Penetrating Thoracic Trauma with Undetected Left Ventricular Injury Presenting as Sudden Hypotension during Surgery / 日本心臓血管外科学会雑誌

A 55-year-old man was brought to our hospital with a knife penetrating his left anterior chest wall following a suicide attempt. Massive left hemothorax was identified on echocardiography ; however, there was no evidence of cardiac tamponade. After draining blood from the left thorax, computed tomography (CT) revealed that the tip of the knife had penetrated the left lung and reached the left pulmonary vein. In preparation for cardiopulmonary bypass, an emergency thoracotomy was scheduled with a plan to access the left lung and left pulmonary vein. The patient was transferred to the operating room, and the procedure was started with the patient in the supine position. During dissection of the femoral vessels, the patient suddenly developed hypotension. After surgical access to the heart was achieved via median sternotomy, a pericardiotomy was performed and cardiopulmonary bypass was established. A 50-mm stab wound was identified at the lateral wall of the left ventricle. The knife was removed, and the left ventricular wound was repaired. The lingular segment of the left lung was partially resected. The patient had no postoperative complications and was transferred to the referral hospital on postoperative day 25. This case report emphasizes the importance of taking appropriate measures for thoracotomy and cardiopulmonary bypass in patients with penetrating thoracic trauma with massive hemothorax, even in the absence of cardiac tamponade on imaging. We were able to successfully manage a life-threatening condition by taking appropriate measures.

Alexander the Great's Life-Threatening Thoracic Trauma

Alexander the Great was a world-class leader with tremendous courage. He paid no heed to the dangers of the battlefield, so he was always in the front lines. However, his excessive courage put his life in danger. Herein, we present an analysis of the information contained in the chronicles about a very severe, life-threatening thoracic trauma that nearly killed the great stratelates. The detailed descriptions made by Arrianus allow us to conclude that Alexander the Great experienced a nearly fatal case of tension pneumothorax. Information on how he was managed is also presented.

Pneumopericárdio após traumatismo penetrante: relato de três casos / Pneumopericardium after penetrating trauma: report of three cases

Pneumopericardium after penetrating wound represents a high suspicion for cardiac wound. Some authors recommend thoracotomy to discharge a cardiac lesion. We present three cases of post-traumatic pneumopericardium one following a gunshot wound and two following a stab wound and discuss about diagnosis and treatment. None showed clinical signs of cardiac tamponade. Diagnosis was made by chest x-ray. Pneumopericardium was identified at the initial evaluation in two patients, who had concomitant hemothorax and underwent chest drainage. The patient with penetrating thoracic wound by gunshot pneumopericardium developed 24h after trauma. Treatment was directed to the associated lesions without specific measurements for pneumopericardium. This aproach was safe in these patients.