[Follow-up study of MRI imaging in a case of traumatic pulmonary hematoma].

A 29-year-old male was suffered from traumatic pulmonary hematoma by blunt chest trauma. We examined chest roentogenograms, chest CT, and MR imaging of the thorax periodically. Those revealed that: 1) Traumatic pulmonary hematoma produce an intense signal and is not influenced by blood stream in the MR imaging. 2) Like other methods, in MRI, pulmonary hematoma gradually decreased its volume. However, as hematoma is visualized solitarily in MRI, small hematoma can be distinguished easily.

[Two cases of pericardial rupture due to blunt chest trauma].

We treated two cases of pericardial rupture from blunt chest trauma. Case 1: A 55-year-old male was injured in an automobile accident. He recovered from the left hemothorax by tube drainage. One year and two months after the trauma, a left pericardial rupture was found during an operation for a left diaphragmatic hernia. As the epicardium adhered firmly to the pericardium, the ruptured pericardium was not sutured. Case 2: A 46-year-old man fell from a tree five meters in height. Chest radiography showed multiple right rib fractures, a pelvic fracture, pneumopericardium, and right hemopneumothorax. After four days, we performed a thoracoscopic examination under local anesthesia. The thoracoscopy revealed a rupture as large as an egg in the right pericardium anterior to the phrenic nerve. Judging from the size of the rupture, cardiac luxation was suspected not to have occurred. So the defect was not repaired. These two patients were discharged uneventfully without cardiac luxation. In the future, the accumulation of thoracoscopic findings may provide adequate information for judging the indication of operative repair in pericardial ruptures.

[Tracheobronchial injury: clinical analysis of 17 consecutive cases].

Consecutive 17 tracheobronchial injury caused by blunt chest trauma were reviewed. 14 patients were injured by traffic accidents, 2 by fall from the high, and one by accident during play in the house. 16 were male and one was female. Patient's age range from 4 to 60 years (average 25). Site of tracheobronchial injuries were scattered and there were not found risky area. Several problem to rescue tracheobronchial injuries are discussed. To maintain the ventilation in the patient of carinal injury, it is supposed that jet ventilation may be a possible method. For the infant victims, it is difficult to evaluate the injury using bronchofiberscopy. It is recommended that repair of tracheobronchial injury may be undergone as soon as the general condition becomes enough for anesthesia. On a technical aspect, stay suture should be put at the healthy site because those injuries are larger than expected before operation. For the victims with cerebral injury or shock, respirator is necessary for ventilatory management. In those cases adequate sedation and muscle relaxation should be applied.

Epithelial myoepithelial tumour of the tracheal gland.

A case of epithelial myoepithelial tumour originating from the tracheal gland in a 57 year old woman is described. The tumour was removed by segmental tracheal resection and end-to-end anastomosis. Histologically, the tumour comprised clear cells and presented a monophasic pattern. Immunohistochemical analysis showed that the tumour cells were positive for both S-100 protein and smooth muscle actin. suggesting that this tumour resembles a subtype of epithelial-myoepithelial carcinoma described in the 1990 WHO international classification of salivary glands. Although some reports describe a clear cell dominant epithelial myoepithelial carcinoma, in this case local invasiveness or regional lymphnode metastasis was not proved through investigation. It is therefore concluded that this was an epithelial myoepithelial tumour rather than a carcinoma.

[A case of complete circumferential aortic rupture due to blunt chest trauma].

A case of complete circumferential rupture of the thoracic aorta due to blunt chest trauma is presented. A 46-year-old woman was admitted after a traffic accident. The admission chest X-ray film demonstrated rib fractures and mediastinal widening. CT scanning and aortography were performed, but acute rupture of the aorta was not detected. Twelve days later, aortography was performed again and an aneurysm was noted at the aortic isthmus. Surgery was performed immediately and aorta was found to be completely disrupted for a length of 1 cm. A short segmental prosthesis was interposed between the two ends of the aorta under temporary bypass. Patients with aortic rupture due to blunt chest trauma are increasing, but only a few cases treated in the acute stage have been reported. To our knowledge, this is the 6th case of complete aortic disruption which has been treated successfully in the acute stage in Japan.

[A case of major pulmonary laceration caused by blunt open chest trauma successfully treated by operation].

A 42-year-old man had his right arm pulled into a belt conveyer and his right upper extremity was amputated only partially leaving the scapula and the clavicle. A penetrating wound was present at the third intercostal space and the rupture of the upper lobe of the lung was diagnosed through this wound. After tracheal intubation, operation was performed under general anesthesia. The penetrating wound at the third intercostal space was widened and the thoracic cavity was examined. The rupture existed between S1 and S2 and it extended to subsegmental bronchus. The ruptured upper lobe was resected. The defect in the chest wall was reconstructed with mobilized anterior serratus muscle and major pectoral muscle after stabilizing the fractured ribs by inserting Kirschner wire into the marrow of the fractured ribs. Postoperative course was uneventful and the wound healed primarily without infection. The patient was sent to a rehabilitation facility 52 days after injury.

Traumatic pulmonary pseudocyst. Report of twelve cases.

Twelve cases of traumatic pulmonary pseudocyst were seen between January 1966 and July 1987 at Saiseikai Kanagawaken Hospital. The cause of the traumatic pulmonary pseudocyst was closed blunt chest trauma in all patients. For the first few days after the injury, computed tomographic scan was more useful in diagnosis than chest roentogenogram. Tube drainage of the pleural cavity was performed in 10 patients who had hemothorax or hemopneumothorax, and antibiotics were administered to all patients. No patient underwent a surgical procedure, and all traumatic pulmonary pseudocysts eventually resolved, without any specific treatment, within 1 to 4 months (average 1.8 month) after the trauma. We conclude that pulmonary resection is not indicated except in the rare instance in which the traumatic pulmonary pseudocyst becomes infected.

Glycosaminoglycans in malignant diffuse mesothelioma.

Because of frequently encountered diagnostic difficulty due to a morphologic similarity between diffuse pleural mesothelioma and peripheral pulmonary adenocarcinoma, glycosaminoglycans (GAG) of human malignant diffuse mesothelioma were histochemically stained and chemically quantitated, and were compared with GAG of papillary adenocarcinoma of the lung. In all seven patients, the diagnosis of diffuse mesothelioma was confirmed morphologically by such findings as abundant bushy microvilli on cell surface and intermediate filaments in cytoplasm. The total GAG in mesothelioma obtained from fresh materials (5 cases) was significantly increased over that in pleural connective tissue (P less than 0.01) and lung adenocarcinoma (P less than 0.02). Two dimensional electrophoretic separation of GAG of mesothelioma and lung cancer showed hyaluronic acid, heparan sulfate, heparin, dermatan sulfate and chondroitin sulfate; among them, the two predominant fractions were hyaluronic acid and chondroitin sulfate. In the quantitative analysis, the hyaluronic acid content of mesothelioma averaged 57% of the total GAG, but that of lung adenocarcinoma, 38%. The results suggest that chemical analysis of GAG may be useful as supplementary diagnostic procedure to morphologic examination in the differentiation of diffuse mesothelioma from papillary adenocarcinoma of the lung.