The combined utility of extended focused assessment with sonography for trauma and chest x-ray in blunt thoracic trauma

Abstrak. Trauma tumpul toraks memiliki insiden yang sangat tinggi pada populasi dewasa, 20 – 50 % dari kasus dapat mengakibatkan kematian. Cedera pada struktur pembuluh darah dari bagian dada atas, terutama pembuluh darah arteri subklavia kiri, sangat jarang ditemukan dan biasanya disertai dengan “hematotoraks massif”. Observasi ketat dari tanda- tanda vital dan foto toraks serial sangatlah penting. Kami paparkan sebuah kasus jarang dari seorang pasien yang mengalami cedera traumatik arteri subklavia kiri. Tidak ditemukan gambaran klinis dari hematoma di supra klavikula, pulsasi arteri radialis kiri tidak teraba, dan tidak ditemukan pelebaran dari mediastinum pada foto toraks. Tetapi didapatkan hematotoraks massif kiri. Dilakukan posterolateral torakotomi kiri, dijumpai sumber perdarahan dari bagian apex paru kiri, dicurigai terdapatnya robekan dari pembuluh darah arteri subklavia kiri. Tindakan dilanjutkan dengan insisi median sternotomy yang diperluas ke arah supraklavikula kiri, ditemukan rupture total dari arteri subklavia kiri dengan jarak 1,5 cm proksimal dari arkus aorta. Tindakan repair (perbaikan) arteri secara primer (end to end anastomosis) dilakukan dengan hasil baik. (JKS 2017; 2: 105-114)Kata kunci : Trauma tumpul toraks, hematotoraks massif, cedera arteri subklavia kiriAbstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture of left subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. (JKS 2017; 2: 105-114)Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

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LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v18i2.17999 ◽

2018 ◽

Vol 18 (2) ◽

pp. 93-100

Author(s):

Yopie Afriandi Habibie ◽

Ign Wuryantoro

Keyword(s):

Subclavian Artery ◽

Thoracic Trauma ◽

Left Subclavian Artery ◽

Primary Repair ◽

Median Sternotomy ◽

Traumatic Rupture ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Massive Hemothorax ◽

Chest X Ray

Abstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture ofleft subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

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Chest x-ray as a screening tool for blunt thoracic trauma in children

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31829bb7fe ◽

2013 ◽

Vol 75 (4) ◽

pp. 613-619 ◽

Cited By ~ 16

Author(s):

Natalie L. Yanchar ◽

Kenneth Woo ◽

Maureen Brennan ◽

Cameron S. Palmer ◽

Michael ZS Ee ◽

...

Keyword(s):

Thoracic Trauma ◽

Screening Tool ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Chest X Ray

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Thoracic Trauma

10.2310/em.4352 ◽

2020 ◽

Author(s):

William E. Baker ◽

Ron Medzon

Keyword(s):

Blunt Trauma ◽

Thoracic Trauma ◽

Flail Chest ◽

Penetrating Trauma ◽

Pulmonary Contusion ◽

X Ray ◽

Computed Tomographic ◽

Computed Tomographic Scan ◽

Chest X Ray ◽

Lung Point

More than 85% of blunt and penetrating trauma to the thorax results in injury to the lungs or ribs. Among civilians, blunt trauma is the most common mechanism, while penetrating trauma is the most common among military sectors. This review describes the assessment and stabilization, diagnosis, treatment and disposition, and outcomes of thoracic trauma. Videos shows the “lung point” sign on M-mode and two-dimensional ultrasonography, and a transthoracic echocardiogram clip of pericardial clot and tamponade due to a gunshot wound. Figures show a sonogram showing the “lung point sign”, a chest x-ray and computed tomographic scan demonstrating right-sided hemothorax in a patient with a right chest stab wound, and a three-dimensional computed tomographic scan and chest x-ray of a blunt trauma patient with displaced fractures of the left lateral sixth to ninth ribs. Tables list types of injuries, NEXUS chest decision instrument imaging criteria, level 2 evidence-based recommendations for the management of pulmonary contusion and flail chest by the Eastern Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma practice guidelines for managing issues with pulmonary contusion and flail chest, and the Vancouver simplified and University of Washington grading systems for blunt aortic injury. This review contains 2 videos, 4 highly rendered figures, 10 tables, and 94 references.

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Cohort Study on the Prevalence and Risk Factors for Delayed Pulmonary Complications in Adults Following Minor Blunt Thoracic Trauma

CJEM ◽

10.2310/8000.2013.131043 ◽

2014 ◽

Vol 16 (02) ◽

pp. 136-143 ◽

Cited By ~ 9

Author(s):

Miville Plourde ◽

Marcel Émond ◽

André Lavoie ◽

Chantal Guimont ◽

Natalie Le Sage ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Thoracic Trauma ◽

Significant Risk ◽

Significant Risk Factor ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Delayed Complications ◽

Delayed Pneumothorax

ABSTRACTObjectives:The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma.Method:A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray.Outcomes:Delayed hemothorax occurred in 11.8% (95% CI 8.8–14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2–2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62–3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60–6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80–14.19) for the upper ribs (third to fifth rib) versus patients with no fractures.Conclusion:The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax.

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Comparison of occult pneumothorax and pneumothorax cases in thoracic trauma: A descriptive, cross-sectional study

Journal of Emergency Medicine Trauma and Acute Care ◽

10.5339/jemtac.2021.5 ◽

2021 ◽

Vol 2021 (1) ◽

Author(s):

Semra Aslay

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Thoracic Trauma ◽

Tension Pneumothorax ◽

Penetrating Trauma ◽

Trauma Patients ◽

Chest Computed Tomography ◽

X Ray ◽

Occult Pneumothorax ◽

Chest X Ray

Background: The emergency department usually takes a supine posteroanterior (PA) chest X-ray imaging in trauma patients. In some cases, pneumothorax is not seen in the chest X-ray because of the patient's position. These cases are called occult pneumothorax. Misdiagnosis of occult pneumothorax in the emergency department may lead to complications such as tension pneumothorax. This study aimed to update patients’ features with occult pneumothorax due to blunt or penetrating trauma. Methods: In this study, data of 615 thoracic trauma patients admitted to the emergency department between January 2008 and December 2010 were evaluated. In total, 157 patients had undergone both chest X-ray and chest computed tomography and were diagnosed with pneumothorax. Of the 157 patients, 52 were excluded due to some criteria. Data of 105 patient, including their characteristics, trauma types, accompanying traumas, etiology of the chest trauma, chest X-ray findings, and computed chest tomography results were recorded. Data obtained were compared with the results of similar studies conducted in the last 10 years. Chest computed tomography was considered the gold standard for the diagnosis of pneumothorax. Results: The mean patient age was 36.19 ± 14.74 years. Occult pneumothorax was detected in 8 of 105 patients, giving a 7.6% overall incidence of occult pneumothorax. A traffic accident was the most common cause of etiology. All occult pneumothorax cases were caused by blunt trauma, and tube thoracostomy was performed in all of them. No significant differences were found between pneumothorax and occult pneumothorax cases concerning the etiology, accompanied trauma, intervention types, and trauma reasons (p < 0.05). Conclusions: This study supports the incidence of occult pneumothorax reported in the literature. When a patient is admitted with thoracic trauma, a physician should carefully evaluate the patient through supine chest X-ray examination. Only one misdiagnosis in trauma patients can be lead to many unintentional clinical and forensic results.

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