Hemothorax resulting from an initially masked aortic perforation caused by penetration of the sharp edge of a fractured rib: A case report
| Autor: | Tsuyoshi Shoji, Yasufumi Goda, Naoki Date, Hiromichi Katakura |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Perforation (oil well) Aortic injury Article TEVAR thoracic endovascular aortic repair 03 medical and health sciences 0302 clinical medicine medicine.artery BTAI blunt traumatic aortic injury Medicine Hemopneumothorax Rib fracture Hemothorax Rib cage Blunt chest trauma business.industry medicine.disease Thoracostomy POD postoperative day Surgery CT computed tomography Chest tube Great vessels 030220 oncology & carcinogenesis Descending aorta cardiovascular system 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Rare aortic injury from a rib fracture, which is not found in primary evaluation. • Hemothorax with great vessel injury can be fatal and should be detected using computed tomography. • Some great vessel injuries cannot be detected through contrast-enhanced chest computed tomography. • Great vessel injury should be considered in hemothorax with multiple rib fractures. Introduction There are multiple causes of hemothorax in blunt chest trauma. However, a traumatic hemothorax with an uncertain cause is potentially life-threatening without treatment, because an undetected and hidden great vessel injury can remain unknown. Delayed diagnosis can lead to death. Presentation of case A 77-year-old man was transferred to a local hospital, after experiencing a 3-m fall. Contrast CT of the chest revealed a left clavicle fracture, multiple left rib fractures and hemopneumothorax, but no obvious signs of great vessel injury, such as aortic injury. His condition was stable, owing to the chest tube thoracostomy with 800 ml blood output and intravenous fluid. The patient was then transferred to our hospital for further treatment. However, his condition rapidly deteriorated in the ambulance on the way to our hospital, and he needed a blood transfusion. On arrival, he was in shock, with his vital signs compromised due to blood loss. Emergency open thoracotomy was performed to explore the bleeding point and stop hemorrhaging. Intraoperative findings revealed sharp edges of the fractured fourth and fifth left ribs to be protruding into the chest cavity toward the descending aorta and causing an aortic pinhole injury. Ruptured aorta was repaired with a pledget-armed sutures and the sharp fractured ribs were resected. The patient was discharged, uneventfully, 35 days after the operation. Conclusion This case suggests that even if great vessel injury is not detected on contrast CT at admission, it should always be considered especially in a hemothorax case with multiple rib fractures. |
| Databáze: | OpenAIRE |
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