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’...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.展开更多
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 ...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.展开更多
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 t...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.展开更多
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 managemen...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.展开更多
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 ...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.展开更多
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...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展开更多
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 dissecti...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.展开更多
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 deter...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.展开更多
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 b...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.展开更多
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 r...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.展开更多
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 manifesta...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.展开更多
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 t...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.展开更多
Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its...Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.展开更多
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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
文摘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.
文摘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.
文摘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.
文摘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.
基金The 13th Five-Year Key Project for Traditional Chinese Medicine of Zhejiang Province,No.2A11951.
文摘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.
文摘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.
文摘Physical traumas are tragic and multifaceted injuries that suddenly threaten life.Although it is the third most common cause of death in all age groups,one out of four trauma patients die due to thoracic injury or its complications.Blunt injuries constitute the majority of chest trauma.This indicates the im porta nee of chest trauma among all traumas.Blunt chest trauma is usually caused by motor vehicle accident,falling from height,blunt instrument injury and physical assault.As a result of chest trauma,many injuries may occur,such as pulm onary injuries,and these require urge nt in terve ntion.Chest wall and pulmonary injuries range from rib fractures to flail chest,pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries.Following these injuries,patients may present with a simple dyspnea or even respiratory arrest.For such patie nt,it is imports nt to understa nd the treatme nt logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries.This is because only 10%of thoracic trauma patients require surgical operation and the remaining 90%can be treated with simple methods such as appropriate airway,oxygen support,maneuvers,volume support and tube thoracostomy.Adequate pain control in chest trauma is sometimes the most basic and best treatment.With definite diagnosis,the morbidity and mortality can be significantly reduced by simple treatment methods.
