Transmediastinal gunshot wound in a pregnant patient with stable hemodynamics

Abstract Transmediastinal gunshot wounds (TGWs) may lead to life-threatening injuries of vital organs such as large vessels, the esophagus, and lungs. Although they are not commonly encountered in pregnant women, additional caution should be given to these patients. Physical examination for the diagnosis and the choice of treatment modality contain controversial points in hemodynamically stable patients, and resuscitation has excessive importance due to physiological changes in pregnancy. We present a hemodynamically stable 26-week pregnant woman brought to the emergency department for TGW. She had a 1-cm diameter of bullet entrance hole on the right anterior 4th intercostal space, 2 cm lateral to the sternum, and a 3-cm diameter exit hole on the right posterior 12th intercostal space on the midscapular line.With our conservative approach, she had an uncomplicated pregnancy period, and gave birth to a healthy baby at term.

A rare case of left sided trans-mediastinal herniation of right lung, its management and review of literature

Mediastinal herniation can occur either due to traction as in the case of lung shrinkage in tuberculosis and chronic bronchostenosis or pulsion as a result of hydropneumothorax, empyema necessitans, and chronic infective etiology. We are reporting a case of left sided trans-mediastinal herniation of right lung in a patient with underlying right pulmonary tuberculosis, presenting with empyema thoracis. Empyema thoracis in pulmonary tuberculosis may either be a cause of trans-mediastinal herniation of lung or be a co-existent condition when the herniation occurs due to hydropneumothorax. Due to the presence of infection in pleural space, a prosthesis cannot be used. Due to the proximity of hernia sac to heart and major vessels, its plication is better avoided. Hence, treatment of such a case can be done by applying negative pressure for a few post-operative days till the dead space has been obliterated. Trans-mediastinal herniation of lung with underlying empyema thoracis requiring decortication can be successfully treated with the application of intermittent strong negative pressure (after completing decortication) in the pleaural cavity near mediastinum to gradually deliver the herniated lung to its normal position followed by application of negative pressure in the post op period  through one of the ICDTs (intercostal drainage tubes) to avoid unnecessary post-operative complications or reherniation.