Sample records for hemopneumothorax

  1. Ultrasonographic Diagnosis of Suspected Hemopneumothorax in Trauma Patients

    PubMed Central

    Ojaghi Haghighi, Seyyed Hossein; Adimi, Ida; Shams Vahdati, Samad; Sarkhoshi Khiavi, Reza


    Background: Bleeding and trapped air in the pleural space are called hemothorax and pneumothorax, respectively. In cases where there are delays in diagnosis and treatment, the mortality rates due to hemopneumothorax can be significant. Hemopneumothorax is characterized by decreased lung sounds or chest percussion and subcutaneous emphysema. Diagnosis of pneumothorax and hemothorax can be achieved by portable chest X-ray (CXR), computed tomography (CT) scan, or ultrasonography. Portable CXR and CT-scans have their individual drawbacks. CXR creates a high percentage of false negative results, and a CT-scan is time consuming and less cost-effective; in addition, both modalities expose patients to radiation. Therefore, the introduction of ultrasonography as an easily available and highly accurate diagnostic modality has particular importance. Objectives: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography in the diagnosis of pneumothorax and hemothorax in comparison with the other two methods, namely portable CXR and CT-scan. Patients and Methods: Patients (163) with multiple trauma who were suspected of having chest injuries, and who had indications for a chest CT-scan according to ATLS algorithms, were included in the study. All patients underwent portable CXR, CT-scan, and ultrasonography. Results: In total, 163 patients were included in this study; 29 patients had a pneumothorax, 24 patients had a hemothorax, and 23 patients had a hemopneumothorax confirmed. The study revealed that ultrasonography had a sensitivity of 96.15%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%, in the diagnosis of pneumothorax. The sensitivity for ultrasonography in the diagnosis of a hemothorax was 82.97%, with a specificity of 98.05%, a positive predictive value of 90%, and a negative predictive value of 92.66%. Portable CXR for pneumothorax detection had a sensitivity of 34.61%, a specificity of

  2. Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients.


    Ojaghi Haghighi, Seyyed Hossein; Adimi, Ida; Shams Vahdati, Samad; Sarkhoshi Khiavi, Reza


    Bleeding and trapped air in the pleural space are called hemothorax and pneumothorax, respectively. In cases where there are delays in diagnosis and treatment, the mortality rates due to hemopneumothorax can be significant. Hemopneumothorax is characterized by decreased lung sounds or chest percussion and subcutaneous emphysema. Diagnosis of pneumothorax and hemothorax can be achieved by portable chest X-ray (CXR), computed tomography (CT) scan, or ultrasonography. Portable CXR and CT-scans have their individual drawbacks. CXR creates a high percentage of false negative results, and a CT-scan is time consuming and less cost-effective; in addition, both modalities expose patients to radiation. Therefore, the introduction of ultrasonography as an easily available and highly accurate diagnostic modality has particular importance. The aim of this study was to evaluate the sensitivity and specificity of ultrasonography in the diagnosis of pneumothorax and hemothorax in comparison with the other two methods, namely portable CXR and CT-scan. Patients (163) with multiple trauma who were suspected of having chest injuries, and who had indications for a chest CT-scan according to ATLS algorithms, were included in the study. All patients underwent portable CXR, CT-scan, and ultrasonography. In total, 163 patients were included in this study; 29 patients had a pneumothorax, 24 patients had a hemothorax, and 23 patients had a hemopneumothorax confirmed. The study revealed that ultrasonography had a sensitivity of 96.15%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%, in the diagnosis of pneumothorax. The sensitivity for ultrasonography in the diagnosis of a hemothorax was 82.97%, with a specificity of 98.05%, a positive predictive value of 90%, and a negative predictive value of 92.66%. Portable CXR for pneumothorax detection had a sensitivity of 34.61%, a specificity of 97.95%, a positive predictive value of 90%, and a

  3. Needle versus tube thoracostomy in a swine model of traumatic tension hemopneumothorax.


    Holcomb, John B; McManus, John G; Kerr, S T; Pusateri, Anthony E


    Traumatic tension hemopneumothorax is fatal if not treated rapidly. However, whether prehospital decompression is better achieved by chest tube or needle thoracostomy is unknown. We conducted this study to compare the immediate results and prolonged effectiveness of two methods of treatment for traumatic tension hemopneumothorax in a swine model. Ten percent of calculated total blood volume was instilled into the hemithorax of spontaneously ventilating swine (n = 5 per group, 40 +/- 3 kg). A Veres needle and insufflator were used to induce tension hemopneumothorax. Animals were randomized to one of four groups: 1) needle thoracostomy with 14-gauge intravenous catheter; 2) needle thoracostomy with Cook catheter; 3) 32-F chest tube thoracostomy; or 4) no intervention (control). Serial chest x-rays were obtained to document mediastinal shift before and after treatment. Arterial blood gas values and physiologic data were recorded. Postoperatively, thoracoscopy was performed to detect possible pulmonary injury from the procedure and/or catheter kinking or clotting. Positive intrapleural pressure was rapidly relieved in all treated animals. Four-hour survival was 100% in the 14-gauge needle and chest tube thoracostomy groups, 60% in the Cook catheter group, and 0% in the control animals (p < 0.05). There were no significant differences in survival or physiologic measurements among the treated animals (p > 0.05). In this animal model, needle thoracostomy using a 14-gauge or Cook catheter was as successful as chest tube thoracostomy for relieving tension hemopneumothorax.

  4. Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline.


    Moore, Forrest O; Duane, Therese M; Hu, Charles K C; Fox, Adam D; McQuay, Nathaniel; Lieber, Michael L; Como, John J; Haut, Elliott R; Kerwin, Andrew J; Guillamondegui, Oscar D; Burns, J Bracken


    Antibiotic use in injured patients requiring tube thoracostomy (TT) to reduce the incidence of empyema and pneumonia remains a controversial practice. In 1998, the Eastern Association for the Surgery of Trauma (EAST) developed and published practice management guidelines for the use of presumptive antibiotics in TT for patients who sustained a traumatic hemopneumothorax. The Practice Management Guidelines Committee of EAST has updated the 1998 guidelines to reflect current literature and practice. A systematic literature review was performed to include prospective and retrospective studies from 1997 to 2011, excluding those studies published in the previous guideline. Case reports, letters to the editor, and review articles were excluded. Ten acute care surgeons and one statistician/epidemiologist reviewed the articles under consideration, and the EAST primer was used to grade the evidence. Of the 98 articles identified, seven were selected as meeting criteria for review. Two questions regarding presumptive antibiotic use in TT for traumatic hemopneumothorax were addressed: (1) Do presumptive antibiotics reduce the incidence of empyema or pneumonia? And if true, (2) What is the optimal duration of antibiotic prophylaxis? Routine presumptive antibiotic use to reduce the incidence of empyema and pneumonia in TT for traumatic hemopneumothorax is controversial; however, there is insufficient published evidence to support any recommendation either for or against this practice.

  5. Clavicle fracture with thoracic penetration and hemopneumothorax but without neurovascular compromise.


    Tjoumakaris, Fotios P; Matzon, Jonas L; Williams, Gerald R


    Clavicle fractures are rarely associated with more severe neurologic or vascular injuries. When these associated injuries are encountered, prompt recognition and treatment are paramount to optimize outcome. The majority of fractures that result in neurovascular compromise are from high-energy trauma; however, a high index of suspicion should be present in all cases as low-energy trauma can also result in more catastrophic injury. This article describes a case of a low-energy clavicle fracture in a 28-year-old woman that resulted in intrathoracic penetration of the fracture fragment with hemopneumothorax. The patient underwent successful chest tube placement and open reduction and internal fixation of the fracture. A multidisciplinary team was used during surgery, including cardiothoracic, trauma, and orthopedic surgery. Two years postoperatively, the patient was back to normal activities with no neurologic, pulmonary, or vascular sequelae. This case highlights the importance of a comprehensive physical examination and inspection of all radiographs so that associated injuries are not missed.

  6. Needle versus Tube Thoracostomy in a Swine Model of Traumatic Tension Hemopneumothorax

    DTIC Science & Technology


    Following induction of anesthesia, vascular catheters were inserted into the right internal jugular vein, right carotid artery, and left and right femoral...location was documented with intraoperative fluoroscopy . All further instrumentation, creation of THP, and interven- tions were performed in the side...New York: Wiley, 1992. 19. Bellamy RF. History of surgery for penetrating chest trauma. Chest Surg Clin N Am. 2000;10(1):55–70, viii. 20. Carrero R

  7. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    PubMed Central

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan


    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  8. Thoracic Trauma: Which Chest Tube When and Where?


    Molnar, Tamas F


    Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system.

  9. Case Report: Bilateral reexpansion pulmonary edema following treatment of a unilateral hemothorax

    PubMed Central

    de Wolf, Steven P; Deunk, Jaap; Cornet, Alexander D; Elbers, Paul WG


    Bilateral re-expansion pulmonary edema (RPE) is an extremely rare entity. We report the unique case of bilateral RPE following a traumatic, unilateral hemopneumothorax in a young healthy male. Bilateral RPE occurred only one hour after drainage of a unilateral hemopneumothorax. The patient was treated with diuretics and supplemental oxygen. Diagnosis was confirmed by excluding other causes, using laboratory findings, chest radiography, pulmonary and cardiac ultrasound and high resolution computed tomography. His recovery was uneventful. The pathophysiology of bilateral RPE is not well known. Treatment is mainly supportive and consists of diuretics, mechanical ventilation, inotropes and steroids. In case of a pulmonary deterioration after the drainage of a traumatic pneumothorax, bilateral RPE should be considered after exclusion of more common causes of dyspnea. PMID:25713699

  10. Unilateral anhidrosis: A rare complication of thoracic epidural analgesia.


    Gulbahar, Gultekin; Gundogdu, Ahmet Gokhan; Alkan, Güzide; Baysalman, Hatice Baran; Kaplan, Tevfik


    Management of pain following thoracotomy is an important issue for the control of early morbidity. We herein present the case of a patient who was referred to our hospital after a fall from a height. Right-sided multiple rib fractures, hemopneumothorax, and diaphragmatic rupture were detected. Thoracic epidural catheterization was performed for pain management just before thoracotomy. The patient developed unilateral anhidrosis postoperatively. We discuss this rare complication of thoracic epidural analgesia with a review of relevant literature.

  11. Age Thresholds for Increased Mortality of Predominant Crash Induced Thoracic Injuries

    PubMed Central

    Stitzel, Joel D.; Kilgo, Patrick D.; Weaver, Ashley A.; Martin, R. Shayn; Loftis, Kathryn L.; Meredith, J. Wayne


    The growing elderly population in the United States presents medical, engineering, and legislative challenges in trauma management and prevention. Thoracic injury incidence, morbidity, and mortality increase with age. This study utilized receiver-operator characteristic analysis to identify the quantitative age thresholds associated with increased mortality in common isolated types of thoracic injuries from motor vehicle crashes (MVCs). The subject pool consisted of patients with a single AIS 3+ thorax injury and no injury greater than AIS 2 in any other body region. A logistic regression algorithm was performed for each injury to estimate an age threshold that maximally discriminates between survivors and fatalities. The c-index describing discrimination of the model and odds ratio describing the increased mortality risk associated with being older than the age threshold were computed. Twelve leading thoracic injuries were included in the study: unilateral and bilateral pulmonary contusion (AIS 3/4), hemo/pneumothorax, rib fractures with and without hemo/pneumothorax (AIS 3/4), bilateral flail chest, and thoracic penetrating injury with hemo/pneumothorax. Results are consistent with the traditional age threshold of 55, but were injury-specific. Pulmonary contusions had lower age thresholds compared to rib fractures. Higher severity pulmonary contusions and rib fractures had lower age thresholds compared to lower severity injuries. This study presents the first quantitatively estimated mortality age thresholds for common isolated thoracic injuries. This data provides information on the ideal ‘threshold’ beyond which age becomes an important factor to patient survival. Results of the current study and future work could lead to improvements in automotive safety design and regulation, automated crash notification, and hospital treatment for the elderly. PMID:21050590

  12. Operative wound implantation of inflammatory sarcomatoid carcinoma of the lung.


    Hata, Atsushi; Sekine, Yasuo; Koh, Eitetsu; Hiroshima, Kenzo


    We describe a patient with iatrogenic chest wall implantation of inflammatory sarcomatoid carcinoma. A 43-year-old man underwent right partial lung resection for hemopneumothorax, with large bullae and an alveolar accumulation of histiocytes found on pathology. Three months later, a subcutaneous tumor appeared at a thoracoscopic port site. Needle aspiration of this tumor suggested a malignant neoplasm; therefore, a right upper lobectomy and chest wall resection were performed, and a pathologic diagnosis of sarcomatoid carcinoma was made. Pathologic reexamination of the original sample suggested that the tumor has been implanted in the patient's chest wall at the time of the first operation.

  13. The Epidemiology of Noncompressible Torso Hemorrhage in the Wars in Iraq and Afghanistan

    DTIC Science & Technology


    The most common thoracic injury pattern in the study of Propper et al. was pulmonary contusion (32%), fol- lowed by hemopneumothorax (19%). In a...of 30 (13) and 18.7%, respectively. Pulmonary injuries were most numerous (41.7%), followed by solid-organ (29.3%), vascular (25.7%), and pelvic (15.1...confidence interval, 1.17Y9.74) and pulmonary injury (odds ratio, 2.23; 95% confidence interval, 1.23Y4.98). CONCLUSION: NCTH can be defined using anatomic

  14. Methylene blue administration in severe systemic inflammatory response syndrome (SIRS) after thoracic surgery.


    Friedrich, Martin; Bräuer, Anselm; Tirilomis, Theo; Lotfi, Shahram; Mielck, Frank; Busch, Thomas


    A 66-year-old male patient developed significant pleural effusion on the right side six years after coronary bypass grafting and mitral valve replacement. After pleurocentesis, hemo-pneumothorax developed and finally resulted in complete atelectasis of the right lung. Three weeks later, the patient was transferred to our department, and underwent a right lateral thoracotomy. The hematoma was removed and a complete decortication was performed. Four hours postoperatively the patient developed severe SIRS with beginning multiorgan failure. Even extremely high doses of norepinephrine could not raise the systemic vascular resistance. Single intravenous administration of methylene blue lead to significant and permanent improvement of the hemodynamic status.

  15. Pneumomediastinum complicated by subclavian central venous catheterization in a severe thoracic trauma patient.


    Chen, Liang-Chih; Tzao, Chi; Liaw, Wen-Jinn; Horng, Huei-Chi; Cherng, Chen-Hwan; Wong, Chih-Shung; Wu, Ching-Tang


    Pneumomediastinum is a rare event in subclavian central venous catheterization. However in severe thoracotraumatized patients, such as with bilateral hemopneumothorax, the catherization may be hazardous and made complex by occurrence pneumomediastinum, even the procedure is rightly carried out. We suggest that in such a risky condition, if it is mandatory, it should be carried out in a more placid condition, such as avoidance of high PEEP ventilation, setting lower tidal volume, or brief interruption of positive ventilation, to reduce the likelihood of unperceivable pneumomediastinum.

  16. Emergency Endovascular Treatment of an Acute Traumatic Rupture of the Thoracic Aorta Complicated by a Distal Low-Flow Syndrome

    SciTech Connect

    Bruninx, Guy; Wery, Didier; Dubois, Eric; El Nakadi, Badih; Dueren, Eric van; Verhelst, Guy; Delcour, Christian


    We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.

  17. Catamenial pneumothorax

    PubMed Central

    Visouli, Aikaterini N.; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos


    Catamenial pneumothorax (CP) is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations. Usually onset of lung collapse is less than 72 hours after menstruation. Most commonly occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis. Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Moreover; CA-125 is elevated. Video-assisted thoracoscopy or medical thoracoscopy is used for confirmation. In our current work we will present all aspects of CP from diagnosis to treatment. PMID:25337402

  18. Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

    PubMed Central


    Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means. PMID:27051252

  19. Tube thoracostomy: the struggle to the "standard of care".


    Monaghan, Sean F; Swan, Kenneth G


    Tube thoracostomy for thoracic injuries has been standard for only the last 40 years. Its theoretic roots trace back to World War II, where the goal of treatment was restoration of intrathoracic organ function. Thoracentesis was used to evacuate the hemopneumothorax resulting from chest trauma and that compromised pulmonary function. Experience gained in military and civilian hospitals contributed to the development of tube thoracostomy as an alternative treatment for patients with chest trauma. Progress stalled due to technologic problems and unacceptable complications associated with tube thoracostomy use during the Korean War. Technology improved, however, as did the success of thoracostomy, and it eventually become the standard of care, first in the civilian community and, ultimately, in the Vietnam War.

  20. Posttraumatic tricuspid valve injury and severe tricuspid valve regurgitation.


    Gucuk Ipek, Esra


    A 66-year-old male was brought to our hospital following a car accident. He had subarachnoid hemorrhage, multiple rib fractures, and left hemopneumothorax. He was referred to the Cardiology Department for elevated troponin levels (42 ng/ml, reference 0-1 ng/ml). The electrocardiogram was free of ischemia, whereas the transthoracic echocardiography revealed dilated right heart chambers, enlarged tricuspid annulus and coaptation failure of the tricuspid valvular leaflets. There was rupture on the subvalvular apparatus of the anterior leaflet of the tricuspid valve with accompanying prolapse, causing severe tricuspid valvular regurgitation. The patient did not present right ventricular failure signs and symptoms; he was referred to surgery after the resolution of associated thoracic and cranial injuries.

  1. Long-term pulmonary function after recovery from pulmonary contusion due to blunt chest trauma.


    Amital, Anat; Shitrit, David; Fox, Benjamin D; Raviv, Yael; Fuks, Leonardo; Terner, Irit; Kramer, Mordechai R


    Blunt chest trauma can cause severe acute pulmonary dysfunction due to hemo/pneumothorax, rib fractures and lung contusion. To study the long-term effects on lung function tests after patients' recovery from severe chest trauma. We investigated the outcome and lung function tests in 13 patients with severe blunt chest trauma and lung contusion. The study group comprised 9 men and 4 women with an average age of 44.6 +/- 13 years (median 45 years). Ten had been injured in motor vehicle accidents and 3 had fallen from a height. In addition to lung contusion most of them had fractures of more than three ribs and hemo/pneumothorax. Ten patients were treated with chest drains. Mean intensive care unit stay was 11 days (range 0-90) and mechanical ventilation 19 (0-60) days. Ten patients had other concomitant injuries. Mean forced expiratory volume in the first second was 81.2 +/- 15.3%, mean forced vital capacity was 85 +/- 13%, residual volume was 143 +/- 33.4%, total lung capacity was 101 +/- 14% and carbon monoxide diffusion capacity 87 +/- 24. Post-exercise oxygen saturation was normal in all patients (97 +/- 1.5%), and mean oxygen consumption max/kg was 18 +/- 4.3 ml/kg/min (60.2 +/- 15%). FEV1 was significantly lower among smokers (71.1 +/- 12.2 vs. 89.2 +/- 13.6%, P = 0.017). There was a non-significant tendency towards lower FEV1 among patients who underwent mechanical ventilation. Late after severe trauma involving lung contusion, substantial recovery was demonstrated with improved pulmonary function tests. These results encourage maximal intensive care in these patients. Further larger studies are required to investigate different factors affecting prognosis.

  2. Does intrapleural length and position of the intercostal drain affect the frequency of residual hemothorax? A prospective study from north India

    PubMed Central

    Kumar, Sunil; Agarwal, Nitin; Rattan, Amulya; Rathi, Vinita


    Context: Thoracic trauma causes significant morbidity; however, many deaths are preventable and few patients require surgery. Intercostal chest drainage (ICD) for hemo/pneumothorax is simple and effective; the main problem is residual hemothorax, which can cause lung collapse and empyema. Aims: Our study aimed to analyze the relationship between radiological chest tube parameters (position and intrathoracic length) and the frequency of residual hemothorax. Settings and Design: This prospective analytical study was conducted in a large tertiary care hospital in north India over 2 years till March 2013. Materials and Methods: Patients of chest trauma aged 18-60 years, with hemothorax or hemopneumothorax requiring ICD insertion were included in the study. Bedside ICD insertion was performed as per current standards. Immediate post-ICD chest radiographs were used to record lung status and ICD position (chest tube zone and intrapleural length). Residual hemothorax was defined as any collection identified on radiological investigations after 48 hours of ICD placement. Statistical Analysis: Univariate analysis was performed with the chi-square test or Student's t-test as appropriate, while multivariate analysis using stepwise logistic regression; a P-value < 0.05 was significant. Results: Out of 170 patients of chest trauma, 154 underwent ICD insertion. Most patients were young (mean age: 31.7 ± 12 years) males (M:F = 14:1). Ninety-seven patients (57.1%) had isolated chest injuries. Blunt trauma (n = 119; 77.3%) and motor vehicle accidents (n = 72; 46.7%) were the commonest causes. Mean hospital stay was 9 ± 3.94 days, and mortality 2/154 (1.1%). Residual hemothorax was seen in 48 (31%). No ICD zone or length was significantly associated with residual hemothorax on univariate or multivariate analysis. Conclusion: Intrapleural ICD zone or length does not affect the frequency of residual hemothorax. PMID:25400388

  3. Negative pleural suction in thoracic trauma patients: A randomized controlled trial.


    Morales, Carlos H; Mejía, Camila; Roldan, Luis Alberto; Saldarriaga, Maria Fernanda; Duque, Andres Felipe


    The study aimed to establish the benefits of using chest tubes with negative pleural suction against trapped water in patients with penetrating or blunt chest trauma who underwent tube thoracostomy, in terms of the incidence of complications, such as persistent air leak, clotted hemothorax, empyema, and duration of stay. Patients who underwent tube thoracostomy because of traumatic pneumothorax, hemothorax, or hemopneumothorax were randomly assigned into one of two groups: in Group 1, the three-bottle drainage system was connected to a negative suction; in Group 2, no suction was given. Patients who required mechanical ventilation or emergency surgery (thoracotomy or thoracoscopy) either at the time of admission to the institution or immediately after the tube thoracostomy, patients who had histories of thoracic procedures or chronic pulmonary diseases (chronic obstructive pulmonary disease, diffuse interstitial lung disease), and patients with multiple injuries with severe traumatic brain injury and a Glasgow Coma Scale (GCS) score less than 8 of 15 were excluded from the study. Hospital stay, duration of tube thoracostomy, prolonged fistula, and other clinical variables were compared. One hundred ten patients were included, 56 in the group with suction and 54 in the group without suction. There were no differences in the demographic characteristics of each group. There were no differences between the groups in terms of hospital stay (p = 0.22), duration of tube thoracostomy (p = 0.35) (3 days in each group), or complications. However, the probability of air leak presence in time was greater for the Group 1 patients with negative suction versus the Group 2 patients (p = 0.023). The use of negative pleural suction did not demonstrate advantages over the three-bottle chest drainage system without suction in patients with uncomplicated traumatic pneumothorax, hemothorax, or hemopneumothorax. Therapeutic study, level II.

  4. Clinical evaluation of active abdominal lifting and compression cardiopulmonary resuscitation in patients with cardiac arrest.


    Li, Min; Song, Wei; Ouyang, Yan-Hong; Wu, Duo-Hu; Zhang, Jun; Wang, Li-Xiang; Li, Jing


    Chest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients. A prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30min post-ROSC. A total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P<0.01; MAP 25 versus 0mm Hg, P<0.01; SpO2 0.68 versus 0.48%, P<0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P<0.01). Active abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries.


    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J


    We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently

  6. Morbidity, mortality, associated injuries, and management of traumatic rib fractures.


    Lin, Frank Cheau-Feng; Li, Ruei-Yun; Tung, Yung-Wei; Jeng, Kee-Ching; Tsai, Stella Chin-Shaw


    Thoracic trauma is responsible for approximately 25% of trauma deaths, and rib fractures are present in as many as 40-80% of patients, and intensive care and/or ventilator support are frequently required for these patients. To identify their risk factors would improve treatment strategies for these patients. Between March 2005 and December 2013, consecutive patients with blunt thoracic trauma, who were admitted to the Department of Thoracic Surgery at Tungs' Taichung Metro Harbor Hospital (Taichung, Taiwan), were reviewed in this retrospective cohort study with the approval of the Institutional Review Board. The duration of hospital stay, ventilator support, injury severity score (ISS), type of injury, associated injuries, treatments, and mortality were analyzed statistically. A total of 1621 thoracic trauma patients were included in this study, with a male majority and an age range of 18-95 years (mean age, 51.2 years). Approximately 11.7% of these patients had an ISS ≥ 16 and a mortality rate of 6.9%. Among them, 78.5% had rib fractures; 31.8%, traumatic hemothorax; 15.6%, pneumothorax; 9.6%, hemopneumothorax; and 4.6%, lung contusion. The most common associated injury was extremity fracture, followed by head injury and clavicle fracture. Surgery on the extremities (20.6% of patients) and chest tube placement (22.7% of patients) were the most common treatments. The number of rib fractures was associated with prolonged hospital and intensive care unit (ICU) stays (≥7 days), an ISS ≥ 16, and pulmonary complications of hemothorax, pneumothorax, and hemopneumothorax, but not with mechanical ventilator use. Furthermore, old age was significantly associated with rib fractures in patients with thoracic trauma. The severity of traumatic rib fractures was identified in this study. Therefore, a trauma team needs better preparation to provide effective treatment strategies when encountering thoracic trauma patients, especially patients who are older and have rib

  7. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries

    PubMed Central

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J


    Objective: We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Subjects and methods: Consecutive admissions to a trauma center with Injury Severity Score ≥ 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ≤ 20% = 1, ≤ 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Results: Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ≥ 3 days (Death/Vdays ≥ 3) (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ≥ 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ≥ 3 occurred in 31%. Death/Vdays ≥ 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ≥ 13 (p < 0.001). Death/Vdays ≥ 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ≥ 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Conclusion: Rib fracture patients have increased risk for truncal injuries and

  8. Traumatic Tricuspid Valve Rupture after Blunt Chest Trauma - A Case Report and Review of the Literature.


    Stoica, B; Paun, S; Tanase, I; Negoi, I; Runcanu, A; Beuran, M


    Despite the high frequency of thoracic injuries secondary to traffic related accidents, the blunt cardiac valve rupture is extremely rare. Case report and review of the literature using PubMed/MEDLINE and EMBASE databases. A 38 year old female patient, victim of car accident was admitted. On primary survey the patient was conscious, cooperative and hemodynamic and respiratory stable. On secondary survey was found a bilateral open leg fracture and a seat belt sign. Whole body Computed Tomography revealed minimal haemorrhagic contusion of the cortex, left hemopneumothorax and right pneumothorax, bilateral rib fractures, liver contusion, left femoral neck fracture and fracture to the lumbar spinal column. After bilateral pleurostomy, the patient becomes hemodynamically unstable, but with no signs of external bleeding. The transthoracic echocardiography revealed an acute severe tricuspid regurgitation with hepatic veins reflux. After orthopaedic surgeries, the tricuspid valve rupture was managed by replacing the valve with a bioprostheses. The hospital stay was 122 days. Only a high index of suspicion may reveal blunt cardiac lesions as a cause for hemodynamic instability in acute setting. Celsius.

  9. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    PubMed Central

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi


    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  10. [Small infundibulectomy versus ventriculotomy in tetralogy of Fallot].


    Bojórquez-Ramos, Julio César


    the surgical correction of tetralogy of Fallot (TOF) is standardized on the way to close the septal defect, but differs in the way of expanding the right ventricular outflow tract (RVOT). The aim was to compare the early postoperative clinical course of the RVOT obstruction enlargement in classical ventriculotomy technique and the small infundibulectomy (SI). We analyzed the database of the pediatric heart surgery service from 2008 to 2011. Patients with non-complex TOF undergoing complete correction by classical ventriculotomy or SI were selected. Anova, χ(2) and Fisher statistical test were applied. the data included 47 patients, 55 % (26) male, mean age 43 months (6-172), classical ventriculotomy was performed in 61.7 % (29). This group had higher peak levels of lactate (9.07 versus 6.8 mmol/L) p = 0049, and greater magnitude in the index bleeding/kg in the first 12 hours (39.1 versus 20.3 mL/kg) p = 0.016. Death occurred in 9 cases (31.03 %) versus one (5.6 %) in the SI group with p = 0.037; complications exclusive as acute renal failure, hemopneumothorax, pneumonia, permanent AV-block and multiple organ failure were observed. morbidity and mortality was higher in classical ventriculotomy group in comparison with SI. This is possibly associated with higher blood volume.

  11. Delayed 31st day traumatic hemothorax on acenocoumarol for aortic valve replacement.


    Siafakas, Konstantinos X; Avgerinos, Efthimios D; Papalampros, Alexandros; Perdikides, Theodossios


    A 48-year-old man, on acenocoumarol due to past aortic valve replacement, was referred to our emergency department for left thoracic pain, progressive dyspnea and fatigue gradually worsening over the past 24 hours. Thirty-one days ago he had suffered from left rib fractures due to a fall, while 15 days ago his regular follow-up chest X-ray was negative for hemopneumothorax. On admission, chest X-ray revealed left pleural effusion, while his peripheral blood hematocrit was 28% and the INR 3.57. Following plasma transfusion his INR recovered to two, but five hours later his blood hematocrit dropped to 22.6%. The hemothorax was then drained by a chest tube and followed by blood transfusion. Acenocoumarol might not have been the initiating factor of delayed hemothorax, but could be blamed for the exacerbation of bleeding. It is recommended that all patients with rib fractures, receiving anticoagulants should have a close surveillance until the 4th week post-injury.

  12. Cocaine-induced pulmonary changes: HRCT findings *

    PubMed Central

    de Almeida, Renata Rocha; Zanetti, Gláucia; Souza, Arthur Soares; de Souza, Luciana Soares; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson


    Abstract Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings. PMID:26398752

  13. Traumatic left ventricular free-wall laceration by a gunshot: report of a case.


    Suzuki, Takamaro; Wada, Takafumi; Funaki, Shigeki; Abe, Hiroyuki; Seki, Ippei; Imaki, Shohei; Nakazawa, Akeo


    This report describes the case of a 47-year-old man who shot himself in the left side of the chest in an attempted suicide, and was transferred to the hospital. Two gunshot wounds were found in the left side of the chest and the back. CT scans revealed left hemopneumothorax, the accumulation of pericardial blood, and lacerations of the heart and the spleen. Emergency thoracotomy and laparotomy were performed. There was a contusion of the left lung and lacerations of the left ventricular free wall, the diaphragm, and the spleen. The laceration of the heart was repaired by 3 pairs of mattress sutures with felt strips, and covered with fibrin glue and a TachoComb(®) tissue sealing sheet without the use of cardiopulmonary bypass. The patient was discharged on foot on the 18th postoperative day. Such patients can only be saved with an efficient emergency medical-care system including quick transportation, and close cooperation of the hospital staff.

  14. Basic ultrasound training can replace chest radiography for safe tube thoracostomy removal.


    Lavingia, Kedar S; Soult, Michael C; Collins, Jay N; Novosel, Timothy J; Weireter, Leonard J; Britt, L D


    An ultrasound (US) examination can be easily and rapidly performed at the bedside to aide in clinical decisions. Previously we demonstrated that US was safe and as effective as a chest x-ray (CXR) for removal of tube thoracostomy (TT) when performed by experienced sonographers. This study sought to examine if US was as safe and accurate for the evaluation of pneumothorax (PTX) associated with TT removal after basic US training. Patients included had TT managed by the surgical team between October 2012 and May 2013. Bedside US was performed by a variety of members of the trauma team before and after removal. All residents received, at minimum, a 1-hour formal training class in the use of ultrasound. Data were collected from the electronic medical records. We evaluated 61 TTs in 61 patients during the study period. Exclusion of 12 tubes occurred secondary to having incomplete imaging, charting, or death before having TT removed. Of the 49 remaining TT, all were managed with US imaging. Average age of the patients was 40 years and 30 (61%) were male. TT was placed for PTX in 37 (76%), hemothorax in seven (14%), hemopneumothorax in four (8%), or a pleural effusion in one (2%). Two post pull PTXs were correctly identified by residents using US. This was confirmed on CXR with appropriate changes made. US was able to successfully predict the safe TT removal and patient discharge at all residency levels after receiving a basic US training program.

  15. [Innominate artery war injury].


    Ilic, Radoje; Kronja, Goran; Markovic, Zoran; Tisma, Svetislav


    A case is reported of successfully surgically treated explosive war injury to the innominate artery. A 26-year-old soldier was injured in combat by a fragment of mortar shell. In the field hospital, the wound gauze packing was applied, followed by orotracheal intubation and thoracic drainage. The soldier was admitted to MMA six hours later. Physical examination, on admission, revealed huge swelling of the neck, the absence of pulse in the right arm and the right common carotid artery. Chest x-ray revealed hemopneumothorax of the right side and the foreign metal body in the projection of the right sternoclavicular joint. Due to the suspicion of large vessel injury, a median sternotomy was immediately performed. Surgery revealed disrupted bifurcation of the right innominate artery, so the ligation was performed. Aortography was performed postoperatively, followed by the reconstruction of innominate bifurcation with synthetic grafts. Control aortography showed good graft patency, and the patient was discharged from the hospital in good general condition with palpable pulses and mild anisocoria as a sole neurological sequela. A rare and life-threatening injury was successfully managed, mainly due to the rational treatment carried out in the field hospital that helped the injured to survive and arrive to the institution capable of performing the most sophisticated diagnostic and therapeutic procedures.

  16. Cuffed-tunneled hemodialysis catheter survival and complications in pediatric patients: a single-center data analysis in China

    PubMed Central

    Wang, Kai; Wang, Pei; Liang, Xian-Hui; Yuan, Fang-Fang; Liu, Zhang-Suo


    This study aims to evaluate the outcome and complications of cuffed-tunneled catheters in pediatric patients. Between January 2010 and December 2013, 16 pediatric patients with end-stage renal disease (ESRD) were included. 21 cuffed-tunneled hemodialysis catheters were inserted in patients for long-term hemodialysis access. No serious complications were observed in all patients receiving catheter insertion operation, except one with hemopneumothorax. Median survival time was 413.5 days, with rate being 67.5% in the first year, 51.5% in the second year and 43.6% in the third year. Among attempted catheter insertions, 21 (100%) achieved successful vascular access with 13 (61.9%) being remained for the required period and 8 (38.1%) being removed due to death, intractable blood or tunnel infections, catheter thrombosis or malposition. The overall rate of catheter-related infections, thrombosis and malposition was 7.3, 23.4 and 3.4 episodes/1000 catheter days, respectively. Cuffed-tunneled hemodialysis catheters could be effectively used for maintenance of hemodialysis vascular access for pediatric patients with ESRD. Various surveillance measures should be taken to ensure cuffed-tunneled catheters’ long-term patency. PMID:26309654

  17. A prospective analysis of thoracic injuries in Harar, Hiwot Fana hospital.


    Asfaw, Mulatu; Aberra, Maruf


    A prospective follow up and analysis of 66 patients admitted to Hiwot Fana Hospital with all forms of thoracic injuries from the period of Aug/2001 - Aug/2003 was undergone. Data on the sociodemographic backgrounds, the type, nature and cause of injuries, time of arrival, clinical profiles, modalities of treatment and outcome were included. Majority of the subjects were males 60/66 (90.9%) and the young were mostly involved Penetrating injuries were the predominant types of injuries 48/66 (72.7%). Homicides accounted for 49/66 (74.2%) of the patients and farming land was the commonest reason for fights 18/49 (27.3%). Most patients 47/66 (71.2%) arrived later than two hours from the time of injury and hemopneumothorax was the commonest final diagnosis 27/66 (40.9%). Half (50%) had associated injuries the commonest being to the extremities. Tube thoracostomy alone was the mainstay of management for 49/66 (74.2 %). Laparatomy and tube thoracostomy was done for 8/66 (12.1%). Five of the patients (7.6%) died. The mean hospital stay was around ten days. It is recommended that public education and introducing family planning methods are crucial to decrease the incidence. Availability of a well equipped set up for proper management of such injuries should also be given due emphasis.

  18. [Gastric wall necrosis owing to its incarceration through a rupture of the diaphragm into the left thoracic cavity].


    Sugar, István; Turcsányi, Gábor; Vajda, Vera; Tulassay, Eszter; Ondrejka, Pál


    A 73 year-old female patient was admitted to the 3rd Medical Department of Semmelweis University with a painful haematoma in the left loin and respiratory disorders. Her general condition was getting progressively worse. Chest X-ray demonstrated a left sided hemopneumothorax caused by a fractured rib. Thoracic drainage was planned, but the tube introduced on the usual place into the left thoracic cavity perforated the stomach which was incarcerated in the chest. After this an urgent operation was carried out. We found an incarcerated, twisted stomach prolapsing through a rupture of the diaphragm. It was partially necrotic. Excision of the stomach wall with suturing the diaphragm, lavage and drainage of the thoracic and abdominal cavity was carried out. Despite the operation multi-organ failure developed as a result of sepsis, and the patient'died. We discuss the literature in connection with the presentation of this rare and interesting case. In the past 15 years we could not find similar case in the Hungarian surgical literature.

  19. Study of 433 Operated Cases of Thoracic Trauma.


    Çakmak, Muharrem; Nail Kandemir, Mehmet


    Patients with thoracic trauma constitute one third of all the trauma cases. Of traumatic patients, 20-25 % die because of thoracic trauma. Our aim was to compare our clinical experience and the results with the related literature. Four hundred thirty-three patients, who underwent surgical interventions due to thoracic trauma, were evaluated. The latest form of treatment applied were taken as the criteria for the quantitative detection of patients. Continuous variables were expressed as mean ± standard deviation, while categorical variables were explained as number and percentage. The significance of the analysis results was evaluated using Fisher's exact test. p values <0.05 were considered as significant. Penetrating injuries were found in 258 (59 %) of the patients, and blunt trauma was identified in 175 (41 %). Depending on the trauma, pneumothorax was discovered in 130 patients (30.02 %), hemothorax in 117 (27.02 %), hemopneumothorax in 61 (14.08 %), pulmonary contusion in 110 (45 %), pneumomediastinum in 14 (3.23 %), and pericardial tamponade in 1 patient (0.23 %). It was demonstrated that 385 of 433 patients examined in the study underwent tube thoracostomy, 41 were treated with thoracotomy, while 6 of them underwent video-assisted thoracoscopic surgery (VATS), and 1 underwent sternotomy. No correlation was observed between mortality, morbidity, and gender and type of trauma and location of trauma (p > 0.05). However, statistically significant correlation was found between mortaxlity, morbidity, and the presence of concomitant injuries, the duration between injury and admission being more than 1 h (p < 0.05). Urgent intervention, early diagnosis, and fast transport are vital for patients with thoracic injuries.

  20. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

    PubMed Central

    Modi, Hitesh N; Suh, Seung-Woo; Yang, Jae-Hyuk; Cho, Jae Woo; Hong, Jae-Young; Singh, Surya Udai; Jain, Sudeep


    Background There are no reports describing complications with posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others) were divided in two groups according to severity of curves; group I (< 90°) and group II (> 90°). All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery) and postoperative (after three months of surgery) complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative) complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68%) patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024). However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion

  1. [Surgical stabilization of multiple rib fractures successfully achieved with the use of long metalic plates].


    Tanaka, A; Sato, T; Osawa, H; Koyanagi, T; Maekawa, K; Watanabe, N; Nakase, A; Sakata, J; Kamada, K


    Surgical stabilization of multiple rib fractures in 5 male patients was successfully achieved with the use of orthopedic A-O metalic plates, which are called reconstruction plates. In each patient, we prevented deformity of the rib cage and flail chest which frequently occurs after multiple rib fractures. Three of these patients received emergency operations because of severe hemopneumothorax and flail chest due to crushing injuries to the chest. They were treated by the standard thoracotomy, hemostasis of intrapleural bleeding, and stabilization of fractured ribs with reconstruction plates, in addition two of the patients underwent a single lobectomy to control the pulmonary hemorrhage. Another two patients were treated with mechanical ventilation and closed-tube thoracotomy following the chest trauma because their thoracic bleeding from drainage tubes was tolerable. But flail chest and respiratory insufficiency did not improve, in spite of positive controlled ventilation as a mode of internal pneumatic stabilization. Then surgical stabilization of the fractured ribs with these plates was carried out ten to twelve days after the accidents in each case. All patients tolerated the surgical procedures well and were successfully removed from the respirator, demonstrating complete stability of the chest wall. The long metal reconstruction plates with many perforations were very useful for the external fixation of segmentary fractured ribs as an external brace. This was because they were long enough to cover the whole length of the fractured ribs and moderately soft enough to be appropriately bent or twisted by hand at the time of operation. Moreover a number of holes in it allowed the suture to pass through the plate and rib, avoiding displacement of the prosthesis. This is the first report which describes the usefulness of orthopedic reconstruction plates for the stabilization of multiple rib fractures.

  2. Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study.


    Oner, Sedat; Okumus, Muhammed Masuk; Demirbas, Murat; Onen, Efe; Aydos, Mustafa Murat; Ustun, Mehmet Hakan; Kilic, Metin; Avci, Sinan


    Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure used for successful treatment of renal calculi. However, it is associated with various complications. We assessed the complications and their potential influencing factors in patients who had undergone PNL. In total, 1750 patients who had undergone PNL from November 2003 to June 2011 were evaluated retrospectively. PNL complications and possible contributing risk factors (age, sex, serum creatinine level, previous operations, hydronephrosis, calculi size, localization, opacity, surgeon's experience, accessed calyxes, number of accesses, and costal entries) were determined. Receiver operating characteristic (ROC) analysis was used to investigate the cutoff values of the data. Ideal cutoff value was determined by Youden's J statistic. All the demographic and clinical variables were examined using backward stepwise logistical regression analysis. Continuous variables were categorized with logistic regression analysis according to the cutoff values. Complications occurred in 396 (24.4%) patients who had undergone PNL. Hemorrhage requiring blood transfusion occurred in 221 (12.6%) patients, hemorrhage requiring arterial embolization occurred in 7 (0.4%) patients, perirenal hematoma occurred in 17 (0.97%) patients, hemo-pneumothorax occurred in 32 (1.8%) patients, and colon perforation occurred in 4 (0.22%) patients. Three patients (0.06%) died of severe urosepsis, and one patient (0.02%) died of severe bleeding. The calculus size, localization, access site, number of accesses, presence of staghorn stones, surgeon's experience, and duration of the operation significantly affected the complication risk. Our retrospective evaluation of this large patient series reveals that, PNL is a very effective treatment modality for kidney stones. However, although rare, serious complications including death can occur.

  3. Experimental Computed Tomography-guided Vena Cava Puncture in Pigs for Percutaneous Brachytherapy of Middle Mediastinal Lymph Node Metastases

    PubMed Central

    Zhao, Min; Liu, Bin; Li, Sheng-Yong; Wang, Yong-Zheng; Li, Yu-Liang; Hertzanu, Yancu


    Background: Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model (group of 12 pigs) to assess the safety and feasibility of computed tomography (CT)-guided vena cava puncture. Methods: Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava (AVC) in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results: Following postoperative enhanced CT, two animals were found to have a small pneumothorax (one being hemopneumothorax). The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93–100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions: CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava. PMID:25881603

  4. Primary pleuropulmonary synovial sarcoma diagnosed by fine needle aspiration with cytogenetic confirmation: a case report.


    Taylor, Cullen A; Barnhart, Amanda; Pettenati, Mark J; Geisinger, Kim R


    Pleuropulmonary synovial sarcomas (PPSSs) are rare neoplasins that have been well described in recent years, although there are only very infrequent reports within the cytology literature. Such lesions present a diagnostic challenge on fine needle aspiration (ENA) due to several factors, particularly when the aspirate material displays monophasic, small cell or poorly differentiated morphology. Immunoperoxidase studies on cell block material and confirmation with molecular cytogenetics are important tools to establish the diagnosis and determine appropriate therapy. We report a case of PPSS in a 27-year-old man diagnosed by computed tomography (CT)-guided FNA with confirmation by conventional and molecular cytogenetics. A 27-year-old man presented with several rapidly enlarging, pleura-based masses following a several-month history of recurrent hemopneumothorax. Previous surgical pathology on decorticated pleura was interpreted as a reactive mesothelial proliferation at another institution. Upon referral, CT-guided transthoracic FNA was performed. Smears revealed a highly cellular, dispersed "small round blue cell" neoplasm in a hemorrhagic background. The cytomorphology, in conjunction with a select immunoperoxidase panel, was diagnostic of PPSS. Conventional and molecular cytogenetics subsequently provided confirmation of the diagnosis. PPSSs are uncommon neoplasms seldom diagnosed by FNA, with only very rare reports in the cytology literature. Although their cytomorphology has been well described, monophasic tumors and other morphologic variants present a diagnostic challenge and may be difficult to discern from a variety of neoplastic and reactive/reparative processes. Emphasis should be placed upon securing material at the time of aspiration for immunoperoxidase studies (cell block or core biopsy). In equivocal cases, conventional and/or molecular cytogenetic studies may be needed.

  5. Complications related to the Nuss procedure: minimizing risk with operative technique.


    Fallon, Sara C; Slater, Bethany J; Nuchtern, Jed G; Cass, Darrell L; Kim, Eugene S; Lopez, Monica E; Mazziotti, Mark V


    Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications. A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed. The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration. The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. [Thoracic drainage in trauma emergencies].


    Bergaminelli, C; De Angelis, P; Gauthier, P; Salzano, A; Vecchio, G


    A group of 191 cases of emergency tube thoracostomy for acute trauma reviewed retrospectively from March 1993 to March 1998 is reported. Of this group 169 were men and 22 were women. Their ages ranged from 16 to 73 years. The causes were as follows: 89 cases (46%) road accident; 33 cases (17%) accidental trauma; 33 cases (17%) someone else violence (assault, gunshot or stab wound); 15 cases (8%) work accident; 11 cases (6%) domestic accident and 5 cases (3%) iatrogenic trauma. In 32 patients a diagnosis of pneumothorax was made (2 tension, 11 for penetrating chest injuries, 19 after blunt trauma). In 2 cases of tension pneumothorax and in 3 cases of open pneumothorax a chest tube (24-28 Fr) in the third space in the mid-clavicular line was introduced. In the other patients it was decided to place a chest tube in the mid-axillary line in the fifth intercostal space to drain pneumothorax. Only in 7 cases suction was necessary. Fifty-four hemothorax (3 bilateral) were treated in 11 cases using thoracentesis, while the remaining cases were treated using the insertion of multiple drainage holes in the intercostal space (fifth in the mid-axillary line directed inferiorly and posteriorly). One hundred and three were the cases of hemopneumothorax: 24 of them received 2 chest tubes, the first (20-26 Fr) apically in the second intercostal space in the mid-clavicular line, the second (32-38 Fr) in the fifth intercostal space in the mid-axillary line. All the other cases were treated using a single thoracostomy. In 14 cases suction was applied. Two cases of chylothorax resolved by a large tube positioned in the chest (fifth intercostal space in the mid-axillary line) with a constant negative pressure were also observed. Duration of tube drainage ranged from 4 and 18 days, with an average of 11 days. Five infections of thoracostomy site and 1 empyema resolved by rethoracotomy were observed. Moreover, there were 3 complications: 2 subcutaneous placements and 1 little laceration

  7. Treatment of thoracic trauma in children: literature review, Red Cross War Memorial Children's Hospital data analysis, and guidelines for management.


    van As, Arjan Bastiaan; Manganyi, Rodgers; Brooks, Andre


    Thoracic injuries continue to be a leading cause of childhood trauma, despite the government's efforts to curb the scourge of this problem. Our review focuses on the incidence, etiology, and management of thoracic trauma in the pediatric population with reference to the recent experience at our institution in a developing country. For the literature review, the National Library of Medicine's PubMed database was searched for the following terms: "pediatric," "chest trauma," "hemothorax," "hemopneumothorax," "pneumothorax," "diaphragmatic," "esophageal," and "mediastinal injury." For the hospital data analysis, data of all 378 pediatric patients treated with thoracic injuries under the age of 13 years from 2008 to 2012 (a 5-year period), at the Red Cross War Memorial Children's Hospital, were retrospectively analyzed. The male to female ratio was 2.1:1 (255 males and 123 females). The mean age was 6.9 ± 2.3 years. Blunt chest trauma was responsible for chest injuries in 90.5%, while penetrating trauma caused 9.5% of the injuries. Road traffic crashes were the mean cause (48.9%) with pedestrian injuries in 72.4% and passenger injuries in 27.6%, respectively. Sports injuries were the cause in 4% and falls from a height in 22%. Most injuries occurred at home: inside one's own home (5%), outside one's own home (52%); inside someone else's home (44%); outside someone else's home (2%). Public space injuries occurred at schools or crèches in 77%, pavement or roads in 6%, and were not specified in 17%. Overall 74% presented with injuries of the thoracic cage; rib fractures occurred in 13%, chest wall contusions in 40%, and abrasions in 31%. Respiratory system injuries occurred in 22%; hemothoraces in 23%, pneumothoraces in 45%, and hemopneumothoraces in 29%. Cardiovascular injuries occurred in 16% of cases with vascular injuries in five patients (two firearms injuries and three motor vehicle crashes). Management was nonoperative in 79.4%, tube thoracotomy in 17.2%, and

  8. [Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters].


    Golubović, Zoran; Stanić, Vojkan; Trenkić, Srbobran; Stojiljković, Predrag; Stevanović, Goran; Lesić, Aleksandar; Golubović, Ivan; Milić, Dragan; Visnjić, Aleksandar; Najman, Stevo


    Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite

  9. Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?


    Zhang, M; Teo, L T; Goh, M H; Leow, J; Go, K T S


    Occult pneumothorax (OPTX) is defined as air within the pleural cavity that is undetectable on normal chest X-rays, but identifiable on computed tomography. Currently, consensus is divided between tube thoracostomy and conservative management for OPTX. The aim of this retrospective study is to determine whether OPTX can be managed conservatively and whether any adverse events occur under conservative management. Data on all trauma patients from 1 Jan 2010 to 31 December 2012 were obtained from our hospital's trauma registry. All patients with occult pneumothorax who had chest X-ray (CXR) and any CT scan visualizing the thorax were included. The exclusion criteria included those with penetrating wounds; CXR showing pneumothorax, hemothorax, or hemopneumothorax; those with prophylactic chest tube insertion before CT; and those with no CT diagnosis of OPTX. The complications of these patients were analyzed to determine if tube thoracostomy is necessary for OPTX and whether not inserting it would alter the outcome significantly. A total of 1564 cases were reviewed and 83 patients were included. Of these 83 patients, 35 (42.2 %) had tube thoracostomy after OPTX detection and 48 (57.8 %) were observed initially. Patients who had tube thoracostomy had similar ISS compared to those without (median ISS 17 vs. 18.5, p = 0.436). Out of the 48 patients who did not have tube thoracostomy on detection of an OPTX, 4 (8.3 %) had complications. In the group of 35 patients who had tube thoracostomy on detection of an OPTX, 7 (20 %) had complications. Of the 83 patients, a total of 12 patients had IPPV, of which 7 (58.3 %) had tube thoracostomy and 5 (41.7 %) did not. Patients who had tube thoracostomy under our care have a statistically significant likelihood of experiencing any complication compared to those without tube thoracostomy (odds ratio 9.92. The median length of stay was also longer (13 days) in those who had tube thoracostomy compared to those without (5

  10. Computed tomography (CT)-guided interstitial permanent implantation of (125)I seeds for refractory chest wall metastasis or recurrence.


    Jiang, Ping; Liu, Chen; Wang, Junjie; Yang, Ruijie; Jiang, Yuliang; Tian, Suqing


    To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence. © The Author(s) 2014.