Trauma
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
Haemothorax is accumulation of blood in the pleural cavity. Features are as for tension pneumothorax except percussion is dull rather than resonant. The pericardium fills with blood and restricts cardiac output. Cardiac tamponade can be easily confused clinically with tension pneumothorax. Causes of agitation in a trauma patient include hypoxia, hypovolaemia, hypoglycaemia, head injury, pain, intoxication, full bladder, tight dressings. The general principles of trauma management apply to any head injury: maintain oxygenation and cerebral perfusion by avoidance of hypoxia and hypotension. The aim of a burr hole is to prevent death by decompressing and partially evacuating a haematoma, e.g. an extradural haematoma due to laceration of the middle meningeal artery. A flail segment exists when two or more adjacent ribs fracture in two or more places, creating a segment of chest wall that moves paradoxically with respiration. Assessment of the pelvis for instability should only be performed once, as this may displace any blood clots that have formed.
Thoracic trauma
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Atelectasis often develops as a consequence of thoracic trauma or any significant trauma, often due to pain and splinting. Similarly, acute respiratory distress syndrome (ARDS) can be seen as a complication of thoracic trauma but also with severe multisystem injuries. The investigation of paediatric thoracic trauma starts with a chest X-ray in the trauma bay to exclude any injury that needs to be addressed emergently such as pneumothorax. A focused assessment sonography in trauma exam can also be performed in the trauma bay to identify a haemopericardium. The most frequent complications of paediatric chest trauma are atelectasis and pneumonia. Empyema is another complication that may occur with an undrained or inadequately drained haemothorax. Patients present with decreased oxygenation, increased respiratory rate, chest pain and fever. Most often, there will be complete opacification of the affected lung on chest X-ray. The treatment of ARDS relies on supportive measures such as high-frequency oscillatory ventilation.
Thoracic trauma
Brice Antao, Michael S Irish in Succeeding in Paediatric Surgery Examinations, Volume 1, 2012
A1 C Overall, traumatic thoracic injuries account for only 5%–12% of trauma admissions in children. Most thoracic injuries are the result of blunt trauma. Rib fractures are not as frequent in children as in adults because of the greater flexibility of the thoracic cage in children. Therefore, energy transmitted to the thorax can cause a significant lung contusion without any rib fractures. For the same reason, flail chest is also very rare in children. Pneumothorax and haemothorax are usually associated with rib fractures.
An unusual cause of “traumatic” hemothorax: perforation of the lung parenchyma by a bifid rib
Published in Acta Chirurgica Belgica, 2020
Sander Ovaere, Anneleen Peeters, Lieven Depypere
Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs). These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited. We present the case of a 36-year old male without any relevant medical history or medication who was referred to our center. After lifting a heavy object, he experienced sudden onset pain on the right anterior chest, with associated shortness of breath. Computed tomography of the chest showed a significant hemothorax on the right side, compression atelectasis of the right lower lobe, and an anomalous fifth right rib – described as a bifid rib. A VATS resection of the bifid rib was performed.The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.
Giant Fibrous Tumor Misdiagnosed as Traumatic Hemothorax
Published in Acta Chirurgica Belgica, 2008
C. Tekinbas, A. Gunduz, S. Turedi, M.M. Erol, S. Ozsu
Solitary fibrous tumors of the pleura are neoplasms of the mesenchymal tissue of the pleural mesothelium. The most frequent symptoms are dyspnea, coughing and chest pain. A 45-year-old female patient presented after a thoracic contusion. A radio-opaque image was evidenced on chest X-ray. At the initial hospital, a hemorrhagic fluid was aspirated at thoracocentesis and the patient was transferred to our hospital with diagnosis of traumatic hemothorax. A thoracic CT showed a tumoral formation filling two-thirds of the left hemithorax. The transthoracic biopsy finding was compatible with a fibrous tumor. The patient was taken for surgery and the large pleural tumor was excised. In conclusion, a large pleural fibrous tumor was initially mistaken for hemothorax. A CT-scan revealed the tumoral nature of the thoracic opacity.
Blunt chest trauma as a cause of acute myocardial infarction
Published in Acta Clinica Belgica, 2014
H. Kara, A. Avcı, M. Akinci, S. Degirmenci, A. Bayir, A. Ak
Chest pain after thoracic trauma may be a symptom of cardiac injury or myocardial infarction. A 63-year-old healthy man had chest pain after blunt chest trauma in a motor vehicle accident. Chest computed tomography scan showed a displaced sternal fracture, lung contusion in the left upper lobe, atelectasis and consolidation in both lower lobes, and bilateral haemothorax. Electrocardiography showed ST elevation (2 mm) in leads II, III, and aVF and ST depression (2 mm) in leads I and aVL, consistent with acute inferior myocardial infarction. Urgent coronary angiography showed ostial occlusion of the right coronary artery. After the right coronary occlusion was passed with a guide wire, dissection of the right coronary artery was observed and treated with a balloon and stent to reestablish normal flow. This case emphasizes the importance of a high index of suspicion for coronary artery injury and myocardial infarction after blunt chest trauma.
Related Knowledge Centers
- Hemorrhage
- Pleura
- Trachea
- Ventricle
- Lung
- Mediastinum
- Pleural Diseases