exam and paying attention to the nature and mechanism of injury. Emergency physicians should be aware of hollow viscus injury in traumatic patients. Any delay in diagnosis and operative management are associated with an increase in mortality.
Collapse
|
12
|
Abstract
Diagnosis of blunt tracheobronchial injuries can be challenging. These injuries may appear within months or years following the initial trauma. In general, diagnosis and treatment of delayed presentation of tracheobronchial injuries are uncommon. Herein, we present the case of a 48-year-old woman with complete transection of the right bronchus that was diagnosed 50 days after the initial trauma. Reconstructive surgery of the bronchus was performed successfully without any need for pulmonary resection.
Collapse
Affiliation(s)
- Ali Reza Mohammadzadeh
- 1 Department of Surgery, 48491 Velayat Hospital, Qazvin University of Medical Sciences , Qazvin, Iran
| | - Hamid Kayalha
- 2 Department of Anesthesiology, 48491 Velayat Hospital, Qazvin University of Medical Sciences , Qazvin, Iran
| |
Collapse
|
13
|
Abstract
Tension pneumopericardium is a rare disease that is very difficult to diagnose. A 3-year old child was run over by a minibus. Computed tomography showed bilateral pneumothorax, multiple rib fractures on both sides, and a hepatic laceration. The massive blunt thoracic trauma caused entrapped air in the pericardium, and a tension pneumoprecordium developed abruptly. We report this unique case of tension pneumopericardium in a child, and the subsequent emergency surgery and damage control measures.
Collapse
Affiliation(s)
| | - Katharina Gaab
- Surgical Department 1, Clinical Center Fuerth, Fuerth, Germany
| |
Collapse
|
14
|
Kalogerakos PD, Lazopoulos G, Palioudakis S, Drositis I, Chionidou K, Chalkiadakis G. Pneumorachis associated with persistent tachycardia after blunt thoracic trauma. Asian Cardiovasc Thorac Ann 2017; 25:463-465. [PMID: 28610438 DOI: 10.1177/0218492317717421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/16/2022]
Abstract
Pneumorachis, or intraspinal air, can be a rare result of blunt thoracic trauma. We report the case of a 40-year-old man with multiple injuries and pneumorachis associated with persistent tachycardia. As factors that increase heart rate were gradually ruled out, intraspinal air was considered the potential culprit. Computed tomography revealed intraspinal air at the thoracic level, which possibly promoted cardiac arrhythmogenesis. Air may transiently compress the preganglionic cardiac sympathetic nerves and increase sympathetic output to the heart.
Collapse
Affiliation(s)
| | - George Lazopoulos
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece
| | - Stefanos Palioudakis
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece
| | - Ioannis Drositis
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece
| | - Kiriaki Chionidou
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece
| | - George Chalkiadakis
- Department of Cardiothoracic Surgery, University General Hospital of Heraklion, Crete, Greece
| |
Collapse
|
15
|
Nair VV, Singh KK, Kathayanat JT, Radhakrishnan R, Babu A, Thanathu Krishnan Nair J. Late presentation of esophageal rupture following blunt thoracic trauma. Asian Cardiovasc Thorac Ann 2017; 25:313-314. [PMID: 28513188 DOI: 10.1177/0218492317709697] [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: 11/17/2022]
Abstract
Esophageal rupture following blunt thoracic trauma is extremely rare. A 30-year-old man sustained a road traffic accident causing blunt thoracic trauma that resulted in lower esophageal rupture. He presented 24 h after the initial trauma and was managed with primary repair and aggressive lavage with a drainage procedure. Early identification and repair of esophageal rupture is vital for preventing mediastinitis, but an aggressive surgical and postoperative management strategy can prevent mortality even in late presentations.
Collapse
Affiliation(s)
- Vinitha V Nair
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Kunal Krishna Singh
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Joseph Thomas Kathayanat
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Ratish Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | - Akash Babu
- Department of Cardiovascular and Thoracic Surgery, Government Medical College, Kottayam, Kerala, India
| | | |
Collapse
|
16
|
Yick DW, Lee JW, Tsang S, Yeung BY, Yuen CY. Preliminary results of CO2 laser-assisted sclerectomy surgery (CLASS) in the treatment of advanced glaucoma in a Chinese population. Medicine (Baltimore) 2016; 95:e5294. [PMID: 27828849 PMCID: PMC5106055 DOI: 10.1097/md.0000000000005294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/25/2022] Open
Abstract
To evaluate the efficacy and safety of CO2 laser-assisted sclerectomy surgery (CLASS) in Chinese patients with advanced glaucoma.Patients with advanced glaucoma who were candidates for glaucoma filtration surgery were included. The intraocular pressure (IOP) and number of antiglaucoma medications were documented before surgery and at all postoperative clinic visits. All intra- and postoperative complications were documented. The primary outcome measures were the changes in IOP and medication use before and after the procedure as well as complications from the procedure. The secondary outcome measure included the CLASS success rate.Twenty patients (23 eyes) underwent CLASS between November 2014 and September 2015. Nineteen eyes had primary open-angle glaucoma, 2 eyes had primary angle-closure glaucoma, and 2 eyes had uveitic glaucoma. One patient was lost to follow-up. The mean age of subjects was 68.1 ± 11.9 years. IOP was significantly reduced at 1 day and 1 week after CLASS. At 6 months, the IOP and number of medications were significantly reduced by 19.0% and 38.2%, respectively (both P < 0.0001). One patient had intraoperative trabeculo-Descemet membrane perforation. Two patients required laser goniopuncture and 2 required needling between 3 and 6 months postoperatively. The overall success rate was 81.8% at 6 months.CLASS achieved a modest IOP reduction in the early postoperative period and was overall a safe procedure for advanced glaucoma.
Collapse
Affiliation(s)
| | - Jacky W.Y. Lee
- Department of Ophthalmology, Caritas Medical Centre
- Dennis Lam & Partners Eye Center
- Correspondence: Dr Jacky W.Y. Lee, Dennis Lam & Partners Eye Center, Suite 1515, Central Building, 1-3 Pedder Street, Hong Kong Special Administrative Region, China (e-mail: )
| | | | - Barry Y.M. Yeung
- Yeung Yat Ming, Barry Clinic, Hong Kong Special Administrative Region, China
| | | |
Collapse
|
17
|
Alimi F, Alijla H, Neily A, Ghannouchi C, El Hadj Sidi C, Jerbi S. Right main bronchus rupture from blunt chest trauma in a child. Asian Cardiovasc Thorac Ann 2016; 24:715-7. [PMID: 27298476 DOI: 10.1177/0218492316655659] [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: 11/16/2022]
Abstract
We report the case of a 6-year-old boy with right main bronchus avulsion after blunt chest trauma. Reimplantation of the right main bronchus at the carina was performed via a right posterolateral thoracotomy, with satisfactory long-term morphological and functional results.
Collapse
Affiliation(s)
- Faouzi Alimi
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| | - Hazem Alijla
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| | - Asma Neily
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| | - Chams Ghannouchi
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| | - Chighali El Hadj Sidi
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| | - Sofian Jerbi
- Thoracic and Cardiovascular Surgery Department, Sahloul University Hospital, Sousse, Tunisia
| |
Collapse
|
18
|
Behboodi F, Mohtasham-Amiri Z, Masjedi N, Shojaie R, Sadri P. Outcome of Blunt Abdominal Traumas with Stable Hemodynamic and Positive FAST Findings. Emerg (Tehran) 2016; 4:136-9. [PMID: 27299142 PMCID: PMC4902207] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Focused assessment with sonography for trauma (FAST) is a highly effective first screening tool for initial classification of abdominal trauma patients. The present study was designed to evaluate the outcome of patients with blunt abdominal trauma and positive FAST findings. METHODS The present prospective cross-sectional study was done on patients over 7 years old with normal abdominal examination, positive FAST findings, and available abdominopelvic computed tomography (CT) scan findings. The frequency of need for laparotomy as well as its probable risk factors were calculated. RESULTS 180 patients were enrolled (mean age: 28.0 ± 11.5 years; 76.7% male). FAST findings were confirmed by abdominopelvic CT scan in only 124 (68.9%) cases. Finally, 12 (6.6%) patients needed laparotomy. Mean age of those in need of laparotomy was significantly higher than others (36.75 ± 11.37 versus 27.34 ± 11.37, p = 0.006). Higher grading of spleen (p = 0.001) and hepatic (p = 0.038) ruptures increased the probability of need for laparotomy. CONCLUSION 68.9% of the positive FAST findings in patients with blunt abdominal trauma and stable hemodynamics was confirmed by abdominopelvic CT scan and only 6.6% needed laparotomy. Simultaneous presence of free fluid and air in the abdominal area, old age, and higher grading o solid organ injuries were factors that had a significant correlation with need for laparotomy.
Collapse
Affiliation(s)
- Firooz Behboodi
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Zahra Mohtasham-Amiri
- Department of Preventive & Social Medicine, Guilan University of Medical Science, Rasht, IR Iran
| | - Navid Masjedi
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Reza Shojaie
- Department of General Surgery, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Peyman Sadri
- Department of General Surgery, Zanjan University of Medical Science, Zanjan, IR Iran
| |
Collapse
|
19
|
Abstract
We present a rare case of intercostal lung herniation due to blunt trauma. A 40-year-old man was admitted to our hospital with lung herniation due to falling off a donkey. Computed tomography demonstrated a fracture of the 8th left rib, a comminuted fracture of the 9th rib, and lung herniation into the 8th intercostal space. The herniation was repaired using a titanium prosthetic rib, a rib plate, and Prolene mesh via a thoracotomy.
Collapse
Affiliation(s)
- Yucel Akkas
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Neslihan Gülay Peri
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Bulent Kocer
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
20
|
Abstract
BACKGROUND Surfing is a popular sport in coastal areas, which can be associated with chest injuries. METHODS Between 2008 and 2013, 6 patients were referred to our hospital with chest injuries sustained during surfing. Clinical data were collected from their medical records and analyzed retrospectively. RESULTS Patient age ranged from 35 to 52 years. Five of the 6 patients were male. Four patients were injured in August, and the other two were injured in September and October. Rib fractures were observed in 3 of the 6 patients. The other 3 patients were diagnosed with chest contusions only. Hemothorax occurred in one patient. No lacerations were observed in any of the 6 patients. CONCLUSION Chest injuries associated with surfing are usually blunt chest injuries; however, they may occasionally be life-threatening.
Collapse
Affiliation(s)
- Atsushi Sano
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Takuma Yotsumoto
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
| |
Collapse
|
21
|
Johnsen NV, Dmochowski RR, Mock S, Reynolds WS, Milam DF, Kaufman MR. Primary Endoscopic Realignment of Urethral Disruption Injuries--A Double-Edged Sword? J Urol 2015; 194:1022-6. [PMID: 25849600 DOI: 10.1016/j.juro.2015.03.112] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE Controversy remains regarding initial management of traumatic urethral disruption injuries. We evaluated the outcomes of primary endoscopic realignment vs suprapubic tube placement in this patient population. MATERIALS AND METHODS We reviewed our urological trauma database for patients with blunt trauma related posterior urethral injuries from 2000 to 2014. Patients underwent primary endoscopic realignment or suprapubic tube placement alone. The primary outcome was the success of primary realignment, defined as no further need for urological intervention. Secondary outcomes were the need for endoscopic interventions and/or urethroplasty, time to urethroplasty, urethroplasty success and long-term functional outcomes. RESULTS A total of 27 patients underwent primary realignment and 14 underwent suprapubic tube placement. Mean followup was 40 months (median 24, range 1 to 152). Realignment was successful in 10 patients (37%) at a mean followup of 67.3 weeks (median 27.3, range 4 to 284). In the 17 cases (63%) that failed mean time to failure was 9.7 weeks (median 8.5, range 1 to 26). Seven patients (26%) treated with realignment and 11 (79%) with a suprapubic tube proceeded to urethroplasty. Mean ± SD time to urethroplasty was significantly shorter in the suprapubic tube group (14.6 ± 7.6 vs 5.8 ± 1.6 months, p = 0.003). There was no difference in operative time, complications, success or functional outcomes. CONCLUSIONS Management of traumatic urethral disruption injuries by primary endoscopic realignment serves as definitive therapy in more than a third of treated patients. It prevents the need for formal urethroplasty in more than half of failed cases.
Collapse
|
22
|
Kalantari N, Bayani M, Abbas-zadeh M. Rupture of Hydatid Liver Cyst into Peritoneal Cavity Following Blunt Abdominal Trauma; a Case Report. Emerg (Tehran) 2015; 3:45-47. [PMID: 26512369 PMCID: PMC4614611] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hydatid cyst is a serious parasitic infection in places, which people has a close contact with dogs or sheep. They may be found as an incidental findings during routine clinical examination or even followed by radiographic or ultrasonography evaluation. The disease becomes more complicated if rupture of the cysts occurs due to blunt trauma or spontaneously increases of intra-cystic pressure. Here, we reported a case of hydatid liver cyst that ruptured into the peritoneal cavity after blunt abdominal trauma.
Collapse
Affiliation(s)
- Narges Kalantari
- Cellular and Molecular Biology Research center, Babol University of Medical Sciences, Babol, Iran
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Masomeh Bayani
- Infectious Disease and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Mina Abbas-zadeh
- Infectious Disease and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
23
|
Barua A, McPherson S, Chaudhuri N. Endovascular intervention in thoracic surgery. Asian Cardiovasc Thorac Ann 2014; 23:722-5. [PMID: 25371441 DOI: 10.1177/0218492314557869] [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: 11/16/2022]
Abstract
There are few reports regarding endovascular treatment in thoracic surgical patients. Here, we describe the cases of 2 patients who received adjuvant endovascular therapy prior to surgery. One presented with recurrent chest infection. Computed tomography revealed systemic blood supply to an intralobar sequestration. The other presented with an avulsion injury to the internal mammary vein. Coil embolization was employed in both patients with subsequent uncomplicated surgery. Endovascular intervention may stop active bleeding in the chest and reduce the risk of operative hemorrhage in selected thoracic surgical patients.
Collapse
Affiliation(s)
- Anupama Barua
- Department of Thoracic Surgery, St. James's University Hospital NHS Trust, Leeds, UK
| | - Simon McPherson
- Department of Radiology, St. James's University Hospital NHS Trust, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital NHS Trust, Leeds, UK
| |
Collapse
|
24
|
Abstract
BACKGROUND Traumatic pulmonary pseudocysts are rarely talked about, developing in less than 3% of patients with pulmonary parenchymal injuries. Resolution usually occurs within a few weeks to a few months. METHOD A prospective study was undertaken in 21 cases treated in Menoufia University Hospital, Egypt from August 2011 through August 2013. RESULTS The overall mean time for complete resolution was 61.1 days. The mean time for resolution of simple traumatic pulmonary pseudocysts was 21 days (n = 6), and the mean time for resolution of complicated (blood filled) traumatic pulmonary pseudocysts was 77.1 days (n = 15). Mean resolution time was 26.3 days for small pulmonary pseudocysts ≤22 mm (n = 11) and 99.4 days for those >22 mm (n = 10). The resolution time was 42.6 days in patients 17-years old or younger (n = 11) and 81.4 days in patients older than 17 years (n = 10). CONCLUSION There was a highly significant difference in resolution time between simple and complicated pseudocysts. There was also a highly significant delay in the resolution time of pseudocysts larger than 22 mm and in patients older than 17 years.
Collapse
Affiliation(s)
| | - Heba Khodari Allam
- Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| |
Collapse
|
25
|
Abstract
OBJECTIVE To present our experience of the management of bronchial injuries in children. METHODS Between 2001 and 2012, we diagnosed 11 cases of bronchial injuries in children and reviewed their records. RESULTS The age range was 3-12 years. Etiologies were passenger traffic accidents in 55%, pedestrian traffic accidents in 27%, and a fall from a height in 18%. Clinical manifestations were pneumothorax with continuous air leak in 81%, subcutaneous emphysema in 55%, and failure of lung expansion in 64%. Three (27%) cases were diagnosed late. All patients were operated on through a posterolateral thoracotomy. Main stem bronchial rupture was identified in the right side in 72% and in the left side in 28%. Bronchial repair was feasible in 7 (64%) cases, but resection was inevitable in 4 cases (3 pneumonectomies and one lobectomy). Two of the patients who required resection died; they had associated intraabdominal injuries. All survivors were discharged in stable condition without complications. CONCLUSION Bronchial injuries in children are rare and challenging. Clinical, radiological, and bronchoscopic examinations facilitate the diagnosis. Early diagnosis and bronchial repair offers favorable results. Delayed diagnosis, lung resection, and associated injuries adversely affect the outcome.
Collapse
|
26
|
Abstract
A 65-year-old man presented with a nonspecific thymic neoplasm following blunt thoracic trauma. The lesion increased in size over 12 years, to reach 47 mm in diameter. After thymectomy, the lesion was described as an epidermoid lining cyst composed of thickened stratified squamous epithelium. We assume that this rare pathological condition was caused by skin tissue islands and fat migrating into the mediastinum.
Collapse
Affiliation(s)
- Francesco Monaco
- Thoracic Surgery Unit, University Hospital of Messina, G. Martino University of Messina, Italy
| | - Mario Barone
- Thoracic Surgery Unit, University Hospital of Messina, G. Martino University of Messina, Italy
| | - Maurizio Monaco
- Thoracic Surgery Unit, University Hospital of Messina, G. Martino University of Messina, Italy
| |
Collapse
|
27
|
Abstract
A 42-year-old man sustained blunt thoracic trauma after a motor vehicle accident. He underwent an urgent operation. Operative findings included a large hematoma, a 4-cm tear in the left atrial appendage, and a long pleuropericardial rupture along the right phrenic nerve. We repaired the left atrial appendage without cardiopulmonary bypass, and closed the pericardial defect primarily. The patient recovered fully and was discharged on the 6th postoperative day.
Collapse
Affiliation(s)
- Nguyen Huu Nhan
- Medical and Health Science Center, University of Debrecen, Hungary
| | - Pham Tho Tuan Anh
- Department of Cardiac Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran Minh Trung
- Department of Cardiac Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | |
Collapse
|
28
|
Dajer-Fadel WL, Ibarra-Pérez C, Borrego-Borrego R, Navarro-Reynoso FP, Argüero-Sánchez R. Descending necrotizing mediastinitis and sternoclavicular joint osteomyelitis. Asian Cardiovasc Thorac Ann 2014; 21:618-20. [PMID: 24570571 DOI: 10.1177/0218492312463570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/16/2022]
Abstract
Descending necrotizing mediastinitis is usually associated with cervical or odontogenic infections. We describe a patient with blunt trauma to the chest 2 years earlier, and a slowly developing chest wall hematoma 18 months prior to admission, complicated by chronic sternoclavicular joint osteomyelitis, eventually leading to descending mediastinitis. Thoracotomy with drainage of the mediastinal spaces and multiple procedures for the sternoclavicular joint infection were successful. The rarity of this association and undefined optimal management prompted this report.
Collapse
Affiliation(s)
- Walid L Dajer-Fadel
- Department of Cardiothoracic Surgery, General Hospital of Mexico, Mexico City, Mexico
| | | | | | | | | |
Collapse
|
29
|
Muthialu N, Hoskote A, Deshpande R, Lister P. Right pulmonary hilar pedicle injury secondary to blunt chest trauma in a child. Asian Cardiovasc Thorac Ann 2014; 21:235-8. [PMID: 24532632 DOI: 10.1177/0218492312452269] [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: 11/16/2022]
Abstract
Combined tracheobronchial and thoracic vascular injury in children following blunt trauma to the chest is potentially life-threatening and almost certain to be fatal unless managed promptly. We report one such incident where prompt identification and early aggressive surgical management prevented an almost certain fatal outcome in a 5-year-old girl with complete disruption of the right main bronchus just distal to the carina, and a tear in the right pulmonary artery.
Collapse
Affiliation(s)
- Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Tracheobronchial injuries are encountered with increasing frequency because of improvements in pre-hospital care. We reviewed our experience of these injuries to determine how to better recognize them and facilitate their correct management. METHODS Patients with traumatic non-iatrogenic intrathoracic tracheobronchial injuries managed in 2 tertiary centers in Saudi Arabia between 2000 and 2012, were studied. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. RESULTS 78 patients with tracheobronchial injuries were included in this study. They were divided into 2 groups according to the management strategy. Forty-seven patients who were managed conservatively, and 31 underwent surgery. Surgery allowed shorter intensive care unit and hospital stays; otherwise, the results were comparable between the two groups. CONCLUSIONS Early recognition and expedient appropriate management are essential in these potentially lethal injuries. Operative management can be achieved with acceptable mortality, and conservative treatment should be considered as a valuable alternative to the well-established surgical treatment.
Collapse
Affiliation(s)
- Mohamed A Alassal
- Prince Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia Cardiothoracic Surgery Department, Banha University, Egypt
| | | | - Nabil Elsadeck
- Cardiothoracic Surgery Department, Zagazig University, Egypt Cardiothoracic Surgery Department, Asir Central Hospital, Saudi Arabia
| |
Collapse
|
31
|
Abstract
We describe a rare case of delayed surgery for blunt ascending aortic injury. A 77-year-old man was injured in a traffic accident. He lost consciousness and suffered severe blunt trauma to the chest. Computed tomography showed multiple head and chest injuries and acute Stanford type A aortic dissection. The operation was postponed because he was hemodynamically stable and his risk of surgical death was increased due to his other injuries. Serial computed tomography showed growth of the aortic lesion, and aortic surgery was successfully performed 11 months after admission to the hospital. The postoperative course was uneventful.
Collapse
Affiliation(s)
- Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Naomichi Uchida
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taiichi Takasaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
32
|
Suri YV, Garg A, Venugopalan VM, Kapoor S, Tripathi PC, Kochhar HK, Mahajan TR. MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY. Med J Armed Forces India 1997; 53:30-34. [PMID: 28769431 DOI: 10.1016/s0377-1237(17)30641-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/25/2022] Open
Abstract
Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.
Collapse
Affiliation(s)
- Y V Suri
- Senior Adviser (Anaesthesiology), Command Hospital Western Command, Chandimandir 134107
| | - A Garg
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - V M Venugopalan
- Classified Specialist (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| | - S Kapoor
- Graded Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - P C Tripathi
- Classified Specialist (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| | - H K Kochhar
- Classified Specialist (Surgery), 92 Base Hospital, C/O 56 APO
| | - T R Mahajan
- Senior Adviser (Anaesthesiology), 92 Base Hospital, C/O 56 APO
| |
Collapse
|