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Tue Sep 15 18:30:18 BST 2009

Dear list members,

I would greatly appreciate your input on this case:

28 y.o. male, presents to the ER 24 hours after being stabbed twice to  
the thoracoabdominal area during a mass gathering. The patient is  
obviously intoxicated on psychoactive drug, complains of swelling and  
only very little pain. Vitals within normal limits. Clinical exam is  
remarkable for a massive cervical and left thoracic subcutaneous  
emphysema, 2 small stab wounds to the left latero-inferior chest wall  
and sub-xyphoid area. Hemodynamic is ok, positive Hamman sign, no  
dyspnea, abdomen is soft and non tender. Images of chest xray and  
chest CT scan are attached: subcutaneous emphysema, pneumomediastinum,  
small left PTX. Abdominal CT is negative, with no evidence of solid  
organ injury, no free air or fluid in peritoneal cavity.

How would you manage this case? I know this kind of trauma is bread  
and butter in some countries, but penetrating trauma are rather  
infrequent in my practice. I am particularly worried about a possible  
left diaphragmatic injury.

Matthieu Gensburger

Matthieu Gensburger
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Stab wound to the thoracoabdominal area