ABSTRACT
Background: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries. Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward. Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission. Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients.
ABSTRACT
Intercostal artery pseudoaneurysm (IAP) is a rare entity and may complicate a percutaneous intervention through an intercostal space or follow thoracic trauma. Its rupture into the pleural space can give rise to haemothorax, which if untreated may lead to a retained haemothorax (RH). Traditionally both the IAP and the RH are managed by a thoracotomy. We report a patient who developed an IAP with haemothorax following a trauma. The diagnosis was established by computed tomography. The patient was treated by endovascular embolisation of the IAP followed by thoracoscopic decortications of the RH.
Subject(s)
Aneurysm, False/etiology , Aneurysm, False/diagnostic imaging , Aneurysm, False/therapy , Diabetes Complications , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Follow-Up Studies , Hemothorax/etiology , Hemothorax/diagnostic imaging , Hemothorax/surgery , Humans , Hypertension/complications , Intercostal Muscles/blood supply , Male , Middle Aged , Risk Factors , Thoracic Injuries/complications , Thoracic Injuries/etiology , Thoracoscopy , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Stab/complicationsABSTRACT
Penetrating thoracic injuries frequently presents a challenge to the clinicians. The situation may become more deleterious owing to the unavailability of adequate blood of required group. We discuss the acute management of a patient with life threatening traumatic haemothorax following penetrating thoracic injury. In this patient, autologous transfusion of patient blood collected in chest drain was performed during intraoperative period using an indigenous technique with successful outcome.
ABSTRACT
We report a case of open fracture of the clavicle with subclavian artery and vein laceration and perforation of the parietal pleural below the first rib that caused massive haemothorax. Emergency thoracotomy and exploration followed by repair of both vessels were able to salvage the patient and the extremity.