Cases reported "Thoracic Injuries"

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1/9. Chronic traumatic pseudoaneurysm of the ascending aorta causing right ventricular inflow obstruction.

    A 28-year-old man developed exertional dyspnea and peripheral edema 1 year after the initial blunt trauma to the chest. The diagnosis of pseudoaneurysm (PSA) of the ascending aorta was made based on the echocardiographic finding of a large echo-free space that communicated with the ascending aorta through the defect in the ascending aortic wall. The PSA caused a right ventricular inflow obstruction with increased diastolic transtricuspid blood flow velocity up to 2.7 m/s. Following the excision of the PSA and repair of the communication between it and the ascending aorta, the sizes of the right atrium and right ventricle, and the diastolic transtricuspid blood flow velocity, normalized.
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2/9. Penetrating injury of the chest and coronary arteriovenous fistula.

    An unusual case of coronary artery fistula, due to a stab wound in the chest in a 17-year-old male patient, with a resultant acute inferior myocardial infarction is presented. At surgery, complete transection of the right coronary artery was found, which formed a fistulous communication with both the right atrium and the right ventricle. The development of a continuous murmur in the period immediately after the injury, the absence of hemopericardium, and multiple cardiac-chamber involvements were unique features of the case. The inferior myocardial wall was akinetic due to infarction and did not improve following revascularization surgery. A brief review of the literature is also presented.
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3/9. Chronic posttraumatic aneurysm of descending aorta with fistulous communication into pulmonary artery.

    We report an unusual case of presumed posttraumatic chronic proximal descending aneurysm associated with a fistula into the pulmonary artery. review of the literature showed that a fistula of the descending aorta into the pulmonary artery is uncommon and that only a few patients have survived. This rare entity is best treated with open repair; however, in patients at high risk an endovascular stent graft is an option.
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4/9. Post-traumatic thoracic arteriovenous fistulas.

    Post-traumatic arteriovenous fistulas (AVF) between vascular structures in the thorax rarely occur. We present an unusual case of the delayed diagnosis of two post-traumatic thoracic AVF in a 70-year-old male. He had abnormal communications between an intercostal artery and an intercostal vein as well as an intercostal artery and a pulmonary vein. He has remained asymptomatic and has not developed a complication from these abnormal vascular structures in a three-year follow up.
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5/9. Blunt traumatic rupture of the thoracic oesophagus.

    A man with a crush injury of his upper abdomen developed bilateral pulmonary empyema after repair of tears of the oesophagus and liver. Attempts to withdraw chest drains led to recurrent septicaemia, treated by reinsertion of the drains plus administration of antibiotics. The communication of the empyema space with both the bronchial tree and the oesophagus was managed successfully with intermittent positive pressure ventilation and with a double lumen endobronchial tube isolating the right lung for 10 days. Traumatic rupture of the thoracic oesophagus carries a high mortality and prompt repair is vital.
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6/9. Hemiazygous continuation of a left inferior vena cava: misleading radiographic findings in chest trauma.

    A widened mediastinum was found on chest radiography following blunt chest trauma. aortography alone could not adequately determine the etiology of the radiographic findings; on computed tomography (CT) benign mediastinal widening was confirmed owing to accessory hemiazygous continuation of a left inferior vena cava (IVC), with communication to the left brachiocephalic vein through an enlarged left superior (highest) intercostal vein. This unusual anatomic variant and its radiographic findings are reviewed, as well as the complementary role of CT in the evaluation of the traumatized thoracic aorta and mediastinum.
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7/9. Right sinus of valsalva-right atrial fistula secondary to nonpenetrating chest trauma: a case report with description of noninvasive diagnostic features.

    A sinus of valsalva-right atrial fistula secondary to nonpenetrating chest trauma is described. Echocardiogrpahy demonstrated diastolic fluttering of the anterior tricuspid valve, suggesting a left-to-right shunt at the level of the right atrium. External jugular venous pulse tracings revealed large alpha waves and attenuation of the y descent. cardiac catheterization disclosed a fistulous communication between the right sinus of valsalva and right atrium. After surgical repair of the fistula, the ultrasonic recording and external pulse tracing reverted to normal. We believe this is the first description of such a shunt after blunt thoracic trauma.
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8/9. Acquired left ventricular to right atrial communication and complete heart block following nonpenetrating cardiac trauma.

    Intracardiac shunts are uncommon cardiac lesions caused by blunt chest trauma. A very unusual case is reported of a young male with an acquired left ventricular to right atrial communication and complete heart block cause by nonpenetrating chest trauma. The left ventricular to right atrial fistula was diagnosed noninvasively by transthoracic and transesophageal echo-Doppler examination and the findings were confirmed by left ventriculography and by the intraoperative findings.
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9/9. Posttraumatic left ventricular pseudoaneurysm due to intramyocardial dissecting hematoma.

    A left ventricular aneurysm can develop in patients sustaining blunt chest injury. This condition has been attributed to myocardial contusion or to a direct vascular lesion leading to myocardial necrosis. We report the case of a pseudoaneurysm resulting from myocardial dissection beginning from a small tear in the endocardial wall. Successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure of the communications between the aneurysm and the left ventricular cavity is described.
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