Papel de la ecografía en la sala de emergencia en el diagnóstico del trauma de tórax / The Role of Sonography in the Emergency Room for the Diagnosis of Thoracic Trauma

Introducción: Dentro de la atención al lesionado con trauma torácico se cuenta con varios medios diagnósticos, entre ellos la evaluación por ecografía focalizada en trauma extendido a tórax, el cual ha mostrado una alta sensibilidad, aun realizado por médicos no radiólogos como cirujanos generales, emergencistas e intensivistas. Objetivo: Determinar la utilidad de la ecografía torácica extendida realizada por cirujanos en lesionados con traumatismo torácico. Métodos: Se realizó un estudio observacional, descriptivo de evaluación de pruebas diagnósticas con un diseño transversal, en 1052 pacientes ingresados en la sala de emergencia. Se les realizó la evaluación por ecografía torácica extendida en el Hospital Universitario "General Calixto García", durante el período comprendido entre enero de 2020 y febrero de 2021. Resultados: Fueron realizados en un periodo de 1 año un total de 1052 ultrasonidos torácicos, 221 casos fueron positivos, de ellos 81 neumotórax (7,7 por ciento) y 62 hemoneumotórax (5,9 por ciento) todos confirmados por tomografía de tórax. La edad promedio fue de 45,27 (18-97), el sexo masculino prevaleció con 772 casos (73,4 por ciento). Los mecanismos productores de trauma más frecuentes fueron: caída de altura 273 casos (26 por ciento) y trauma contuso 181 casos (17,2 por ciento). La ecografía torácica extendida obtuvo una sensibilidad de un 95,24 por ciento y una especificidad de 99,88 por ciento en el diagnóstico lesiones torácicas. Conclusiones: La ecografía torácica extendida demostró que en manos de los cirujanos generales es una herramienta confiable, segura, no invasiva, poco costosa, repetible, que permite diagnosticar rápidamente lesiones torácicas y tratarlas(AU)

Introduction: Within care for the injured patient with thoracic trauma there are several diagnostic means. For example, extended focused assessment with sonography for thoracic trauma has shown high sensitivity, even when performed by non-radiologists such as general surgeons, emergency specialists and intensivists. Objective: To determine the usefulness of extended thoracic sonography performed by surgeons on injured patients with thoracic trauma. Methods: An observational, descriptive and cross-sectional study of diagnostic tests assessment was carried out in 1052 patients admitted to the emergency room. They were assessed by extended thoracic sonography at General Calixto García University Hospital, during the period between January 2020 and February 2021. Results: A total of 1052 thoracic ultrasounds were performed in a period of one year, of which 221 cases were positive. Of them, 81 were pneumothorax (7.7 percent) and 62 were hemopneumothorax (5.9 percent), all confirmed by chest tomography. The average age was 45.27 (18-97). The male sex prevailed, with 772 cases (73.4 percent). The most frequent trauma-producing mechanisms were altitude fall, accounting for 273 cases (26 percent), and blunt trauma, accounting for 181 cases (17.2 percent). Extended thoracic ultrasound showed a sensitivity of 95.24 percent and a specificity of 99.88 percent in the diagnosis of thoracic injuries. Conclusions: Extended thoracic ultrasound showed that, in the hands of general surgeons, it is a reliable, safe, noninvasive, inexpensive and repeatable tool that allows rapid diagnosis and treatment of thoracic injuries(AU)

Hemopneumotórax recorrente: descrição da síndrome da endometriose torácica / Recurrent hemopneumothorax: thoracic endometriosis syndrome description

A endometriose torácica é uma forma de endometriose extrapélvica encontrada em tecidos pulmonares ou na pleura. Caracteriza- se clinicamente pela presença de pneumotórax catamenial, hemotórax catamenial, hemoptise e nódulos pulmonares. O pneumotórax catamenial é a manifestação mais frequente, sendo caracterizado pelo acúmulo recorrente de ar na cavidade torácica durante o período menstrual. Ocorre, geralmente, no hemitórax direito e possui maior incidência na faixa etária dos 30 aos 40 anos de idade. Nosso objetivo é descrever um caso de derrame pleural hemorrágico recorrente e pneumotórax espontâneo correlacionados ao período menstrual em paciente de 34 anos. (AU)

Thoracic endometriosis is a form of extrapelvic endometriosis found in pulmonary tissue or the pleura. Clinically, it is characterized by the presence of catamenial pneumothorax, catamenial hemothorax, hemoptysis, and pulmonary nodules. The most frequent clinical presentation is catamenial pneumothorax, which is typified by a recurrent collection of air in the thoracic cavity occurring in conjunction with menstrual periods. It occurs more commonly on the right side and its highest incidence is between 30 and 40 years of age. Our objective is to describe a case of recurrent hemorrhagic pleural effusion and spontaneous pneumothorax correlated to the menstrual period in a 34-year-old patient. (AU)

Massive Hemopneumothorax during Breast Augmentation

Although it is very rare, hemopneumothorax can occur during breast augmentation. This potentially fatal surgical complication can be experienced by any plastic surgeon who performs breast augmentation surgery. In this article, we present a case from our institution and review the related literature in order to explore the etiological mechanism of hemopneumothorax, as well as preventive measures and treatments. In addition, we have tried to emphasize the importance of a thorough knowledge of anatomical variations and proper surgical techniques as ways to minimize the likelihood of this complication.

Common Carotid Artery Dissection in Multiple Extracranial Injury: A Case Report / 대한신경손상학회지

Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.

Delayed Death Due to Aortic Laceration after Chest Blunt Trauma: An Autopsy Case / 대한법의학회지

A traumatic aortic injury due to blunt chest trauma is well recognized. However, a delayed death due to an aortic laceration after blunt chest trauma is very rare. A 49-year-old man arrived at the emergency room after falling from a height of approximately 4 m. Upon radiological examination, multiple fractures to his left ribs with a hemopneumothorax on his left side were found. After undergoing a closed thoracostomy, he was admitted to the general ward due to his vital signs being stable. After 13 hours from his admission, he complained of chest discomfort with the sudden development of massive blood drainage through his chest tube. A cardiopulmonary resuscitation was performed, where the patient then died and an autopsy was performed 36 hours after his death. On internal examination, a small laceration of the descending aorta with irritation of the tunica adventitia was revealed. Given the findings of an additional histological examination and the aforementioned findings, the author thought that the fractured fragments of the posterior ribs had irritated the tunica adventitia of the adjacent descending aorta for some time after the chest trauma and that a perforation had finally occurred. The author here reports a case of a delayed death due to an aortic laceration after a blunt chest trauma with the patient's clinical information and full autopsy findings.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. METHODS: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. RESULTS: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). CONCLUSION: Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture / 대한중환자의학회지

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture / 대한구급학회지

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

Manejo del trauma de tórax y características demográficas, Hospital Vicente Corral Moscoso. Cuenca ­ Ecuador / Management of thorax trauma and demographic characteristics, Hospital Vicente Corral Moscoso. Cuenca-Ecuador

Objetivo: Analizar el manejo del trauma de tórax en el Hospital Vicente Corral Moscoso y describir las características demográficas de la población estudiada.Método: Estudio descriptivo retrospectivo, la muestra fue de 167 pacientes atendidos en el servicio de Emergencia del Hospital Vicente Corral Moscoso, con diagnóstico de trauma de tórax, durante el periodo enero de 2013 a junio de 2015; los datos se obtuvieron de las historias clínicas. Se analizaron las variables de datos demográficos y tratamiento, utilizando frecuencias, porcentajes y chi cuadrado. Se empleó el programa SPSS versión 18, Excel 2010.Resultados: La edad promedio fue de 37 años, con mayor frecuencia en varones con el 84.4%. Los diagnósticos fueron: hemotórax 36.53%, neumotórax 25.75%, hemoneumotórax 27.54%. El 4.8% de los pacientes recibió tratamiento no quirúrgico, el 82.6% avena-miento pleural; al 12.6% se practicó toraco-tomías al ingreso. Al 19.8% se realizó toracotomía durante la estancia hospitalaria debido a complicaciones como el hemotórax coagulado o residual. La mortalidad fue del 5.4% (9 pacientes), 7 presentaron lesiones extra to-rácicas. Conclusiones: El trauma de tórax se presen-tó en alto porcentaje en la tercera década de vida y se resolvió mayormente con avenamiento pleural. Las lesiones extra torácicas incrementan la mortalidad y necesitan un manejo multidisciplinario

Objective: To analyze the management of chest trauma at the Vicente Corral Moscoso Hospital and describe the demographic cha-racteristics of the population studied.Method: It is a retrospective, descriptive study, the sample was 167 patients treated in the Emergency service at the Vicente Corral Moscoso Hospital, who were diagnosed with thoracic trauma during the period January 2013 to June 2015; Data were obtained from medical records. Demographic variables and treatment data were analyzed using frequen-cies, percentages and chi square. The SPSS program, version 18, and Excel 2010 were used.Results: The average age was 37 years, with high frequency in men 84.4%. The diagnoses were: 36.53% hemothorax, pneumothorax 25.75%, and 27.54% hemopneumothorax. The 4.8% of patients received nonsurgical treat-ment, 82.6% pleural drainage; a 12.6% tho-racotomy was performed at the moment to arrive. The 19.8% thoracotomy was performed during hospital stay due to complications such as coagulated or residual hemothorax. The mortality was 5.4% (9 patients), 7 had ex-tra-thoracic injuries. Conclusions: Chest trauma occurs in high percentage in the third decade of life and it mostly was resolved with pleural drainage. Extra thoracic injuries increase mortality and need a multidisciplinary approach.

Primary spontaneous haemopneumothorax: An overlooked emergency.

Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.

Hemoneumotórax espontáneo: presentación de caso / Spontaneous Hemopneumothorax: A Case Report

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.

A Case of Simultaneous Bilateral Spontaneous Pneumothorax Combined with Hemopneumothorax

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.

Treatment of thoracolumbar tumors with total en bloc spondylectomy and the results of spinal stability reconstruction / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of total en bloc spondylectomy (TES) for thoracolumbar tumors and the results of spinal stability reconstruction.</p><p><b>METHODS</b>From January 2007 to June 2011 there were 18 patients with thoracolumbar tumors distributed in the thoracic vertebrae (n = 10) and lumbar vertebrae (n = 8). There were 7 haemangiomas, 5 giant cell tumors of bone, 1 malignant schwannoma, 1 solitary plasmocytoma, 1 neuroblastoma, 1 osteoblastoma, 1 metastatic malignant fibrous histiocytoma, and 1 metastasis of breast cancer. All the 18 patients were treated with improved TES under electrophysiological monitoring of spinal cord. Four patients were treated through one-stage combined anteroposterior approach and 14 patients through one-stage posterior approach. The anterior reconstructions included titanium mesh cages filled with bone or bone cement in 15 cases, titanium mesh cage with strengthened rings in 2 cases and artificial vertebral body replacement in 1 case. The posterior reconstruction included multiple segmental fixation with pedicle screw-rod system in 15 cases and short segmental fixation in 3 cases. Massive bone auto-graft was employed in 13 cases and fragmental bone graft in 5 cases.</p><p><b>RESULTS</b>The total en bloc spondylectomy was performed successfully in 15 patients and unsuccessful in 3 whose spinal tumors were resected by piecemeal technique. In 15 patients with successfully performed TES, the duration of surgery was from 340 to 610 min (average, 450.7 min), the blood loss was from 3000 to 10 200 ml (average, 4850 ml), and the intraoperative blood transfusion was from 2800 to 9600 ml (average, 4200 ml). The operation-related complications comprised hemopneumothorax, intercostal nerve pain, stress ulcer and bleeding, and so on. One year after operation, the patients with neurological dysfunction recovered from grade A to grade D in one patient, and to grade E in the other 14 cases. The average visual analog scale (VAS) scores was 0.5. One patient with plasmacytoma and another one with L5 metastatic tumor suffered progression of the disease and were living with the diseases. The patient with metastatic malignant fibrous histiocytoma died of local recurrence and lung metastasis 16 months postoperatively. One patient with L4 neuroblastoma died of other reason and all the rest were free from relapse. The Cobb angle of upper and lower vertebral body adjacent to the involved vertebrae in sagittal plane was from -26.7° to 12.0° (average, -2.57°) just postoperatively and from -17.5° to 57.2° (average, 11.5°) at the last follow-up or before reoperation. There were 2 patients with screw-rod breakdown and 2 patients with internal fixation loosening. The measurement of titanium mesh cage subsided into adjacent vertebral bodies was average 7.5 mm. The revision surgery was performed in 3 patients, through combined anteroposterior approach in 2 and only posterior approach in 1 patient.</p><p><b>CONCLUSIONS</b>TES significantly increases the therapeutic effect of spinal tumors, although accompanied with high difficulty and massive bleeding. In spinal stability reconstruction after total spondylectomy, it should be emphasized that posterior long segment fixation with pedicle screw-rod system, massive bone bridging graft and the application of thoracolumbosacral orthosis can achieve short-term firm fixation and long-term fusion-stabilization.</p>

Factors Affecting Pneumonia Occurring to Patients with Multiple Rib Fractures

BACKGROUND: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. MATERIALS AND METHODS: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. RESULTS: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). CONCLUSION: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.

Management of thoracic trauma in emergency service: analysis of 1139 cases

Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome. Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome. A total of 1139 patients with thorax trauma were included in the study. Of these, 698 [61.3%] were male and 441 [38.7%] were female, and the average age was 54.17 +/- 17.39 years. 1090 [95.7%] of the patients had blunt trauma, whereas 49 [4.3%] had penetrating trauma. Etiological factors were falls in 792 [69.5%], motor vehicle accidents in 259 [22.8%], animal related accidents in 39 [3.4%] and penetrating injuries in 49 [4.2%] patients. It was found that 229 [20%] patients had single, 101 [8.9%] had double, 5 [3%] had three or more, 10 [0.9%] had bilateral rib fractures and 19 [1.7%] had sternal fracture. Pneumothorax was diagnosed in 58 [5.1%] patients, whereas hemothorax, hemopneuomothorax and other system injuries were diagnosed in 36 [3.2%], 38[3.3%] and 292 [25.6%] respectively. In our series, thirteen patients [mortality rate 1.1%] died as result of hemorrhagic shock [n=8], respiratory distress [n=3] and severe multiple trauma [n=2]. Although majority of the patients with thorax trauma receive treatment as outpatients; thoracic traumas may be a life threatening condition, and should be identified and treated immediately. Mortality varies based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary approach to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly reduce the morbidity and mortality

Isolated traumatic giant diaphragmatic hernia mimicking a haemopneumothorax: A report of two cases.

We report two cases who presented with respiratory distress after trauma that were treated for a left-sided haemopneumothrax. These were finally diagnosed as giant diaphragmatic hernias. The diagnostic difficulties and complications arising out of a wrong diagnosis are discussed.

Boerhaave Syndrome Presenting as Abrupt Onset of Massive Hydropneumothorax

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.

Clinical Experience of Spontaneous Hemopneumothorax / 대한흉부외과학회지

BACKGROUND: Spontaneous hemopneumothorax is characterized by the accumulation of air and more than 400 mL of blood in pleural cavity without any apparent cause. It is a rare disease and can cause life-threatening situation. We analyzed clinical reviews of two medical centers to aid in optimal management. MATERIAL AND METHOD: Retrospective review between March 2003 and August 2010 with 18 spontaneous hemopneumothorax patients was made. RESULT: These 18 patients were comprised of 15 male and 3 female with average 24.6 years (range 15~46 years). Almost patients (16) underwent a closed thoracostomy initially and 15 patients received video-assisted thoracic surgery (VATS). Mean postoperative chest tube removal was 2.9 days and one complication was post-removal pneumothorax. During the follow-up periods there were no other complications and recurrence. CONCLUSION: Proper initial diagnosis and management of spontaneous hemopneumothorax prevent significant hypovolemic shock. Video-assisted thoracic surgery should be considered an early surgical management in spontaneous hemopneumothorax. However conservative manage without bleb excision may be effective in selected patients.

Clinical Analysis of Old-aged Chest Trauma Patient and Traumatic Hemopneumothorax

PURPOSE: This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax. METHODS: We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax. RESULTS: Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients. CONCLUSION: Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended.

Influence of Multiple Rib Fracture upon Traumatic Hemo-pneumothorax

PURPOSE: Multiple rib fracture (MRF) and a hemopneumothorax accompany with most blunt chest traumas. We aimed to analyze the factors increasing the probability of a hemopneumothorax. In addition, other injuries accompanying MRF were analyzed. METHODS: We retrospectively reviewed the medical records of 154 mutiple rib fracture patients who visited our hospital between January 2005 and December 2007. The medical records were reviewed for sex, age, mechanism of injury, location, number of fractures, distance of dislocated rib fragments, and presence of complications. We measured the distance of bony dislocations by using the PACS (Picture Archiving and Communication System). RESULTS: The average number of rib fractures was 3.7+/-2.1, and the number of rib fractures significantly influenced the incidence of a hemothorax (p<0.001). The risk of a phemothorax was increased in a bilateral MRF compared to a unilateral MRF (p=0.027). The distance of dislocated rib fragments influenced the probability of a hemothorax significantly (p=0.018), and subcutaneous emphysema and lung contusion were significantly associated with a pneumothorax (p=0.021, p=0.036). CONCLUSION: The number of MRFs did not influence the risk for a pneumothorax, but did influence the risk for a hemothorax. The laterality, distance of dislocation, also had an influence on the risk for a hemothorax. Also, subcutaneous emphysema and lung contusion were increased in cases with a pneumothorax. We must consider the possibility of a hemothorax even when the initial chest X-ray shows no evidence of a hemothorax. If a lung contusion is present, then an occult pneumothorax must be considered.