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Thoracic Trauma

Featured Article: Haemothorax

Haemothorax

Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, lung parenchymal and minor venous injuries, and as such are self-limiting. Less commonly there is an arterial injury, which is more likely to require surgical repair.

 

Featured Case Study: A Stab Wound to the Right Auriculoventricular Junction

A patient came to our hospital trauma center with profound shock following a stab attack. The stab entry point was the right anterior chest wall. The injury was repaired and the patient discharged following a good recovery.

Featured Images

  • Aortic Arch stab wound - Pledget repair

    Cervicosternotomy revealing haematoma in aorta, innominate trunk and left common carotid artery

    César Benítez Pozo ,Victor Vasquez ,Pamela Pedrero ,José Salinas .Equipo Cirugia Torax y Cardiaca y S Urgencia Hospital San Juan de Dios Universidad de Chile .Santiago de Chile

  • Total inflow occlusion manoeuvre of the heart

    Occlusion of the venous return to right cardiac chambers by clamping the superior and inferior vena cava

    Lt Col Luis Manuel Garcia-Nunez MD Military Central Hospital, Mexico City.


  • Pulmonary contusion injury in blunt trauma

    A pulmonary contusion

    Dr. Gabriel Mejia Consuelos, SF, ACS, COT Hospital General Balbuena, Mexico City


  • Right Atrial Injury

    Injury to the right atrium

    Juan C Duchesne MD, FACS, FCCP Spirit of Charity Hospital, New Orleans


  • Sternotomy Post Stab Wound to the Heart

    Stab wound to the heart

    Juan C Duchesne MD, FACS, FCCP

  • Tension Pneumothorax

    Servicio de Urgencias Hospital La Moraleja Madrid-Spain Dr. Santiago Doménech

    Santiago Domenech MD Hospital La Moraleja. Madrid-Spain Emergency Dpt.



Recent Images

  • Blast injury to the diaphragm

    Repair of the left hemidiaphragm via a pericardial patch

    John Barba P.,César Benítez P., Gabriela Icaza Z, Elsa Freire M. CardioThoracic Surgery Team, Hospital Luis Vernaza - Universidad de Guayaquil, Ecuador.

  • A Tension Pneumothorax

    Chest radiograph of a left sided tension pneumothorax

    Dr B. Hanterdsith


  • Post-traumatic pseudoaneurysm of the bracheocephalic trunk

    Intra-operative image of a double preicardial patch repair to a post-traumatic brachiocephalic pseudoaneurysm

    Dr. Juan Javier Zuniga Bohorquez, Dr.Cesar Benitez Pozo, Dr. Moises Idrovo Hugo, Dr. Manuel Reyes Marin, Dr Cesar Guarquila, Dr. Leslie Flor Izaguirre, Cardiothoracic Surgery, Luis Vernaza Hospital, Guayaquil, Ecuador


  • Penetrating cardiac injury repair

    Penetrating cardiac injury repair

    Dr Juan Javier Zuñiga Bohorquez, Dr Cesar Benitez Pozo, Dr Carlos Luis Salvador - Cardiothoracic Surgery Team, Hospital Luis Vernaza JBG Guayaquil - Ecuador


  • Aortic Arch stab wound - Pledget repair

    Cervicosternotomy revealing haematoma in aorta, innominate trunk and left common carotid artery

    César Benítez Pozo ,Victor Vasquez ,Pamela Pedrero ,José Salinas .Equipo Cirugia Torax y Cardiaca y S Urgencia Hospital San Juan de Dios Universidad de Chile .Santiago de Chile

  • Drain sutured in place

    Trauma.org



All Images in This Category »

Article List

Initial evaluation

Chest Trauma Initial Evaluation

, February 09, 2004

Summary

Hypoxia and hypoventilation are the primary killers of acute trauma patients. Assessment of ventilation is therefore given high priority in the primary survey - as the second ‘B’ or Breathing stage. It may be obvious that there is a ventilatory problem during assessment of the airway. Similarly, the identification or actual severity of certain conditions may only be determined subsequently, after assessment of the circulation or the use of monitoring or diagnostic adjuncts.

Rib fractures & Flail Chest

Chest Trauma Rib fractures & Flail Chest

, February 09, 2004

Rib fractures & Flail Chest

Chest wall injury is a extremely common following blunt trauma. It varies in severity from minor bruising or an isolated rib fracture to servere crush injuries of both hemithoraces leading to respiratory compromise.

Pneumothorax

An overview of pneumothoraces - diagnosis & management

, May 09, 2009

Diagnosis & management of simple pneumothorax

Tension Pneumothorax

The diagnosis and management of tension pneumothorax.

Karim Brohi, London, UK, July 01, 2006

Diagnosis and management of tension pneumothorax.

Haemothorax

Chest Trauma Haemothorax

, September 30, 2010

Haemothorax

Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, lung parenchymal and minor venous injuries, and as such are self-limiting. Less commonly there is an arterial injury, which is more likely to require surgical repair.

 

Pulmonary Contusion

Chest Trauma
Pulmonary Contusion

, February 09, 2004

Pulmonary Contusion

Pulmonary contusion is an injury to lung parenchyma, leading to oedema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance.

Chest drain insertion

Intercostal Chest Drains

, March 09, 2004

Chest Trauma

Intercostal Chest Drains

Drainage of the pleural space by means of a chest tube is the commonest intervention in thoracic trauma, and provides definitive treatment in the majority of cases. While a relatively simple procedure, it carries a significant complication rate, reported as between 2% and 10%. While many of these complications are relatively minor, some require operative intervention and deaths still occur.

Emergency Department Thoracotomy

Indications and technique of resuscitative thoracotomy

Karim Brohi, London, UK, September 30, 2006

Emergency department thoractomy is performed in the emergency room for patients in traumatic arrest or profoundly shocked. This article discusses the indications for emergency department thoracotomy and describes the operative technique and resuscitative management of these patients.

Focused Assessment with Sonography for Trauma (FAST)

A primer on the FAST exam

Karim Brohi, London, UK, July 02, 2006

A primer on the FAST ultrasound examination.

Tension pneumothorax

Chest Trauma Pneumothorax - Tension

, February 09, 2004

Tension pneumothorax

Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect.  Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest.

Needle Thoracostomy

, February 08, 2003

Case Presentations

Cardiac laceration

Athanasios Pantelis, MD

, August 13, 2012

A patient was transferred to the Emergency Department of our hospital, having sustained two major stab injuries to the upper abdomen.

Traumatic diaphragmatic Injury (Right side)

b banga, December 22, 2010

A middle aged female presented with multiple # ribs and right side haemothorax after a road accident. A chest tube was put in to drain the hemothorax. She was comfortable, no respiratory distress and maintaining the oxygen saturation without oxygen supplementation. There is decrease air entry at base and check X-ray revealed markedly elevated diaphragm on Rt. Side.

C.T.Chest-suspicion of traumatic diaphragmatic hernia with herniation of liver in thorax. I planned lateral thoracotomy through 7th I.C.space. Before opening I put Laparoscope through chest tube site and confirmed the diagnosis. Liver and a part of colon were in thorax. After opening both structures could be reduced easily. Rent in diaphragm repaired with 1/0 Prolene suture. Post operative – uneventful recovery

A Stab Wound to the Right Auriculoventricular Junction

sam zeraatian nejad davani, October 18, 2010

A patient came to our hospital trauma center with profound shock following a stab attack. The stab entry point was the right anterior chest wall. The injury was repaired and the patient discharged following a good recovery.

Aortic Dissection in Blunt Trauma

Tiffany Frederickson, MD, August 21, 2010

A patient involved in a car accident causing his vehicle to roll, sustained an aortic dissection just distal to the renal arteries requiring open aortic grafting to repair it.

Biventricular shotgun injury of the heart

with involvment of proximal RCA and LAD

sam zeraatian nejad davani, July 31, 2010

20 years old man came with profound shock and bilateral massive hemothorax and jugular vein distension as result of cardiac tamponade. He underwent successful cardiac repair and had an uneventful post operative course.

Penetrating Cardiac Injuries

How to get the best possible outcome?

Denis Allard, GF Jooste hospital Manenberg, January 10, 2009

82% survival in 35 consecutive stab heart patients was achieved in a South African metropolitan community hospital during the year 2008. Excellent and expediant prehospital management, skilled emergency room personnel and available surgical skill is necessary to achieve these results. The survival rate depends on the number of patients analyzed. The last 160 patients have a 70% survival rate, the last 35 patients have an 82% survival rate. Every surgical team can achieve good results under appropriate leadership.

Impalement on the top of fence

Edoardo Ghirardi, March 15, 2008

Thoracic trauma caused by a dart on the top of a fence.

Thoracic gunshot and retroaortic bullet

An example of why bullets should not be removed.

Karim Brohi, London, UK, July 27, 2007

Classic Case: Tension Haemothorax

A classic description of the tension haemothorax

Karim Brohi, London, UK, July 01, 2006

A classic description of tension haemothorax.

Classic Case: Tension Gastrothorax

Karim Brohi, London, UK, July 01, 2006

A rare case of tension gastrothorax following blunt trauma and diaphragmatic rupture.