RESUMO
We experienced a case of a subtype of spontaneous hemopneumothorax caused by external forces associated with a seat-belt injury. A female aged 39 years sustained a minor collision with an oncoming car while she was driving. Although pneumothorax was not detected, hemothorax and bleeding from the area surrounding the subclavian artery were observed on contrast-enhanced chest computed tomography (CT). After confirming continuous bleeding into the thoracic cavity after superselective arterial embolization, we performed emergency open surgery. We found a bulla in the apex of the lung, and the thoracic stump of the bulla was considered the source of bleeding. In this case, the direct cause of hemothorax was considered to be the external force associated with the seat-belt injury. When a bulla in the apex of the lung and continuous bleeding are both observed on CT, spontaneous hemopneumothorax should be suspected, necessitating open chest surgery in cases where pneumothorax is not observed.
Assuntos
Hemopneumotórax/etiologia , Hemotórax/etiologia , Lesão Pulmonar/etiologia , Cintos de Segurança/efeitos adversos , Ferimentos não Penetrantes/etiologia , Acidentes de Trânsito , Adulto , Vesícula/etiologia , Meios de Contraste , Emergências , Tratamento de Emergência/métodos , Feminino , Hemopneumotórax/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Humanos , Lesão Pulmonar/diagnóstico por imagem , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/lesões , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
Most of hydrogen sulfide poisoning has been reported as industrial accidents in Japan. However, since January 2008, a burgeoning of suicide attempts using homemade hydrogen sulfide gas has become evident. By April 2008, the fad escalated into a chain reaction nationwide. Mortality of the poisoning was very high. There were 220 cases of attempted gas suicides during the period of March 27 to June 15, killing 208. An introduction of new method of making the gas, transmitted through message boards on the internet, was blamed for this "outbreak". The new method entailed mixing bath additive and toilet detergent. The National Police Agency instructed internet providers to remove information that could be harmful. Of the victims of the fad in 2008, several cases were serious enough that family members were involved and died. Paramedics and caregivers were also injured secondarily by the gas. This fad has rapidly spread by internet communication, and can happen anywhere in the world.