Kinoshita, Haruyuki; Akiyama, Naoko; Murao, Masaki; Yamauchi, Yosuke; Nakamura, Teruya; Sekiya, Naosumi; Toyota, Naoyuki; Miyagatani, Yasusuke
We experienced a case of a subtype of spontaneous hemopneumothorax caused by external forces associated with a seat-belt injury. A female aged 39 years sustained a minor collision with an oncoming car while she was driving. Although pneumothorax was not detected, hemothorax and bleeding from the area surrounding the subclavian artery were observed on contrast-enhanced chest computed tomography (CT). After confirming continuous bleeding into the thoracic cavity after superselective arterial embolization, we performed emergency open surgery. We found a bulla in the apex of the lung, and the thoracic stump of the bulla was considered the source of bleeding. In this case, the direct cause of hemothorax was considered to be the external force associated with the seat-belt injury. When a bulla in the apex of the lung and continuous bleeding are both observed on CT, spontaneous hemopneumothorax should be suspected, necessitating open chest surgery in cases where pneumothorax is not observed.
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
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
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.
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.
Myre, L E; Black, R E
There were over 70,000 injuries to children caused by air guns reported from 1981 to 1984. The majority of these injuries were minor; however, serious injury resulted in eight deaths. Reported injuries include corneal perforation, liver laceration, stomach and intestinal perforation, intracranial bleeding, cardiac perforation, and hemopneumothorax. Primary care physicians must be aware of the potentially serious or lethal nature of air gun injury and educate their patients accordingly. Legislation is also needed to restrict the sale of these guns, or increase the safety of air gun use. We report five cases of potentially life-threatening injury caused by air guns, three of which required emergency laparotomy. PMID:3313302
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; Zarogoulidis, Paul
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
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.
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
Vaccarili, M; Lococo, A
Video assisted thoracic surgery (VATS) has assumed greater importance in the management of pleural diseases. From 1994 to 1998 the Authors report their experience about 11 cases of hemothoraces depending on various causes: 6 hemothoraces and 3 hemopneumothoraces, some spontaneous or iatrogenic, others in patients with chest trauma; 2 clotted hemothoraces. All patients were studied by VAT detecting the source of bleeding in 6 cases of acute hemothorax and in 3 cases of acute hemopneumothorax; in 5 cases the lesions were successfully repaired with thoracoscopic technique. In others 4 patients the VATS approach was converted to thoracotomy for the seriousness of lesions: 3 acute hemothoraces (1 patient with penetrating thoracic firearms injury, 1 patient with extended lung laceration, 1 patient with iatrogenic lesion of right subclavian artery); 1 acute hemopneumothorax in one patient with penetrating thoracic firearms injury and left hemidiaphragmatic double perforation: in this case laparotomy was also operated in order to exclude others abdominal lesions. 2 cases of clotted hemothorax were operated by VATS performing the removal of clots after their fragmentation by endobabcock and pleural irrigation-aspiration with physiological solution. No procedure related complications were occurred. The authors conclude that the video-thoracoscopic approach is certainly advantageous for the management of spontaneous, traumatic or iatrogenic acute hemothoraces. This technique permits, with minimal traumatism and very little complications, the correct therapeutic programming (VATS operation or conversion to thoracotomy). However some hemothoraces (hemothoraces in patients with serious cranial trauma, with spleen rupture, with great vessels rupture, with heart rupture or with massive post-operating hemothorax) contro-indicate the thoracoscopic treatment: immediate thoracotomy and/or laparotomy, in these cases, is indispensable. In the treatment of clotted hemothoraces the VATS
Rosato, R M; Shapiro, M J; Keegan, M J; Connors, R H; Minor, C B
During a 3-year period (1986-1989), 8 patients were seen at St. Louis University Medical Center exhibiting the stigmata of traumatic asphyxia. Fewer than 200 cases of traumatic asphyxia have been reported and there is only a single report of a cardiac injury. In this series, 3 of 8 (37.5%) patients were found to have an injury to the heart: two cardiac contusions and a ventricular rupture. Five patients were crushed in motor vehicle collisions, one by an elevator counterweight, and two patients by river barges. Injuries associated with these patients include pulmonary contusion, hemopneumothorax, traumatic pneumatocele, traumatic retinopathy, bone fractures, mental confusion, and liver contusion. There was one death in the series, a patient with rupture of the right ventricle and severe splenic and liver injuries. The cardiac status of the patients was evaluated by serial serum cardiac enzyme determinations, electrocardiograms, and echocardiography. This report illustrates the importance of complete cardiac evaluation in patients with traumatic asphyxia. PMID:1942148
Demir, Uygar; Alemdar, Ali; Ureyen, Orhan; Eryavuz, Yavuz; Mihmanli, Mehmet
Background This study aimed to propose treatment strategies for high-output chylous ascites (CA) developed after gastric cancer surgery. Methods The data of patients with CA after gastric cancer surgery in three high volume Training and Research Hospitals between 2005 and 2015 were retrospectively evaluated. Results Nine patients out of 436 gastrectomies were detected with CA. The mean amount of daily fistula output was 939 mL. Treatment consisted of cessation of oral feeding, total parenteral nutrition (TPN), somatostatin analogs administration, clamping and/or removal of the drainage tube, diuretic administration and diet therapy with medium-chain triglycerides (MCTs) alone or in combination. The mean fistula closure time and length of hospital stay were 23 and 24 days respectively. Hemopneumothorax developed during right subclavian vein catheterisation for TPN implementation in one patient. There was no mortality. Conclusions Combined cessation of oral feeding and TPN are usually used for treatment of CA as first-line treatment. However, TPN is no harmless. Although our data are limited they do allow us to conclude that diet with MCT’s may use for medical treatment of CA as first-line. PMID:27284475
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
Karbeyaz, Kenan; Ayranci, Unal; Balci, Yasemin; Gunduz, Tarik
Cattle-caused injuries and deaths are much more than predicted. The aim of this research is to determine the prevalence of cattle-caused fatalities and the factors affecting it in a province of western Turkey. The court files on cattle-caused fatalities during a 15-year period between 1996 and 2010 were explored. The proportion of forensic-qualified deaths from the total of 3753 was 0.9% (35/3753). Most of the cases were between the ages of 18 and 65 (60%). Most deaths occurred in the spring and summer months compared with autumn and winter months (9 and 22 vs. 3 and 1, respectively). The mortality rate was much higher in men compared with women (94.3% and 5.7%, respectively). The majority of deaths were caused by injuries on the chest (71.4%). The reason for most deaths was due to hemopneumothorax and lung injury (71.4%). Predicting the behavior of cattle may not always be possible, as such, it is advisable that one wears protective equipment when dealing with cattle. PMID:23550776
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
Liu, Yueju; Li, Guangbin; Dong, Tianhua; Zhang, Yingze; Li, Heng
OBJECTIVE: To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures. METHOD: From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed. RESULTS: All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences in the anterior vertebral body height pre- and post-surgery and in the sagittal Cobb angle and the percentage of spinal stenosis (p<0) in all patients. CONCLUSIONS: This surgical procedure is simple and can accomplish decompression, reduction, fixation and fusion of the spine in one stage. This approach could be widely used in orthopedics. PMID:25627991