Stab wound to the thoracoabdominal area

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Matthieu,
Impressive photos, but given the fact that it is 24 hours after the stabbing, the LT pneumothorax is truly small (and I could not appreciate it on the plain film), the patient is pretty much asymptomatic and his VS are normal, I would FAST the fellow, admit, observe and probably only repeat the CXR.  If he had an injury to the esophagus or trachea,  mediastinitis would have already declared itself and he would probably be much sicker.  The only concern would be the left diaphragm, and depending on the location of the lateral stab wound, one could consider laparoscopy to r/o a diaphragmatic injury.
Ron


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Matthieu G.
Sent: Tuesday, September 15, 2009 1:30 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Stab wound to the thoracoabdominal area

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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