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The Spread of Chest Tumours to the Abdomen, and some Abdominal Tumours to the Chest - also a consideration of some relevant abdominal conditions in differential diagnosis, particularly of the Liver, Spleen and Pancreas.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Splenic trauma - a ruptured spleen does not always manifest immediately, and it is not uncommon for traumatised spleens to present with basal pleural reaction, basal 'pneumonia', or after a considerable interval (months or years) with a large post-traumatic splenic cyst. In cases of delayed presentation, the author has used ultra-sound and colloid isotope scans (Illus. SPLEEN SCAN) to demonstrate a large defect within the spleen, or that the splenic tissue is in two parts. CT may also demonstrate a ruptured spleen and a perisplenic haematoma (Illus. SPLENIC HAEMATOMA & SPLENIC TRAUMA).
The birth of modern surgery – from Lister to the 20th century
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
The spleen is the viscus most commonly damaged in closed abdominal injuries, particularly with a severe crushing blow to the left lower chest or the abdomen. Although spontaneous healing may occasionally occur, untreated the majority of patients with this injury will die of exsanguination. Rather surprisingly, therefore, there seemed in the pioneer days of abdominal surgery to be a diffidence by surgeons to open the abdomen in this condition and to remove the ruptured spleen. This was in spite of the fact that Jules Péan (see Figure 8.3) had performed a successful elective splenectomy in 1867 in a girl of 20 suffering from an enormous splenic cyst. The first two unsuccessful attempts to be recorded were reported in 1892 by Sir William Arbuthnot Lane (1856–1943) (see Figure 10.8) of Guy’s Hospital. The first was a boy of 15 who fell off a brougham, landed on its pole and was operated on by Lane shortly afterwards. The pulped spleen was removed, but the patient died 5 hours later. The second was a boy of 4 who received a blow on the abdomen from the pole of a carriage. Splenectomy was performed for the completely ruptured spleen, but the child survived only a few hours. The following year Friedrich Trendelenburg (1844–1924), a professor of surgery in Leipzig, reported a further unsuccessful splenectomy for trauma and indeed published two further fatal cases. Reading these case reports suggests that, had blood transfusion been available, these patients might well have survived.
Do we still need cryoprecipitate? Cryoprecipitate and fibrinogen concentrate as treatments for major hemorrhage — how do they compare?
Published in Expert Review of Hematology, 2018
Alex Novak, Simon J. Stanworth, Nicola Curry
A 21-year-old motorcyclist was brought to the Emergency Department (ED) having been thrown from his vehicle at 70 mph. Primary survey of his injuries was indicative of blunt trauma to his chest, abdomen and pelvis, with left thigh deformity suggestive of a femoral fracture. His blood pressure was found to be 60/40 mmHg, with a pulse of 136, and resuscitation was commenced immediately, with red cells and plasma along with 1 g tranexamic acid. In response to a low Glasgow Coma Score and the extent of his injuries, he was intubated and ventilated, and transported to ED via helicopter, receiving a total 2 units of blood and 2 units FFP during transfer due to ongoing hemodynamic instability. Upon arrival to the ED, he was observed to lose his cardiovascular output, and the trauma team immediately proceeded to perform a resuscitative thoracotomy, while continuing to administer PRBCs and FFP from the major hemorrhage pack in a 1:1 ratio via a Belmont Rapid Transfuser. Subsequent emergency thoracotomy identified no discernible cardiac injury or intrathoracic source of major hemorrhage other than a moderate left-sided hemothorax. Further bloods were requested including fibrinogen concentration. Following continued transfusion of further PRBCs, FFP and platelets from the second major hemorrhage pack, he regained cardiac output and was transferred urgently to theater for emergency laparotomy, which identified a large volume of intra-abdominal blood secondary to a ruptured spleen and left kidney, and a hepatic laceration. The fibrinogen concentration measured in theater was 0.9 g/L. Attempts to control the hemorrhage and continue resuscitation were unsuccessful and the patient died in theater shortly afterward.
Integrity of the tectorial membrane is a favorable prognostic factor in atlanto-occipital dislocation
Published in British Journal of Neurosurgery, 2020
Gil Kimchi, Gahl Greenberg, Vincent C. Traynelis, Christopher D. Witiw, Nachshon Knoller, Ran Harel
A 20-year-old male was admitted following a high-velocity motorcycle accident. He suffered multiple injuries including a subdural hematoma that required an ICP monitor insertion, a sternum fracture, a left pneumothorax and multiple lung contusions that necessitated the insertion of a chest tube. On presentation, he was in hemodynamic shock due to a ruptured spleen. His neurological status was GCS 9T and ASIA E. Once stabilized, a CT scan of the cervical spine was performed as part of a multi-trauma extended CT protocol that is practiced in our hospital. Radiographic indicators for AOD included a BDI of 17.4 mm, Powers Ratio of 1.09 and a Condylar-C1 Interval (CCI) of 5.7 mm bilaterally (Figure 1(A,B)). The patient was rigidly immobilized (sand bags immobilization was used in all cases upon diagnosis) and an emergent splenectomy was performed. Immediately following surgery, a cervical MRI demonstrated extensive cervical ligamentous injuries with disruption of the apical and alar ligaments, albeit a preserved tectorial membrane (Figure 1(D)). Medullary edema was also noted (Figure 1(C)). This dislocation was classified as a combined Traynelis Type I and II, based radiographically on an anterior and upward cranial displacement. The patient remained intubated and was admitted to the intensive care unit (ICU). He underwent an occipitocervical fusion three days thereafter. The patient was able to breathe independently through an endotracheal canula, and remained ASIA E throughout his admission. He completed a three months rehabilitation program. He returned to work four months following his injury. His latest follow up visit at our clinic was eight months after the injury; he has no sensory-motor deficits and ambulates independently. He was noted to have a positive bilateral Babinski’s, Tremner’s and Hoffman’s signs but remains asymptomatic.
Emergency Ambulance Utilization in Harlem, New York (July 1985)
Published in Prehospital Emergency Care, 2022
Superior levels of training however necessitate vigorous medical control. Rosen notes it would be frivolous to spend an hour in the field giving normal saline to a patient with a ruptured spleen (14). Boyd, Edlich, and Micik in their 1983 textbook – the first in the area of EMS System Development – point out “the problem of paramedics spending excessive amounts of time in the field evaluating ‘protocol’ trauma cases, thus losing valuable minutes, while not yet under surgical control” (37).