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
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
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
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
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.
