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Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
The CT angiogram reveals a large haematoma at the root of the neck extending into the superior thoracic aperture. The left subclavian artery has been lacerated at the root of the neck, about 2-cm deep into the superior thoracic aperture. It is not transected nor is it thrombosed. The Foley catheter is sitting just next to it and tamponading the bleeding area, but there is still some minor contrast extravasation around this area. A small amount of contrast is still passing into the distal subclavian artery beyond the injury, and the distal subclavian still appears to be patent. There is a moderate haemopneumothorax of the left chest, but the chest drain appears to be in the correct position. The subclavian vein does not obviously appear to be injured or bleeding, but to be honest the large haematoma makes interpretation challenging.
Role of Intercostal Drainage Tube in Chest Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
The most common indication for tube thoracostomy is pneumothorax and the second is hemithorax. The indications are multiple and commonly divided into emergent and non-emergent. The emergent indications are commonly seen in trauma patients. The indications include:Pneumothorax in the setting of mechanical ventilation or traumaA large pneumothoraxPneumothorax in a clinically unstable patientTension pneumothorax after needle decompressionHemopneumothorax and haemothoraxOesophageal rupture with evidence of leak into pleural space
The Extra-Pleural and Pleural Spaces, including Plombages, Pleural Tumours and the Effects of Asbestos.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
A spontaneoushaemopneumothorax is a type of spontaneous pneumothoraces, adhesions being torn by the sudden lung collapse. Clotting of blood in the pleural cavity has been studied by several authors, but in the absence of anticoagulants, it appears to occur normally, though not as solidly as blood within soft tissues. Blood which clots rapidly after aspiration almost certainly has come from a vessel in the chest wall or lung, etc. as respiratory movement tends to remove fibrin from clots and effusions. This fibrin becomes deposited as pleural thickening, or as a more localised mass, and may lead to a fibro-thorax, a fibrinous pleural body or a 'pleuralmouse' see also ps. 14.3 & 14.28 and Illus. PL-MOUSE.
Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study
Published in Expert Review of Respiratory Medicine, 2022
Hela Attia, Helmi Ben Saad, Karim Masmoudi, Imen Bannour, Mouna Ouaz, Kais Gardabbou, Ali Majdoub
The mean ± standard deviation of rib fractures was 5 ± 3. The topography of the rib fractures was bilateral in 32% of the patients. Flail chest was noted in 28% of the patients. Pleural effusions were observed in 52% of the patients, of which 23% were hemopneumothorax. Pulmonary contusions were noted in 28% of the patients. Table 3 presents the comparison between responses to nebulized MOR based on the described lesions. Compared to the MOR (+) group, the MOR (-) group had a higher mean of rib fractures (p = 0.005), and it included higher frequencies of patients with bilateral rib fractures (p < 0.0001), flail chest (p < 0.0001), hemothorax (p = 0.005), hemopneumothorax (p = 0.026), and pulmonary contusions (p = 0.002). A number of fractured ribs > 4 predicted the failure of inhaled MOR (AUC = 0.693, 95% confidence interval = 0.567 to 0.819) (Figure 3(b)).
Tension Hemopneumothorax in the Setting of Mechanical CPR during Prehospital Cardiac Arrest
Published in Prehospital Emergency Care, 2021
Dustin Rowland, Nicholas Vryhof, David Overton, Joshua Mastenbrook
Lastly, the authors acknowledge that one cannot state with absolute certainty that the patient had a tension component to the hemopneumothorax. Although the patient did have a rush of air during needle thoracostomy, research in the trauma literature using a swine model has shown that nearly two-thirds of tension pneumothorax cases treated with needle thoracostomy fail to relieve tension physiology and restore pulses (23). Despite 30 minutes of CPR, multiple defibrillations, epinephrine and lidocaine, it was not until after finger thoracostomy that ROSC was achieved. The EMS physician did report a rush of blood from the finger thoracostomy site immediately upon entering the pleural cavity but did not recall specifically if there was another significant amount of air released. Although the timing of ROSC may have been coincidental with the thoracostomy, there nevertheless exists the time association between finger thoracostomy and ROSC.
A rare cause of recurrent hemopneumothorax
Published in Acta Clinica Belgica, 2020
Mike Ralki, Alaaddin Yilmaz, Jacques Vanwing, Kristof Cuppens
Interestingly, our patient presented with a recurrent hemopneumothorax on the right side 1 month later. Chest tomography showed the emergence of multiple bilateral thin-walled cysts with surrounding ground glass attenuation compatible with progressive pulmonary metastasis (Figure 1(b)). Thoracoscopic exploration showed diffuse ulcerative pleural metastases and a mechanical pleurodesis was performed (Figure 3). Moreover, local recurrence of the angiosarcoma on the scalp was observed.