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PubMed1985

Mediastinal position and air-fluid height after pneumonectomy: the effect of the respiratory cycle.

After pneumonectomy, a shift of the mediastinum toward the nonoperated side may be the initial indicator of a postoperative problem such as empyema, bronchopleural fistula, esophageal-pleural fistula, hemothorax, or recurrent tumor. Postoperatively, a drop in the fluid level on the operated side may indicate a bronchopleural fistula or other fistulous connection. To assess the effect of the respiratory cycle on these two signs, 16 patients were studied with inspiration-expiration films. In every case the mediastinum shifted toward the normal side in expiration, and in no case did a fluid level change position by more than 5 mm with respiratory maneuvers. Therefore, the respiratory phase must be considered when assessing the significance of mediastinal shift after pneumonectomy.

Adult↗

PubMed1986

Thoracic injuries. A review of 93 cases.

A report is presented of 93 patients referred for specialist management of thoracic injuries in the 5-year period 1973-1978. Penetrating trauma to the thorax had been sustained by 18 patients and blunt trauma by 75. Falls and traffic accidents were the most common causes (32 and 35 cases). Rib fractures were the most frequent lesions, and 10 of these 67 patients had flail chest. Hemothorax and/or pneumothorax were found in four-fifths of the patients. The diaphragm was torn in five cases. Three had lesions of the heart and/or pericardium and one patient had a tracheal lesion. Closed pleural drainage was the most commonly used treatment. Thoracotomy was performed in 10 of the 93 patients. The mortality rate in the series (10%) agreed with findings from other, similar studies.

Accidents, Home↗

PubMed1991

A survey of koala road kills in New South Wales.

Between 1984 and 1990, 75 koalas (Phascolarctos cinereus) from the central northern coast of New South Wales (Australia) were presented for necropsy due to motor vehicle accidents. The koalas consisted of 44 males and 31 females. Fifty one of these were between 2 and 7 yr (39 males and 12 females). The greater proportion of koalas, especially males, were struck by vehicles between June and December. The main injuries detected were head injuries (44), hemoperitoneum (16), limb injuries (16), hemothorax (15) and spinal injuries (7). Nine koalas were not dead at the time of the accident but died later following complications from the trauma. Twelve koalas had evidence of underlying disease at the time of accident. Ten of these had either conjunctivitis, cystitis, prostatitis, periovarian cysts, endometritis or a combination of the diseases. All 10 koalas still had good body condition. It is suggested that healthy young to middle-aged males are particularly prone to vehicular accidents during the mating period. This has implications for the management of local koala populations.

Accidents, Traffic↗

PubMed1999

[Thoracic drainage in trauma emergencies].

A group of 191 cases of emergency tube thoracostomy for acute trauma reviewed retrospectively from March 1993 to March 1998 is reported. Of this group 169 were men and 22 were women. Their ages ranged from 16 to 73 years. The causes were as follows: 89 cases (46%) road accident; 33 cases (17%) accidental trauma; 33 cases (17%) someone else violence (assault, gunshot or stab wound); 15 cases (8%) work accident; 11 cases (6%) domestic accident and 5 cases (3%) iatrogenic trauma. In 32 patients a diagnosis of pneumothorax was made (2 tension, 11 for penetrating chest injuries, 19 after blunt trauma). In 2 cases of tension pneumothorax and in 3 cases of open pneumothorax a chest tube (24-28 Fr) in the third space in the mid-clavicular line was introduced. In the other patients it was decided to place a chest tube in the mid-axillary line in the fifth intercostal space to drain pneumothorax. Only in 7 cases suction was necessary. Fifty-four hemothorax (3 bilateral) were treated in 11 cases using thoracentesis, while the remaining cases were treated using the insertion of multiple drainage holes in the intercostal space (fifth in the mid-axillary line directed inferiorly and posteriorly). One hundred and three were the cases of hemopneumothorax: 24 of them received 2 chest tubes, the first (20-26 Fr) apically in the second intercostal space in the mid-clavicular line, the second (32-38 Fr) in the fifth intercostal space in the mid-axillary line. All the other cases were treated using a single thoracostomy. In 14 cases suction was applied. Two cases of chylothorax resolved by a large tube positioned in the chest (fifth intercostal space in the mid-axillary line) with a constant negative pressure were also observed. Duration of tube drainage ranged from 4 and 18 days, with an average of 11 days. Five infections of thoracostomy site and 1 empyema resolved by rethoracotomy were observed. Moreover, there were 3 complications: 2 subcutaneous placements and 1 little laceration of the lung. Thirty-one drained patients were operated: in 5 cases thoracotomy and laparotomy (2 exitus in tabula); only thoracotomy in 8 cases; 19 laparotomy and thoracostomy (1 exitus in tabula).

Accidents, Home↗

PubMed2000

Traumatic false aneurysm of the descending aorta which ruptured to right thoracic cavity.

A 54-year-old male, who had been involved in a traffic accident one week earlier, suddenly died in hospital without any warning. Autopsy revealed right hemothorax due to rupture of a subpleural hematoma of the right lung which was connected to a false aneurysm of the descending aorta. It is likely that the false aneurysm began to grow just after the traffic accident, forming an aortopleural fistula due to preceding adhesion. This led to the formation of a hematoma in the right subpleural space, which ruptured one week after the traffic accident. The present case indicates that the natural course and pathogenesis of traumatic false aneurysm depends upon the preceding local anatomical circumferences.

Accidents, Traffic↗

PubMed2001

[Recent concepts regarding the treatment of traumatic hemopneumothorax].

BACKGROUND: The aim of the study was to examine the different therapeutic options for traumatic hemopneumothorax and in particular the latest concepts (videothoracoscopy). METHODS: A retrospective study was performed on a group of 20 patients with post-traumatic hemothorax and/or pneumothorax attending the emergency department at Ospedale Vittorio Emanuele in Catania over the past 10 years where 2500 patients with abdominal and/or thoracic trauma were treated during the same period. The patients included 18 males and 2 females with a mean age of 35 years (range 13-70). The cause of injury was a gunshot wound in 8 patients, a blunt trauma following a road accident in 9 and a stab wound in 3 patients. A drainage tube was inserted in 15 patients (a videothoracoscopic approach was used in 2 cases); 3 patients required a diaphragmatic suture and 2 thoracotomy (inferior lobectomy and repair of the main left bronchus). RESULTS: Three out of 20 patients died with an overall mortality rate of 15%. Two patients died respectively from severe brain and abdominal injuries associated with thoracic trauma, while the third patient died from septic complications. CONCLUSIONS: In the past few years videothoracoscopy has allowed a different approach to be used in patients affected by hemo-pneumothorax since it allows a more accurate diagnosis (extent and origin of bleeding, identification of associated diaphragmatic lesion) and the possibility of treating pleuro-pulmonary injuries without performing extensive thoracotomies.

Adolescent↗

PubMed1975

[Development of treatment of severe thoracic injuries].

About 25 p. 100 of cases of closed trauma of the thorax may be classified as severe, for they rapidly endanger life. Their treatment has made considerable progress since the report of J. Dor and H. Le Brigand in 1960. However, when severe trauma is treated, the mortality has remained unchanged over the last ten years. The treatment of fractures of the sternum includes respiratory assistance and internal fixation of the fractured bones, these two methods together, when correctly applied, give good results. Endothoracic lesions are now better recognised. Hemothorax and pneumothorax are now treated by a well recognised method. Visceral lesions, such as bronchial rupture, or major vascular ruptures, e.g. aorta, and heart lesions may be diagnosed at an early stage and be operated on more often. On the other hand, it is now better recognised that diffuse pulmonary lesions, e.g. pulmonary contusions or "shock lung", which is usually treated by artificial respiration alone, still may have a poor prognosis in some cases. From this it results that many surgical teams have enlarged the indications for early thoracotomy in the same way as laparotomy is more often carried out in abdominal trauma. In fact, these indications require circumspection and thoracotomy should only be carried out in specialised thoracic surgery units. If this is not available, aspiration, drainage, tracheotomy, continuous extension, are still applicable, but it is also necessary for them to be carried out correctly; if not, failures and complications of these minor measures are frequent. The use of these methods has shown the existence of therapeutic failures, including major bilateral bony lesions, diffuse severe lung injuries with resistant anoxia, complex multiple injuries with thoracic involvement and, finally, combined thoracic and cranial lesions, the mortality of which is about 50 p. 100. These facts explain why treatment of severe thoracic trauma gives variable results. The mortality varies from 12 to 15 p. 100, in some series up to 50 or 60 p. 100 These discrepancies may be explained by different modes of recruitment of the services, some of which receive a large number of very severe cases of multiple injury with a high mortality. However, over the last 15 years, one may consider that the general prognosis of severe thoracic trauma has improved considerably.

Fracture Fixation, Internal↗

PubMedDate not supplied

[Acute necrotizing pancreatitis following abdominal trauma].

We present 11 cases of acute necrotizing pancreatitis following abdominal trauma operated in our clinic during the last five years. All patients except one were male. All of them had obvious symptoms of acute diffuse peritonitis when they came to hospital. The diagnosis was established by CT scan in four observations. All operations were performed during 12-36 hours after they came. During surgery, there was complete pancreatic necrosis in seven cases and incomplete in the other four cases. Associated injuries following trauma were represented by: hemothorax--two cases, spleen injury--one case, lesion of mesentery--one case, intestinal lesion--one case. In all cases we performed a wide opening of the lesser sac, pancreatic capsulectomy, necrosectomy and multiple drainage of the pancreatic side (behind the peritoneum) and peritoneal cavity. The postoperative outcome was difficult in all cases. Postoperative morbidity recorded pancreatic leakage (three cases), pseudocysts (two cases) and a perforation of gastric wall. There were 10 cases cured and one patient died.

Abdominal Injuries↗

PubMed1953

Chest injuries among Korean casualties.

Major wounds of the chest usually cause immediate or early death. Of 35 patients with major thoracic battle injuries who were treated in one naval hospital, six had non-penetrating wounds of the chest and other areas. Of the 29 with penetrating wounds of the chest, 23 were treated by aspiration of hemothorax, decortication in three cases, and thoracotomy for control of hemorrhage in one case and for removal of a foreign body in another. Four cases are reported, two to illustrate the usual course of treatment and two in which the patient died.

Asian People↗

PubMed2003

[Thoracoscopy in surgery of thoracic wounds].

One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. Injuries uncorrectable by endosurgically were diagnosed during thoracoscopy in 2.9% patients. Indications for urgent thoracoscopy in thoracic injuries are the following: 1) middle and small hemothorax or hemopneumothorax; 2) suspicion for heart wound; 3) suspicion for diaphragm injury; 4) tense pneumothorax. Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.

Emergencies↗

PubMed2004

Severe hemorrhagic complication of talc pleurodesis for idiopathic pleural effusion.

Talc is a commonly used sclerosing agent for pleurodesis. However, there have been recent reports of a number of complications associated with the use of talc. Although there is significant data regarding the respiratory complications associated with talc, reports of bleeding complications are extremely rare. We present the case of a 78 year-old man who was treated with talc pleurodesis for recurrent pleural effusion and subsequently developed a massive hemothorax, a rare complication.

Aged↗

PubMed2006

[Autopsy case of sarcomatoid malignant pleural mesothelioma].

A 61-year-old man with a sensation of chest compression was admitted to our hospital. He had hemothorax. After drainage with a chest tube, chest CT scan revealed multiple bilateral pulmonary nodules with slight pleural thickening. Open pleural biopsy was performed and the biopsy specimens showed tumor cells with sarcomatoid proliferation, but no definite epithelial pattern. Initial immunohistochemical staining was negative for keratin and carletinin, but positive for desmin, suggesting rhabdomyosarcoma. After supportive care, he died due to progression of the disease. Autopsy revealed extensive invasion suggesting mesothelioma, so the immunohistochemical staining was repeated. Because it revealed patchy staining for keratin and carletinin, this case was diagnosed as sarcomatoid mesothelioma. Differential diagnosis of sarcomatoid mesothelioma or rhabdomyosarcoma is made by immunohistochemical staining, but it is sometimes difficult. For the selection of the best treatment strategy for mesothelioma especially in the early stage, we should be aware of this difficulty.

Autopsy↗

PubMed2006

Post-traumatic pseudoaneurysm of internal mammary artery: a case report.

Pseudoaneurysm of the internal mammary artery can be a rare complication of surgery, particularly post-sternotomy, or determined by a direct trauma, usually a stab wound. This report presents a pseudoaneurysm by a stab, diagnosed by chest computed tomography scan performed for hemothorax recurrence. The patient underwent left thoracotomy in third intercostal space; mammary vessels were identified above and below the pseudoaneurysm sac and tied. The postoperative course was uneventful.

Adult↗

PubMed1991

[Chest injuries in children. Apropos of 93 cases].

UNLABELLED: Ninety-three cases of thoracic trauma (age ranging from 1.1/2 to 15 years) were observed over a 10 year-period (1980-1990): 86 cases of blunt trauma and 7 cases of perforating injuries. Road accidents were the most prevalent (63 cases) followed by home and sport injuries (9), falls (9), perforating trauma (9) and others. Associated lesions were frequent: skeletal (67), abdominal (19), and head injuries (5)--the latter influence the vital prognosis. Rib fractures were observed in 60% of cases of blunt trauma (86). Pulmonary lesions were as follows: pneumothorax (41), hemothorax (21), and lung contusions (29). In 48 cases, several of these pulmonary lesions were associated. Diagnosis and therapy problems were encountered in 21 cases. Results were as follows: 3 deaths, within 24 hours due to hemorrhage (1 case with aortic lesion). FOLLOW-UP: 85 good results, 5 sequelae, without any clinical consequence--either pleural (2), diaphragmatic (2), or lung (1). The treatment was as follows: none (27), pleural aspiration (2), thoraco-synthesis by drain in other cases for 2 to 9 days. Surgery was necessary in 10 cases, with 2 thoracotomies, 1 orthopedic traction, 1 embolization of iliac artery.

Abdominal Injuries↗

PubMed1990

[Value of pulmophonography in the diagnosis of pleural complications in closed thoracic injuries].

Mathematical analysis of the qualitative and quantitative signs of pulmophonograms taken in 103 patients with closed chest trauma complicated by hemothorax, pneumothorax, and traumatic exudative pleurisy and a changed method of pulmophonographic examination showed that the diagnosis of these complications can be established. The exact diagnosis was made in 87.4% of cases. The authors discuss the differential diagnosis of pneumo- and hydrothorax recognized by this method and various pathological conditions of the lungs. Areas of hypoventilation were present in the lungs after removal of fluid or air from the pleural cavity for 2-4 days.

Adolescent↗

PubMed1990

[Conservative treatment of hemophiliac bleeding].

Since the introduction of home-care replacement therapy for hemophilic patients, life-endangering spontaneous bleeding is rare. We describe a 15-year-old boy with severe hemophilia, who without antecedent trauma developed massive abdominal bleeding and hemothorax, leading to hypovolemic shock. Although an operation was advised, intensive conservative replacement therapy and drainage of the thorax led to complete recovery. We stress that in the absence of acute trauma, bleeding due to hemophilia consists of oozing, so conservative treatment is recommended.

Adolescent↗

PubMed1989

[Surgical treatment of residual defects following closure of secundum atrial septal defect].

Among 1485 patients with secundum atrial septal defect repaired from May, 1958 through May, 1986, 6 and 1 additional patient were readmitted to our hospital with symptomatic recurrence. In all but 1, their systolic murmur persisted. Cardiothoracic ratio and pulmonary plethora remained unaltered. A residual defect in all of the 7 patients was confirmed by right heart catheterization. They were reoperated upon under cardiopulmonary bypass. There was no early mortality, nor late death. The major postoperative complications include: hemothorax in 2 cases; temporary atrial fibrillation in 1. This article analysis the common causes of residual defect and discussed methods of diagnosis, treatment and prognosis.

Adolescent↗

PubMed1986

Umbilical artery catheterization complicated by multiple mycotic aortic aneurysms.

A premature infant had three pseudoaneurysms of the thoracic and abdominal aorta secondary to umbilical artery catheterization and sepsis. The infant had septicemia as the direct result of bacterial contamination of an umbilical artery catheter with Staphylococcus aureus. The thoracic pseudoaneurysm caused massive hemothorax and the infant's death. The upper abdominal aortic aneurysm developed at the level of the renal arteries and caused decreased left renal blood flow and renal hypoplasia. The lower abdominal aneurysm involved the right iliac artery and was complicated by mural thrombosis and ischemia of the right leg. To our knowledge, this is the first published case of multiple mycotic aortic aneurysms after umbilical artery catheterization.

Aorta, Abdominal↗