Delayed Massive Hemothorax Due to a Diaphragmatic Laceration Associated With Lower Rib Fractures. A Penetrating Injury in Blunt Trauma

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

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Video-Assisted Minithoracotomy for Pulmonary Laceration with a Massive Hemothorax

Case Reports in Emergency Medicine ◽

10.1155/2014/454970 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Hideki Ota ◽

Hideki Kawai ◽

Shuntaro Togashi ◽

Tsubasa Matsuo

Keyword(s):

Blunt Trauma ◽

Thoracoscopic Surgery ◽

Middle Lobe ◽

Computed Tomographic ◽

Video Assisted ◽

Threatening Condition ◽

Massive Hemothorax ◽

Pulmonary Parenchyma ◽

Pulmonary Laceration ◽

The Right

Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy. The safety and efficacy of video-assisted thoracoscopic surgery (VATS) techniques for this life-threatening condition have not been fully evaluated yet. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy). A 22-year-old man was transferred to our department after a falling accident. A diagnosis of right-sided pneumothorax was made on physical examination and urgent chest decompression was performed with a tube thoracostomy. Chest computed tomographic scan revealed pulmonary laceration with hematoma in the right lung. The pulmonary hematoma extending along segmental pulmonary artery in the helium of the middle lobe ruptured suddenly into the thoracic cavity, resulting in hemorrhagic shock on the fourth day after admission. Emergency right middle lobectomy was performed through video-assisted minithoracotomy. We used two cotton dissectors as a chopstick for achieving compression hemostasis during surgery. The patient recovered satisfactorily. Video-assisted minithoracotomy can be an alternative approach for the treatment of pulmonary lacerations with a massive hemothorax in hemodynamically unstable patients.

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Transdiaphragmatic Intercostal Herniation following Blunt Trauma

Case Reports in Radiology ◽

10.1155/2012/502765 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Debkumar Sarkar ◽

Melissa Warta ◽

Jason Solomon

Keyword(s):

Blunt Trauma ◽

Surgical Repair ◽

Rib Fractures ◽

Diaphragmatic Rupture ◽

Clinical Entity ◽

Rare Clinical Entity ◽

Intercostal Hernia

Intercostal herniation is very rarely and sporadically reported in the literature. Intercostal hernia can occur following blunt trauma and may be associated with rib fractures. We present a case of a patient who presented with rib fractures, diaphragmatic rupture, and intrathoracic herniation of abdominal contents with subsequent herniation of both lung and abdominal contents through an intercostal defect. The patient was successfully treated with primary surgical repair of the diaphragm and intercostal hernia. The presentation, pathophysiology, and management of this rare clinical entity are discussed.

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Hepatic trauma: effects of delay in presentation

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.904 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Hasnat Ahmad Butt ◽

Saquib Zahur ◽

Anwar Ul Haq

Keyword(s):

Prospective Study ◽

Blunt Trauma ◽

Penetrating Injury ◽

Hepatic Trauma ◽

Early Presentation ◽

Different Types ◽

Ultimate Outcome ◽

Age Range

Objective: Hepatic trauma carries a substantial amount of morbidity & mortality. Purpose of study: The purpose of the study is to study the effects of delay in initiation of management of patients suffering from hepatic trauma. Design: Prospective study. Place & duration: The study was carried out in the Department of Surgery, Mayo Hospital Lahore from the year 1995-1997. Patient & methods: 57 patients were included in this study. They were operated and different methods of repair were employed. Results: 57 patients were studied. 50 were males, 7 were females. They belonged to an age range of 12-62 years. 55.7% patients suffered from blunt trauma while the rest of the cases were of penetrating injury. Over 50% of the patients presented within 4 hours of injury. All of the patients were operated and there findings noted. Different types of haemostatic measure were employed. There were ten mortalities in this study. Conclusions: Early presentation to the hospital of hepatic trauma cases, has a good impact o n the ultimate outcome of the patients.

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To be a surgeon may be life saving

Trauma ◽

10.1177/1460408620933202 ◽

2020 ◽

Vol 22 (4) ◽

pp. 320-323

Author(s):

Erhan Aysan

Keyword(s):

Hemodynamic Instability ◽

Rib Fractures ◽

General Surgeon ◽

Late Development ◽

Multiple Rib Fractures ◽

Motorcycle Accident ◽

Life Saving ◽

Massive Hemothorax ◽

Life Threatening ◽

At Home

In the first 24 h after multiple rib fractures, a life-threatening massive hemothorax is very rare but can cause death at home in cases who have been discharged. A 50-year-old male general surgeon, was admitted to the emergency unit after a motorcycle accident. Multiple rib fractures were diagnosed but no hemopneumothorax or hemodynamic instability were observed. After 24 h of observation, he was discharged. On the fifth day at home he was woken by symptoms of acute massive hemothorax. With the assistance of his wife he commenced intravenous fluid resuscitation to treat his own hemodynamic instability and transferred himself to his own hospital via ambulance where he subsequently underwent thoracotomy for arrest of haemorrhage. Late development of a massive hemopneumothorax after multiple rib fractures is rare, but may be a life-threatening risk. Such patients should be more closely followed up and informed about symptoms and treatment.

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