Imaging manifestations and the related clinical characteristics of chest trauma during the Yushu Earthquake

The purpose of this study was focused on the imaging features of the chest trauma and its relation to clinical characteristics. All the injured patients were from the Yushu Earthquake areas on days April 14 - 23,2010. After an initial treatment,the injurers were rapidly transported from Yushu at an altitude of 4 000 m via air to Xining at 2 260 m within 6~8 h,and promptly admitted to Qinghai Provincial People’s Hospital. A total of 130 wounded injurers who had high suspicion of chest injuries all had examinations of Chest X-ray and computed tomography(CT)images. Of them 63 injurers presented at least one of the features of the chest trauma in imaging with a positive rate of 48.5 %. Of these,37 cases (28.5 %) were multi-system with multiple injuries ,33 cases (25.4 %) were chest trauma with multi-injury types,which included thoracic fractures in 54 cases (85.7 %),pleural injury in 56 cases (88.9 %),lung injury in 54 cases (85.7 %),lungs complications in 37 cases (58.7 %),and extrapulmonary complications of 35 cases (55.6 %). The radiological data were analyzed retrospectively. The features of chest trauma in Yushu Earthquake,the complications of chest injuries,and the relation between imaging findings and clinical manifestations,as well as the differences of chest trauma between Yushu Earthquake and Wenchuan Earthquake were discussed in detail.

Chest Trauma at the Emergency Department of the Gabriel TouréUniversity Hospital Bamako, Mali

In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. Method and Material: This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. Analysis and Entry: Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. Results: We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. Conclusion: Urban violence with its share of ballistic wounds determined the severity of this condition.

Right Main Bronchus Disruption Discovered after One Year of Blunt Chest Trauma

Central airway injury is a very rare entity during blunt chest trauma. It is serious and may be fatal. Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately. It’s suspected when major air leaks from the chest tube and the lung fail to expand despite adequate chest drainage. Right main bronchus injuries are the most frequent. Diagnosis can be suspected clinically and confirmed by Ct scan and bronchoscopy. Conservative management can be applied in special cases but the majority of cases need surgical intervention which depends on primary reconstruction. An early diagnosis and treatment can avoid dramatic complications and provide complete recovery. Associated other organ injury is common and is an important mortality factor. Close cooperation with the emergency team and anesthesiologists is necessary. Here I presented a case of right main bronchus disruption discovered after one year of blunt chest trauma with complete lung atelectasis, managed successfully by resection of the fibrotic injured bronchus and primary reconstruction saving the lung.

Management of computed tomography scan detected hemothorax in blunt chest trauma:What computed tomography scan measurements say?

AIM To investigate the hemothorax size for which tube thoracostomy is necessary.METHODS Over a 5-year period, we included all patients who were admitted with blunt chest trauma to our level 1 trauma center. Focus was placed on identifying the hemothorax size requiring tube thoracostomy.RESULTS A total number of 274 hemothoraces were studied. All patients with hemothoraces measuring above 3 cm received a chest tube. The 50% predicted probability of tube thoracostomy was 2 cm. Pneumothorax was associated with odds of receiving tube thoracostomy for hemothoraces below 2 cm(Odds Ratio:4.967, 95%CI: 2.225-11.097, P < 0.0001).CONCLUSION All patients with a hemothorax size greater than 3% underwent tube thoracostomy. Prospective studies are warranted to elucidate the clinical outcome of patients with smaller hemothoraces.

Clinical Approach for the Pneumomediastinum after Blunt Chest Trauma

Objective: Pneumomediastinum (PM) can be observed after blunt and penetrating chest trauma. Most of the patients with PM due to trauma can be managed conservatively. This study aimed to evaluate the cases with PM on thorax computed tomography (CT) after blunt chest trauma (BCT). Methods: Medical records of patients with PM due to BCT between January 2000 and December 2014 were reviewed retrospectively. Thorax CT was used to verify pneumomediastinum in all patients. Twenty-four patients which had different causes of PM (penetrating trauma, iatrogenic, spontaneous) were excluded from the study. Data of sixty-nine patients with the diagnosis of PM secondary to BCT and who were observed without any further procedure for the cause of PM, were evaluated retrospectively. Results: There were 59 male and 10 female patients with the mean age of 47.60 ± 17.47 years (range, 16 to 80 years). The most common cause of PM etiology was traffic accident with a rate of 38 (55.06%) patients, followed by fall from height in 25 (36.24%), compression in 3 (4.35%) and drubbing in 3 (4.35%) patients. There was a 12.46 ± 6.42 days (range, 6 to 28 days) mean duration of chest tube drainage which was performed for accompanying pathologies like pneumothorax and hemothorax. No complication was determined for short and long term follow-up of patients when all hospital records were analyzed in terms of complication. Conclusions: PM after BCT may be a marker of esophageal and tracheobronchial injury and invasive procedures like bronchoscopy and endoscopy can be needed for differential diagnosis. We evaluated 69 patients in good general status and no need for intensive care management with PM in this study and observed them without any further procedure. As a result of these findings we concluded that for the PM patients after BCT with uneventful clinical course, conservative treatment without any further procedure is a safe and sufficient method.

CT as a first-line modality in elderly patients with stable blunt chest trauma

Blunt thoracic injuries are common among elderly patients and may be a common cause of morbidity and death from blunt trauma injuries.We aimed to examine the impact of chest CT on the diagnosis and change of management plan in elderly patients with stable blunt chest trauma.We hypothesized that chest CT may play an important role in providing optimal management to this subgroup of trauma patients.;A retrospective analysis was performed on all the admitted adult blunt trauma patients between January 2014 and December 2018.Stable blunt chest trauma patients with abbreviated injury severity(AIS)<3 for extra-thoracic injuries confirmed with chest X-ray(CXR)and chest CT on admission or during hospitalization were included in the study.The AIS is an international scale for grading the severity of anatomic injury following blunt trauma.Primary outcome variables were occult injuries,change in management,need for surgical procedures,missed injuries,readmission rate,intensive care unit(ICU)and length of hospital stay.;There are 473 patients with blunt chest trauma included in the study.The study patients were divided into two groups according to the age range:group 1:289 patients were included and aged 18-64 years;group 2:184 patients were included and aged 65-99 years.Elderly patients in group 2 more often required ICU admission(11.4%vs.5.2%),had a longer length of ICU stay(days)(median 11 vs.6,p=0.01),and the length of hospital stay(days)(median 14 vs.6,p=0.04).Injuries identified on chest CT has led to a change of management in 4.4%of young patients in group 1 and in 10.9%of elderly patients in group 2 with initially normal CXR.Chest CT resulted in a change of management in 12.8%of young patients in group 1 and in 25.7%of elderly patients in group 2 with initially abnormal CXR.;Chest CT led to a change of management in a substantial proportion of elderly patients.Therefore,we recommend chest CT as a first-line imaging modality in patients aged over 65 years with isolated blunt chest trauma.

Delayed diagnosis for tricuspid regurgitation after blunt chest trauma

Tricuspid valve regurgitation is a rare complication of blunt chest trauma.Approximately 150 cases have been reported since first being described by Todd et al in 1848.1 During the past few decades traumatic tricuspid regurgitation has been reported with increasing frequency,which may in part be attributed to more patients surviving blunt chest trauma as well as improved diagnostic imaging studies,such as echocardiography.The incidence of traumatic tricuspid regurgitation is likely underestimated since chronic,isolated tricuspid insufficiency may be well tolerated in some patients who experience few or no symptoms after the traumatic event.2 Furthermore,some patients may not recall antecedent chest trauma unless specifically questioned.Most cases of traumatic tricuspid regurgitation are secondary to blunt chest trauma.1

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

The occurrence, bleeding, and treatment of internal mammary artery（IMA） injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.

Coronary artery dissection and acute myocardial infarction after blunt chest trauma

Coronary artery dissection and acute myocar-dial infarction（AMI） after blunt chest trauma （BCT） has rarely been reported1＇2. This report describes two cases of the left anterior de-scending（LAD） artery dissection and AMI after BCT, successfully treated with percutaneous coronary intervention （PCI） and they dis-charged without complications.

The Selective Conservative Management of Small Traumatic Pneumothorax Following Stab Injuries of the Chest in Emergency Department Patients

Background: Chest trauma is a catastrophic event that affects large number of population and leads to morbidity, disability and mortality. The definition of an occult pneumothorax is uncontested. It is a pneumothorax that was not suspected on the basis of clinical examination or plain radiography, but was ultimately detected with CT and usually treated conservatively. We evaluated the success of selective conservative management of small pneumothorax following stab chest injuries, in Emergency Department patients. Methods: This prospective study was conducted on 30 adult patients admitted to the emergency department with small traumatic pneumothorax following stab injury. All enrolled patients (n = 30) were assessed for the following, demographic data, laboratory investigations, chest x-ray and CT scan. The outcomes measured were discharge safely after successful conservative management, Initial conservative then invasive measurement. Results: There was a statistically significant difference between conservative and non-conservative types of management in the incidence of complications after 1 week follow up (p = 0.001). Conclusion: The majority of asymptomatic small pneumothorax patients following a stab injury can be managed conservatively. Haphazard chest tube insertion and aging may lead to complications in such patients.

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

Thoracoscopic diagnosis of traumatic pericardial rupture with cardiac hernia:A case report

BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury,preoperative diagnosis is difficult;it is easily misdiagnosed and causes serious consequences.CASE SUMMARY A 60-year-old man,previously healthy,was transported to the emergency room after falling from a great height.Upon arrival,his vital signs were stable.Electrocardiography and echocardiography were performed,and there was no sign of cardiac injury or ischemia.Chest and abdomen computerized tomography revealed pneumopericardium,hemopneumothorax,lung contusion,multiple rib fractures on the right side(Figure 1),and right scapula and clavicle fractures.He was admitted to the inpatient department for further observation after tube thoracostomy.The next day,the patient suddenly experienced rapid arrhythmia(the ventricular rate reached 150-180 beats/min)when turning onto his right side,accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation.Thoracoscopy was performed urgently,and a large vertical tear(8 cm×6 cm)was found in the pericardium.The defect was successfully repaired using a heart Dacron patch.His postoperative condition was uneventful without any fluctuations in vital signs,and he was transferred to the orthopedics department for further surgery on postoperative day 8.CONCLUSION Although the possibility of pericardial rupture combined with cardiac hernia is extremely low,it is one of the causes of cardiogenic shock following blunt trauma.Therefore,clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.

Lifesaving Emergency Sternotomy in Traumatic Cardiac Tamponade in a Teaching Hospital in Ghana: Survival of Two Rare Cases

Introduction: Patients presenting with cardiac injuries from gunshot wounds and blunt chest trauma have high mortality, without any observed survival benefit when presenting with cardiac tamponade. Cardiac tamponade is a life-threatening hemodynamically significant compression of the heart by a sudden or gradual accumulation of collections in the pericardial space that incites and overrides the body’s compensatory mechanism. Clinical Case: We present and discuss the successful management and survival of two patients with traumatic cardiac tamponade from gunshot wounds to the precordium who underwent successful lifesaving median sternotomy at a Teaching Hospital in Ghana with a new Cardiovascular and Thoracic Surgery Unit. Discussion: Usually the diagnosis of cardiac tamponade from traumatic haemopericardium is made by clinical findings which though may not always be present especially after blunt chest trauma. EFAST is a reliable tool for diagnosing and following cardiac tamponade. Median sternotomy is the standard procedure in these patients to access and repair cardiac injury either with or without cardiopulmonary bypass. Conclusion: Emergency median sternotomy in patients with cardiac tamponade from chest trauma especially after EFAST diagnosis can be lifesaving even in less resourced centres.

Blunt traumatic tension chylothorax:Case report and minireview of the literature

Tension chylothorax following blunt thoracic trauma is an extremely rare condition.Here we report such a case and review its management.A 31-year-old man was involved in a road traffic collision.The car rolled over and the patient was ejected from the vehicle.On arrival at the Emergency Department the patient was conscious and haemodynamically stable.Clinical examination of the chest and abdomen was normal.The patient had sustained fractures of the sixth cervical vertebra and the tenth thoracic vertebra,left pleural effusion,haematoma around the descending aorta and fracture of the right clavicle.The left pleural effusion continued to increase in size and caused displacement of the trachea and mediastinum to the opposite side.An intercostal chest tube was inserted on the left side on the second day.It drained 1500 mL of milky,bloodstained fluid.We confirmed the diagnosis of chylothorax by a histopathological examination of a cell block prepared from the left pleural effusion using Oil red O stain.The patient was managed conservatively with chest tube drainage and fat free diet.The chylothorax completely resolved on the eighth day after the injury.The patient was discharged home on day 16.

Blunt Traumatic Pericardial Rupture with Traumatic Amaurosis Fugax Presenting as Massive Haemothorax: A Conundrum?

Introduction: Blunt traumatic pericardial rupture (BTPR) or traumatic pericardiotomy is a rare typical trauma. It is usually discovered at autopsy. Surgical repair is mandatory especially if prompt diagnosis is made because of the associated high mortality. Clinical Case: We report the successful management and survival of BTPR patient after chest trauma presenting with massive haemothorax and transient loss of vision, necessitating urgent surgical treatment. The patient was involved in a road traffic accident having a head-on collision with the rear of the vehicle ahead whiles trying to overtake it. Discussion: It is usually discovered at autopsy or during emergent surgical exploration through either sternotomy or thoracotomy [1] due to its delayed diagnosis, unusual presentation, association with other major cardiopulmonary injuries and complications such as cardiac herniation, fatal arrhythmias, cardiogenic shock and cardiac arrest. Conclusion: Blunt traumatic pericardial rupture should be suspected in any patient in whom hemodynamic instability occurs rapidly after trauma without evidence of major bleeding. Prompt surgical exploration may yield excellent results.

Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.

Ventricular Septal Defect after Blunt Trauma in a Case of Preexisting Prosthetic Mitral Valve

We present a case of an isolated large ventricular septal defect (VSD) following blunt chest trauma in a motor vehicle accident in the patient with preexisting mechanical mitral valve. Transthoracic echocardiography revealed a large muscular VSD with significant left to right shunt along with septal edema. Surgical repair was performed in view of Qp:Qs of 2.5 with significant hemodynamic instability despite intra-aortic balloon pump. The ventricular septal defect was found in apical muscular portion of the interventricular septum, which was closed through left ventriculotomy. We here discuss the possible mechanisms of damage and importance of timely surgery. To conclude, minor looking external injury might contain devastating damage inside, especially with patients on anti-coagulant therapy.

新型冠状病毒肺炎常态化疫情防控时期急诊胸外伤的处理策略

目的探讨新型冠状病毒肺炎(COVID-19)常态化疫情防控时期急诊胸外伤的处理策略。方法2020年5月至2022年12月常态化疫情防控期间收治的78例急诊胸外伤患者为观察组,依托“互联网+”智慧医疗平台,在出诊、接诊、预检分诊、急诊处置等方面,做好疫情防控的同时,采用一体化救治新模式;另取2017年5月至2019年12月收治、采用传统救治方法的81例急诊胸外伤患者为对照组。比较两组的院前转运时间、院内急救等待时间、送检时间、送手术室/住院部时间和病死率,分析评价常态化疫情防控期间一体化胸外伤救治新模式的急救效果。结果两组的院前转运时间比较,差异无统计学意义(P>0.05);观察组院内急救零等待,送检时间、送手术室/住院部时间均少于对照组,差异有统计学意义(P<0.05);观察组病死率(1.28%)低于对照组(4.94%),但比较差异无统计学意义(P>0.05)。结论胸外伤救治的时效性不受常态化疫情防控措施实施的影响,依托“互联网+”智慧医疗平台,采用一体化救治新模式处理胸外伤,健全新冠肺炎防控措施,可以简化抢救流程,降低新冠肺炎感染风险,提高胸外伤救治效率。

腔镜技术在胸腹部战创伤救治中的应用进展

胸腹部战创伤是一种严重威胁生命的伤情,传统的开放手术在救治中存在创伤大、恢复慢等问题。腔镜技术的引入为胸腹部战创伤救治带来了革命性的变化。文章主要就腔镜在胸腹部战创伤救治中的应用,包括技术优势、诊断和治疗作用、荧光镜和无线镜技术等腔镜技术的新发展、新应用、面临的挑战及未来展望等进行综述。

探讨急诊外科抢救胸腹部外伤致使延迟性脾破裂的临床效果

目的分析对胸腹部外伤导致延迟性脾破裂的患者进行急诊外科抢救的临床效果。方法回顾性选取枣庄市立医院于2021年2月—2023年2月收治的86例胸腹部外伤导致延迟性脾破裂患者的临床资料,通过治疗方式的不同分常规组和研究组,每组43例。常规组、研究组分别采用手术方式和非手术方式治疗。比较两组抢救结果,包括创伤严重度、治疗情况、疼痛程度、并发症、治疗有效率等。结果两组患者治疗总有效率、创伤严重度对比,差异无统计学意义(P均>0.05)。研究组输血量为(2.04±0.85)U,少于常规组,住院时间为(20.82±1.76)d,长于常规组,差异有统计学意义(t=8.745、20.370,P均<0.05)。研究组并发症发生率为0.00,低于常规组的9.30%,差异有统计学意义(χ^(2)=4.195,P=0.040)。研究组疼痛程度评分低于常规组,差异有统计学意义(t=7.819,P<0.05)。结论为胸腹部外伤导致延迟性脾破裂患者使用非手术方式进行治疗,可以减轻患者疼痛度,减少并发症,疗效显著。