Contralateral hemopneumothorax after penetrating thoracic trauma:A case report

BACKGROUND Trauma is the leading cause of death in young adults up to the age of 45 years.Hemothorax is a frequent consequence of penetrating thoracic trauma,and is usually associated with pneumothorax and pneumoderma.Intercostal arterial bleeding or intrathoracic hemorrhage occurs after penetrating thoracic trauma,and uncontrolled bleeding is the main cause of death.CASE SUMMARY In this case report,a patient who developed a right hemopneumothorax after penetrating thoracic trauma was examined.A 19-year-old male patient,who was brought to the emergency room with a penetrating stab injury to the posterior of the left hemithorax,was diagnosed with a right hemopneumothorax after physical examination and thoracic imaging.Chest tube thoracostomy was performed as the initial intervention.Bleeding control was achieved with right posterolateral thoracotomy in the patient,who developed massive hemorrhage after 1 h and hemodynamic instability.The patient recovered and was discharged on the fourth postoperative day.CONCLUSION Contralateral hemopneumothorax that accounts for 30%of thoracic traumas and can be encountered in penetrating thoracic traumas requiring major surgery in 15-30%of cases was emphasized and the contralateral development mechanism was addressed.

Tracheal rupture developing after blunt thoracic trauma

Tracheal and bronchial injuries are life-threatening traumas that usually develop after traffic accidents or a fall from heights. The most common cause is motor vehicle accidents. Tracheobronchial injuries develop in 1%-2% of blunt thoracic traumas. The mortality rate is 30% in these patients and deaths usually occur within the first hours. Sixty five percent of surviving patients are diagnosed in later periods where complications are frequent. In conclusion, clinical evaluation and diagnostic tests should be performed immediately and carefully. In this study, a patient who developed tracheal rupture after blunt cervical and thoracic trauma was presented.

Study on the Significance of TLR-9 Expression in Rats with Acute Lung Injury Induced by Thoracic Trauma

Objective:To investigate the significance of toll receptor-9(TLR-9)expression in rats with acute lung injury(ALI)induced by thoracic trauma.Methods:Fifty healthy male SD rats were selected for the study,and 40 of them were randomly selected to establish the acute lung injury model induced by thoracic trauma,and 8 rats were randomly selected at 5,24,48 and 72 h after the impact,which were killed by cervical dislocation after arterial bleeding,and the lung tissue sections were made.Randomly select 8 rats from the remaining 10 rats as the control group,take blood and kill them to make lung tissue sections for reference.The lung dry/wet weight ratio(W/D)of the five groups were compared,and the levels of TLR-9 in bronchoalveolar lavage fluid(BALF)and serum,and the levels of TLR-9 mR NA,IL-6 mR NA,TLR-9 protein and IL-6protein in lung tissue were detected.Results:There was no significant difference in W/D levels among the control group,experimental group 1 and experimental group 4(P>0.05),while the W/D level of experimental group 3 was higher than that of the other four groups,and the W/D level of experimental group 2 was higher than that of the control group(P<0.05).The levels of ILR-9 in serum and BALF of rats in experimental group 1,experimental group 2 and experimental group 4 had no significant difference(P>0.05),which were higher than those in control group and lower than those in experimental group 3(P<0.05).The levels of TLR-9 mR NA,IL-6 mR NA,TLR-9 protein and IL-6 protein were the highest in the experimental group 3,and the lowest in the control group(P<0.05).The levels of TLR-9 mR NA and IL-6 mR NA in lung tissue of rats in experimental group 1,experimental group 2 and experimental group 4 had no significant difference(P>0.05).There was no significant difference in the levels of TLR-9 protein and IL-6 protein between experimental group 2 and experimental group 4(P>0.05),which were higher than those in experimental group 1(P<0.05).Conclusion:The expression level of TLR-9 is significantly increased in rats after thoracic trauma,and the expression of TLR-9 can reflect the degree of lung injury in rats after trauma to a certain extent,which is inferred to be related to the inflammatory response after lung injury.

Diagnosis and treatment of bronchial rupture from blunt thoracic trauma

Objective To evaluate the diagnosis and management of bronchial rupture from blunt thoracic trauma. Methods A group of 31 patients with bronchial rupture was involved. Chest roentgenography, tornography and bronchoscopy were performed on all patients. The surgical technique and complications were described.Results Diagnosis was confirmed by tomography and bronchoscopy in all the patients. End to end anastomosis was used in 26 patients. Four patients were operated with total pneurnonectomy. One patient was repaired with an intercostal muscle and rib flap with blood supply. Of the 31 patients, one died of adult respiratory distress syndrome after operation. Most patients had excellent surgical outcomes. 81％ (25/31)of the bronchial rupture were delayed in diagnosis and treatment. The classic symptoms and signs of bronchial rupture included subcutaneous emphysema, dyspnea and an intermediate coma interval. The roentgenogram showed mediastinal emphysema, pneumothorax, “drop lung” sign and marked radiodensity of hilum widened mediastinum.Conclusion Bronchoscopy is a useful and accurate method to diagnose and treat the bronchial rupture, with which surgeons can easily locate the rupture site during surgery. Surgical treatment could restore pulmonary function in most patients.

Video-assisted thoracoscopic surgery for penetrating thoracic trauma

Purpose： For penetrating thoracic trauma, there is no consensus on whether operative exploration or conservative treatment is better. In this study, we compared the clinical effect of video-assisted thoracoscopic surgery （VATS） and thoracotomy on the patients with penetrating thoracic trauma. Methods： From January 2000 to December 2010, 123 patients with penetrating thoracic trauma were treated in Affiliated Hospital of Chengdu University. Based on the inclusion criteria, 80 patients were enrolled and randomly assigned into VATS and thoracotomy group. Results： The operation time, amount of bleeding and drainage in VATS group were all lower than traditional operation （p 〈 0.05）. Conclusion： The results indicate that VATS has the merits of shorter operation time, non-blind area, exact surgical path and less bleeding comparing with traditional operation.

Secondary Spontaneous Rupture of the Diaphragm in a Child after Blunt Chest Trauma

Traumatic diaphragmatic rupture (TDR) is very rare in the pediatric age group. Because of its rarity and its coexistence with more injuries, the diagnosis is often delayed. Very little has been written about this condition in the pediatric age group. TDR, while uncommon, should be considered in cases of blunt thoracic trauma. All patients should undergo meticulous examination preoperatively. The clinical presentation and importance of making an accurate diagnosis and surgery is highlighted. We report a case of secondary spontaneous traumatic left-sided diaphragmatic rupture in a child that was managed by delayed surgical repair.

Trauma-induced“Macklin effect”with pneumothorax and large pneumomediastinum,disguised by allergy

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs(NSAIDS).The triage nurse assigned the patient to Accident&Emergency(A&E)doctor as probable allergic reaction to NSAIDS.Chest X-ray(CXR),ordered after 24 hours,revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax.Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum.The patient was conservatively treated since he was eupnoeic and hemodynamically stable.The pathophysiology of pneumomediastinum was first described by Macklin in 1939.The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum.In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.