Chylothorax after Blunt Chest Trauma: A Case Report

Traumatic chylothorax after blunt chest trauma alone is considered rare. Our patient was a 27-year-old female who was in a motorcycle accident and sustained blunt thoracic and traumatic thoracic aortic injuries with T1–T2 vertebral subluxation. She underwent thoracic endovascular aortic repair from T4 to T9 without any thoracic or spinal surgery. On postoperative day 7, the drainage from her left chest turned into a milky-white fluid indicative of chyle leakage. The patient was treated conservatively for 2 weeks and then the chest drain was safely removed. The results show that traumatic chylothorax can be successfully managed with conservative treatment.

Chylothorax after Blunt Chest Trauma: A Case Report

Traumatic chylothorax after blunt chest trauma alone is considered rare. Our patient was a 27-year-old female who was in a motorcycle accident and sustained blunt thoracic and traumatic thoracic aortic injuries with T1–T2 vertebral subluxation. She underwent thoracic endovascular aortic repair from T4 to T9 without any thoracic or spinal surgery. On postoperative day 7, the drainage from her left chest turned into a milky-white fluid indicative of chyle leakage. The patient was treated conservatively for 2 weeks and then the chest drain was safely removed. The results show that traumatic chylothorax can be successfully managed with conservative treatment.

Pattern of Chest Injuries in a Tertiary Care Centre in Western U.P.

Background: Chest trauma is a leading cause of morbidity and mortality among all age groups.. This retrospective study has been undertaken to analyse the pattern of chest injuries among patients admitted in a tertiary care centre. Methods: All the in-patient records of patients, admitted with abdominal injuries in the emergency department of the Teerthankar Mahaveer Medical College & Research Centre, located in Moradabad (U.P.). Results: There were total 139 cases of chest injuries, during the study period. 84 victims were in 2nd to 4th decades of life, 18 in 5th decade, 8 in 1st decade and the remaining 19 patients were in either extremes of age groups. The male to female ratio was 2.4:1. There were 111 cases of blunt chest injuries and 28 cases of penetrating injuries. Most common X ray findings were haemothorax, seen in 94 cases followed by pneumothorax in 59 cases and multiple rib fractures in 50 cases. Blunt injuries were caused due to accidents in 102 cases and homicides in 9 cases. Penetrating injuries were caused due to accidents in 15 cases and homicides in 13. The mortality rate was 6.4%. Conclusion: Chest Injuries were more common among males than females.

Análisis comprensivo de los traumatismos torácios penetrantes atendidos en Hospital Padre Hurtado de Santiago / Penetrating chest trauma

Objectives: Penetrating chest trauma (PCT) is a life threatening condition that challenges emergency surgeons daily. The aim of this study is to make an epidemiological characterization of these patients, and secondarily analyze their treatment and outcome. Methods: A retrospective analysis of a series of consecutive patients experiencing PCT who presented at our hospital, was performed from 1st May 2009 to 30th April 2013. Results: Of 274 consecutive patients who presented to the emergency department (ED) with PCT, 257 (94 percent) were male and 17 (6 percent) were female. The median age was 26 (range 15-66) years. Stab wounds (SW) accounted for 185 (68 percent) of the injuries, and 80 (29 percent) suffered from gunshot wounds (GSW). As first treatment, chest tube drainage was performed in 229 (84 percent) patients, emergent thoracotomy in 21 (8 percent) and observation, in 13 (5 percent). 26 (9 percent) patients died: 21 (81 percent) from GSW and 4 (15 percent) with SW P<0.0001; 20 (77 percent) had heart or thoracic great vessels involvement. Thoracic complications occurred in 30 (12 percent) patients. There was no mortality associated with thoracic complications. The median hospital stay was 4 days. Conclusions: PCT is frequent in our hospital compared with historical series. The majority of the patients who died had cardiac or thoracic great vessels involvement due to GSW. Therefore, healthcare improvements are needed to reduce mortality in this group of patients.

Objetivos: Los traumatismos torácicos penetrantes (TTP) son graves y desafían diariamente a los cirujanos de urgencia. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con TTP, y como objetivo secundario analizar el tratamiento efectuado y su evolución. Métodos: Se realizó un estudio retrospectivo de los pacientes atendidos en el Hospital Padre Hurtado de Santiago que presentaron un TTP desde el 1 de mayo de 2009 hasta el 30 de abril de 2013. Resultados: 274 pacientes que se consultaron al servicio de urgencia con un TTP, 257 (94 por ciento) eran hombres y 17 (6 por ciento) eran mujeres. La mediana de edad fue 26 (15-66) años. Lesiones por arma blanca 185 (68 por ciento), y 80 (29 por ciento) fueron por arma de fuego. Como primer tratamiento la pleurostomía fue realizada en 229 (84 por ciento) pacientes. La toracotomía de emergencia fue realizada en 21 (8 por ciento) pacientes. No se realizó tratamiento y solo observación en 13 (5 por ciento) de los casos. 26 (9 por ciento) de los pacientes murieron, 21 (81 por ciento) fueron consecuencia de lesiones por arma de fuego y 4 (15 por ciento) por arma blanca P<0,0001, 20 (77 por ciento) tenían lesiones cardíacas o de grandes vasos torácicos. 30 (12 por ciento) pacientes presentaron complicaciones torácicas. No hubo mortalidad asociada a complicaciones torácicas. La mediana de días de hospitalización fue 4. Conclusiones: El TTP es frecuente en nuestro hospital comparado con series históricas. La mayoría de los pacientes fallecidos presentaban TTP por arma de fuego con lesiones cardíacas o de grandes vasos torácicos. Se precisan mejoras asistenciales en este grupo para disminuir su mortalidad.

Cardiac Tamponade from Chest Trauma During Snowboarding

As snowboarding has become one of the most popular winter sports, lots of young people enjoy it and they have become the center of this winter sports. However, this increased number of snowboarding lovers results in raising the number of injuries. In the case of severe chest injury caused by snowboarding can be a source of a serious injury such as cardiac tamponade. The development of cardiac tamponade is an acute, life-threatening emergency. To test a cardiac tamponade, a patient with chest trauma should be diagnosed from the information given by a physical examination and simple chest radiography. If the heart is doubted to be wounded, an emergency echocardiography has to be executed. An emergency treatment for the cardiac tamponade patient is to normal saline infusion quickly to augment the capacity of a blood vessel. Extremely, surgeries such as pericardiocentesis or pericardiotomy can be applied to ease the pressure inside the heart. Some patients with chest blunt trauma while snowboarding developed cardiac tamponade and they were successfully recovered through pericardiocentesis. This precedent is reported here with the consideration of the references.

The management of chest injuries

In the over all management of chest injuries we may divide treatment into the first aid procedures and those that are definitive. First aid or early treatment procedures must be done immediately and they can be performed by the general practitioner. A good understanding of the anatomical relationships and cardiorespiratory physiology is of course necessary. Early treatment on first aid basis will include closure of an open pneumothorax or sucking wound, treatment of shock, correct respiratory obstruction, relief of tension penumothorax by thoracentesis, immobilization of a crushed chest, control of pain, and transfer of the patient to a hospital with adequate facilitiesDefinitive treatment requires the services of a competent surgeon and an adequate hospital. After a thorough evaluation of the case thoracotomy may be done to control intractable bleeding, to correct fractures or wounds of the traches or bronchus and esophagus, to explore thge thoraco-abdominal injuries, to correct cardiac tamponade and to perform cardiorrhaphy, and to repair vascular injuries such as false aneurysmMost chest injuries can be managed with conservative treatment. They respond fairly well when there is restoration of the normal physiology and anatomical relationship as early as possibleThe indications for highly surgical precedures are rather well dilineated and when it is determined that they are necessary they must be utilized without delay.(Summary)