1/866. pulmonary artery bullet injury following thoracic gunshot wound. Thoracic trauma occurs frequently but seldom requires surgery (10-20%, [1]). The mortality rate for gunshot wound of the chest varies from 14.3 to 36.8% [2]. We report, herein an example of bullet injury to the pulmonary artery (PA) following a thoracic gunshot wound. This patient had previous history of coronary surgery. Absolute and relative indications for exploratory thoracotomy in emergency will be reviewed. ( info) |
| myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac pain is commonly attributed to contused myocardium or the traumatic injuries in the local chest wall. There are only scattered reports on the coronary pathology associated with MI secondary to blunt chest trauma. Because differentiation of the pathology is difficult but important, we report here three cases of acute anterior MI secondary to coronary dissection following blunt chest trauma. Coronary dissection was demonstrated by coronary angiography. Two of the patients had intimal tears at the proximal left anterior descending artery (LAD) with normal flow, and the other patient had nearly total occlusion of the LAD associated with filling defects probably caused by an intracoronary thrombus. All three patients received conservative treatment without major complications and remained free from angina or heart failure throughout a 5-year follow-up period. In order to exclude associated MI in cases of blunt chest trauma, electrocardiography is necessary, and coronary angiography may be indicated to demonstrate coronary arterial pathology. dissection of the coronary artery with subsequent thrombus formation is one of the possible pathophysiologic mechanisms of MI following blunt chest trauma. ( info) |
3/866. Surgical treatment of traumatic aneurysm of the ascending aorta. Traumatic aneurysm of the ascending aorta is a rare event. This case describes a patient with such an aneurysm, resulting from injuries received in a motorcycle accident. The patient was admitted to the emergency room of a local hospital complaining of chest pain, and was subsequently referred to our institution. On admission, a chest x-ray showed mediastinal widening. Computed tomography and aortography revealed an ascending aortic aneurysm and contusion of the upper lobe of the right lung. Due to concerns about bleeding from the lung contusion, surgery was delayed for one week. During surgery, intimal tears were detected at two sites in the ascending aorta. The wall of the ascending aorta was subsequently resected and a prosthetic graft inserted. The postoperative period was uneventful and a postoperative aortogram showed that the graft had molded well. ( info) |
4/866. Aorto--bronchial fistula resulting from an accidental fall one year earlier. A 75-year-old woman presented with massive haemoptysis 12 months after tripping over her shopping trolley. CT scanning and transoesophageal echocardiography demonstrated a traumatic false aneurysm which was confirmed at surgery to be partially ruptured. Aortobronchial fistula is an unusual cause of massive haemoptysis. It should be considered particularly in patients known to have abnormalities of the thoracic aorta. ( info) |
5/866. Aortobronchial fistula after coarctation repair and blunt chest trauma. A 34-year-old man had development of an aortobronchial fistula 17 years after patch aortoplasty for correction of aortic coarctation and 5 years after blunt chest trauma, an unusual combination of predisposing factors. The clinical presentation, characterized by dysphonia and recurrent hemoptysis, and the surgical findings suggested the posttraumatic origin of the fistula, which was successfully managed by aortic resection and graft interposition under simple aortic cross-clamping, associated with partial pulmonary lobectomy. When hemoptysis occurs in a patient with a history of an aortic thoracic procedure, the presence of an aortobronchial fistula should be suspected. early diagnosis offers the only possibility of recovery through a lifesaving surgical procedure. ( info) |
6/866. Perforation of the intrathoracic esophagus from blunt trauma in a child: case report and review of the literature. rupture of the intrathoracic esophagus from blunt trauma is an exceedingly rare injury in children and often presents on a delayed basis. The authors encountered a case of this unusual injury and review six additional cases found in the literature. ( info) |
7/866. Isolated fracture of the ventricular septum after blunt chest trauma. Isolated rupture of of the ventricular septum after blunt chest trauma is a very rare traumatic affection. A 21-year-old man was admitted to our hospital because of blunt chest trauma and a forearm fracture. Initial echocardiography did not show any intracardiac or extracardiac pathologic lesions, but 12 hours later this examination was repeated because of the onset of a holosystolic murmur. An unusual traumatic rupture of the ventricular septum was demonstrated. The hemodynamically stable condition of the patient allowed surgical repair to be performed 3 months later. ( info) |
8/866. The abdominal compartment syndrome: a report of 3 cases including instance of endocrine induction. Three patients with the abdominal compartment syndrome are presented and discussed. In one of the patients the condition was induced in an endocrine fashion, since trauma was sustained exclusively by the middle third of the left leg. The development of the syndrome as a remote effect of local trauma has never been reported previously. In all three instances only insignificant amounts of intraperitoneal fluid was found and the increase in abdominal pressure was due to severe edema of the mesentery and retroperitoneum. Since the condition is highly lethal, early diagnosis is imperative, and this starts by carrying a high index of suspicion. Measurement of the intraperitoneal pressure easily confirms this diagnosis. It is emphasized that measurements at various sites, like bladder and stomach, in each patient is essential to confirm the diagnosis, since one of the sites may be rendered unreliable due to intraperitoneal processes impinging on the affected site and affecting its distensibility. ( info) |
9/866. On scene thoracotomy: a case report. We report a case of on scene resuscitative thoracotomy performed by an anaesthetist on a patient in cardiac arrest following a stab wound to the chest. The patient made a good recovery and was discharged from hospital within 2 weeks. The rationale for performing resuscitative thoracotomy and who should perform this procedure are discussed. ( info) |
10/866. Blunt trauma-induced bilateral chylothorax. This report describes the case of a man who presented in a delayed manner after blunt trauma with bilateral chylothoraces, a rare result of trauma. He presented with shortness of breath and chest pain. A diagnostic workup resulted in the determination of traumatic chylothorax. His course in the hospital identified a disruption at a level of the 5th thoracic vertebra. No surgical ligation was required because his leak spontaneously sealed after conservative measures. The anatomy, physiology, mechanisms, and management of this injury are discussed. ( info) |