[Clotted hemothorax caused by hemorrhage from the omentum in penetrating thoraco-abdominal injuries].
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After posttraumatic diaphragm ruptures in some cases life threatening haemorrhages from intraabdominal organs (especially from the spleen) into the thorax were found. In general, the diagnosis cannot be established by peritoneal lavage or abdominal sonography. And in case of emergency, there is often not enough time to obtain a computed tomography. It is therefore extremely important for the patient's prognosis that the surgeon initially performing treatment be aware of this cause of bleeding. Correct interpretation of the chest x-ray, for instance in the case of stomach air in a left basal shadow above the diaphragm, can confirm the suspicion, and the urgently required operation can be performed in time.
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Based on the experience with treatment of 26 patients the authors recommend to use mainly conservative treatment with the intrapleural administration of fibrinolytic drugs. The method was used in 20 patients. All of them recovered.
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The myocardial perforation of a pacemaker electrode is an extremely rare complication associated with the danger of cardiac tamponade. We report on a perforation of a ventricular screw-in electrode with migration through the pericardium and bleeding in the left thoracic cavity. Two-dimensional echocardiography in combination with clinical, electrocardiographic and X-ray examination permits a reliable non-invasive diagnosis.
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The authors describe what they believe is the first reported case of rupture of an infrarenal abdominal aortic aneurysm into the right pleural cavity. A 75-year-old woman presented simultaneously with two common causes of severe abdominal pain and hypotension: perforated duodenal ulcer and ruptured abdominal aortic aneurysm. The absence of an infrarenal retroperitoneal hematoma delayed the diagnosis of rupture of the abdominal aortic aneurysm and the terminal event was exsanguination into the right pleural cavity through an erosion in the right hemidiaphragm.