Vias de acesso aos grandes vasos mediastinais no trauma torácico / Surgical accesses to the major mediastinal vessels in thoracic trauma

O traumatismo é a causa mais comum de mortes na população economicamente ativa e o trauma torácico é responsável direta ou indiretamente em um quarto destas mortes, aos quais as lesões de grandes vasos torácicos relacionam-se às mortes imediatas ou precoces no ambiente hospitalar. Dentro dos doentes que chegam vivos, pode-se dividi-los em estáveis ou instáveis, a via de acesso para a abordagem destes vasos irá depender desta situação, bem como de suas particularidades anatômicas, o que poderá implicar em incisões combinadas para uma adequada exposição. Neste artigo serão revisadas e discutidas as lesões destas estruturas e as vias acesso às mesmas.

Trauma is the most common cause of death in the economically active population and thoracic trauma is directly or indirectly responsible for one quarter of these deaths. Lesions to the large thoracic vessels are associated with immediate or early death in the hospital setting. Patients admitted alive can be classified as stable or unstable. The access route to be elected for management of these veins will depend on this status, as well as on the anatomical particularities of the patient, which may require combined incisions for adequate access. This article provides a review and discussion of lesions to these structures as well as access routes to them.

Management of penetrating superior caval vein injury

Penetrating injuries to the superior caval vein [SCV] are rare but are very serious. They can be associated with hemodynamic instability and often produce a substantial technical challenge to the surgeons. We report a case of 32-year old man who was admitted to our hospital having sustained multiple stab wounds over the right chest wall and extremities. Many victims of penetrating thoracic trauma with SCV injury are in profound shock, whereas our patient on arrival in the emergency department had a stable condition, so the diagnosis was delayed. We consider that associated mediastinal pleural adhesions confined the bleeding into the mediastinum which prevented prompt massive bleeding. Therefore he tolerated a preoperative delay of six hours. Caval injury should be kept in mind in the differential diagnosis of hemothorax

Variaciones de las comunicaciones linfático-venosas en la fosa supraclavicular izquierda del hombre / Variations of the lymphatic-venous communications in the human left supraclavicular fossa

Considerando la importancia clínica y quirúrgica de las comunicaciones linfático-venosas, poco descritas en la región cervical, presentamos y analizamos variaciones de estas comunicaciones, las que fueron observadas después de la disección de la fosa supraclavicular izquierda de 34 cadáveres en la Disciplina de Anatomía Descriptiva y Topográfica de la Universidade Federal de Sao Paulo-Escola Paulista de Medicina, Brasil. Encontramos dos casos (5,9 por ciento) de vasos linfáticos que desembocaban en la vena subclavia izquierda, próximo del ángulo yúgulo-subclavio. En ambos casos, estaba presente el conducto torácico desembocando en el lugar habitual. Los estudios anatómicos de estas variaciones son importantes, ya que su conocimiento ayuda a evitar secuelas después de la realización de procedimientos quirúrgicos en la región cervical permitiendo, además, aportar detalles sobre las vías linfáticas de esa región