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RESUMEN Introducción: Los traumas de tórax con lesiones vasculares asociadas, empeoran el pronóstico de los pacientes debido a la hemorragia. El 80 % de todos los traumas vasculares afectan las extremidades y el 30 % se localizan en los miembros superiores. Poder utilizar los propios tejidos del paciente para su reparación, es una alternativa de tratamiento viable, y en ocasiones la única posible. Objetivo: Presentar un paciente con trauma de tórax, con lesiones vasculares, en quien se utilizó la vena safena para restaurar el daño en la arteria axilar y la técnica de tractotomía, por hemotórax masivo con lesión del parénquima pulmonar. Caso clínico: Paciente masculino de 32 años, con herida causada por arma de fuego a nivel del hombro y hemitórax derecho, que ocasionó lesión de arteria axilar derecha y hemotórax masivo. Se realizó toracotomía con tractotomía a nivel del lóbulo superior derecho y ligadura de la arteria intercostal; y se exploró la región axilar derecha para reparar el daño vascular. Conclusiones: Para tratar el traumatismo torácico penetrante con lesión pulmonar sangrante, se debe realizar una tractotomía pulmonar y hemostasia, para evitar los hematomas intraparenquimatosos. Ante una lesión de arteria axilar irreparable, la vena safena es una alternativa viable para su restauración y lograr la vitalidad de la extremidad.
ABSTRACT Introduction: Chest traumas with associated vascular lesions worsen the prognosis of patients due to hemorrhage. 80 % of all vascular traumas affect the extremities and 30 % are located in the upper limbs. Being able to use the patient's own tissues for repair is a viable treatment alternative, and sometimes the only possible one. Objective: To present a patient with chest trauma with vascular lesions, where the saphenous vein was used to restore the damage in the axillary artery and the tractotomy technique for massive hemothorax with lesion of the lung parenchyma. Clinical case: 32-year-old male patient with a gunshot wound to the shoulder and right hemithorax, which caused injury to the right axillary artery and massive hemothorax. A thoracotomy with tractotomy was performed at the level of the right upper lobe and ligation of the intercostal artery; and the right axillary region was explored to repair vascular damage. Conclusions: To treat penetrating chest trauma with bleeding lung injury, a pulmonary tractotomy and hemostasis should be performed to avoid intraparenchymal hematomas. Faced with an irreparable axillary artery injury, the saphenous vein is a viable alternative for its restoration and to achieve the vitality of the limb.
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Introduction: Penetrating chest injuries may seriously damage the lungs, heart and other thoracic structures. Blunt injuries are most commonly deceleration injuries associated with motor vehicle crashes that result in falls or blows to the chest. Aim of study: To determine the magnitude and management of patients with chest trauma in a rural setup. Materials and methods: A study of 50 cases of chest trauma admitted in, Government Mohan Kumaramangalam Medical College Hospital, from 2013-2017. The data collected included the patient’s demographic profile; mode, type and severity of chest injuries, management scheme and outcome. Results: There were 62(79.5%) males and 38 (20.5%) females, giving a male to female ratio of 3.8:1. The age ranged between 5-67 years with a mean of 32.28 years. Blunt injuries constituted the remaining 30(38.46%) and were all as a result of road traffic accidents (RTA). All patients had chest radiographs from which the commonest lesions; simple rib fractures, hemopneumothorax, hemothorax, and pneumothorax were diagnosed. There were none with major vascular or esophageal injuries. The commonest extra-thoracic associated injuries were limb fractures and abdominal injuries Conclusion: The outcome of thoracic injuries will depend upon the health care provider’s knowledge of the physics of the event and the urgency of the diagnosis, as well as the ability to assess and manage all the variables involved. The proper approach to the patient can positively influence the quality of the assessment, the level of cooperation and the long term outcome of care.
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El hemoneumotórax espontáneo es una condición inusual, caracterizada por la acumulación de aire y sangre en la cavidad pleural, no precedida por trauma. La radiografía de tórax es la herramienta principal en el diagnóstico de esta entidad. Se presenta el caso de un hombre de 22 años con hemoneumotórax espontáneo. El paciente se recuperó sin complicaciones luego de la cirugía.
Spontaneous hemopneumothorax is an unusual condition, characterized by the accumulation of air and blood in the pleural cavity, not preceded by trauma. Chest radiography is the main tool in the diagnosis of this entity. We present, a case of a 22-year-old male with spontaneous hemopneumothorax. The patient recovered after surgery with no complications.
Subject(s)
Humans , Hemopneumothorax , Pneumothorax , Hemothorax , Hydropneumothorax , HydrothoraxABSTRACT
Bilateral pneumothorax is very rare in primary spontaneous pneumothorax patients. This condition can cause chest pain, dyspnea, and even lead to tension pneumothorax. Spontaneous hemopneumothorax can be lethal due to massive bleeding and hypovolemic shock. This condition requires precise decision making and emergency management. We report on a case of simultaneous bilateral spontaneous pneumothorax combined with hemopneumothorax in a healthy 21-year-old male patient with chest discomfort. In the emergency department, closed thoracostomy was performed for decompression of hemopneumothorax, with drainage of 850 mL of blood. Then bilateral video-assisted thoracoscopic surgery was performed successfully.
Subject(s)
Humans , Male , Young Adult , Chest Pain , Decision Making , Decompression , Drainage , Dyspnea , Emergencies , Emergency Service, Hospital , Hemopneumothorax , Hemorrhage , Pneumothorax , Shock , Thoracic Surgery, Video-Assisted , Thoracostomy , ThoraxABSTRACT
Objective idiopathic hemothorax .Methods 46 patients wifh idiopathic hemothorax To explore the treatment method of were first closed thoracic drainage catheter ,of which 12 patients underwent emergency explor-atory thoracotomy,with video-assisted thoracic surgery in 10 cases,non-surgical treatment of 24 cases.Results 46 patients were cured without complications ,were followed up 3 months to 5 years.without recurrence .Conclusion Idi-opathic hemothorax once diagnosed , treatment principles that should be placed closed thoracic drainage , and timely surgical treatment,especially video-assisted thoracic surgery ,patients can reduce the amount of blood transfusion ,ef-fective,less invasive,faster recovery,less bleeding,the patient easy to accept .
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Spontaneous hemo-pneumothorax, a hemothorax that occurs without trauma, is a very rare condition; however, as a result of excessive bleeding, it can be lethal. Also, if the bleeding is scanty, the physician might recognize hemothorax in case of performing invasive procedures, such as chest tube insertion, and may misunder stand as a complication of the procedure. For this reason, acknowledgement of the spontaneous hemo-pneumothorax in the emergency department is very important. We report on a case of a spontaneous hemo-pneumothorax in a healthy 18-year-old male presenting with chest pain who developed a spontaneous pneumothorax with a profuse amount of hemothorax.
Subject(s)
Humans , Male , Chest Pain , Chest Tubes , Emergencies , Hemorrhage , Hemothorax , PneumothoraxABSTRACT
Objective To investigate the therapeutic efficacy of Video-assisted thoracoscopic surgery (VATS)in treating hemopneumothorax. Methods 83 cases of hemopneumothorax treated with exploratory thoracotomy with the help of VATS were retrospectively analyzed. Results All the 83 cases were completed successfully by the VATS.22 cases were treated with bunamiody resection,42 eases were treated with lung repair operation,12 cases were treated with pleuropexy,5 cases were treated with albumingel injection,2 cases were treated with thoracotomy because of serious injury.All patients were followed up 1 year and were found in good condition. Conclusion VATS could treat bunamiody resection and lung repair operation,can stop the bleeding effectively, cause less injury,good therapeutic effect and quickly recovery.
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Objective To investigate the value of ultrasound diagnosing for hydropneumothorax. Methods In a prospective double-blind randomized concurrent controlled trial. 213 patients doubted pneumotborax were exam-ined with CT, senography and conventional radiography. Results In 213 cases, hydropneumothorax diagnosed in 30 hemithoraces of 30 patients by CT,29 hemitboraces by ultrasound and 22 hemithoraces by X-ray. The sensitivity, nega-tive predictive value,accuracy by ultrasound and X-ray were 96.7% vs 73.3% ,99.8% vs 98.0% ,99.8 vs 98.1% respectively(P<0.05), the specificity and positive predictive value of both ultrasound and X-ray were 100%. Ultra-sound surpassed the X-ray in detecting pneumothorax ( McNemar test P<0.025 ). Conclusion If ultrasound is served to detect pneumothorax, it can make up the defects of the methods commonly used cuxrently.
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Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.
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Although the papillary thyroid carcinoma generally follows an indolent course characterized by slow growth and abscence of distant metastasis, distant metastases to extrathyroid organ may occur in the lung, bone and brain in about 5% of patients. The lung metastases are usually diagnosed by plain X-ray, chest CT and 131I whole body scan. However, we present a case of papillary thyroid carcinoma with microscopic pulmonary metastasis that could not be detected by conventional method, such as chest X-ray, chest CT and 131I whole body scan. A 62-year-old female visited due to traumatic hemopneumothorax. In the pathology of resected tissues from lacerated lung parenchyme, metastatic papillary carcinoma was diagnosed without evidence of abnormality in radiologic examination and we diagnosed and treated an asymptomatic papillary thyroid carcinoma.