RESUMEN
Traumatic rupture of the diaphragm is an uncommon condition. The prevalence of diaphragmatic rupture among blunt trauma victim ranges from 0.8 to 8%. The etiologic factors are blunt trauma (for example, in motor vehicle accidents) and penetrating trauma. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. We present a case which was misdiagnosed as a case of left sided hemopneumothorax and treated with tube thoracotomy in other center.
Asunto(s)
Errores Diagnósticos , Hernia Diafragmática Traumática/diagnóstico , Diafragma/lesiones , Hemoneumotórax/diagnóstico , Hemoneumotórax/cirugía , Humanos , Rotura , Traumatismos Torácicos/diagnóstico , Toracotomía , Heridas no Penetrantes/complicacionesRESUMEN
Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.
Asunto(s)
Hemoneumotórax/complicaciones , Hemoneumotórax/diagnóstico , Neumotórax/complicaciones , Adolescente , Servicios Médicos de Urgencia , Hemoneumotórax/cirugía , Humanos , Masculino , Neumotórax/cirugíaAsunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Lesiones por Contragolpe , Ecocardiografía Transesofágica/métodos , Aneurisma Cardíaco , Lesiones Cardíacas , Traumatismo Múltiple , Tabique Interventricular , Adolescente , Lesiones por Contragolpe/diagnóstico , Lesiones por Contragolpe/fisiopatología , Lesiones por Contragolpe/terapia , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Aneurisma Cardíaco/cirugía , Lesiones Cardíacas/sangre , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/fisiopatología , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Hemoneumotórax/cirugía , Humanos , Hemorragia Intracraneal Traumática/diagnóstico , Hemorragia Intracraneal Traumática/etiología , Hemorragia Intracraneal Traumática/cirugía , Imagen por Resonancia Cinemagnética/métodos , Masculino , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/fisiopatología , Traumatismo Múltiple/terapia , Manejo de Atención al Paciente/métodos , Resultado del Tratamiento , Troponina T/sangre , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/lesiones , Tabique Interventricular/patologíaAsunto(s)
Hemoneumotórax , Gripe Humana/complicaciones , Aspergilosis Pulmonar Invasiva , Pulmón/diagnóstico por imagen , Nasofaringe/microbiología , Oseltamivir/administración & dosificación , Anciano , Antivirales/administración & dosificación , Líquido del Lavado Bronquioalveolar/microbiología , Manejo de la Enfermedad , Progresión de la Enfermedad , Resultado Fatal , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Hemoneumotórax/cirugía , Humanos , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/virología , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/etiología , Aspergilosis Pulmonar Invasiva/fisiopatología , Masculino , Radiografía/métodos , Choque Séptico/diagnóstico , Choque Séptico/etiología , Choque Séptico/terapia , Toracocentesis/métodosAsunto(s)
Tubos Torácicos , Hemoneumotórax/cirugía , Derrame Pleural/terapia , Neumotórax/cirugía , Toracocentesis/métodos , Contraindicaciones , Diseño de Equipo , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Humanos , Posicionamiento del Paciente , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Neumotórax/diagnóstico , Neumotórax/etiología , Instrumentos Quirúrgicos , Toracocentesis/instrumentaciónRESUMEN
Spontaneous tension haemopneumothorax is a very rare condition. Forty two-year- old male patient who applied with sudden onset of dyspnea, chest pain was tachypneic, tachycardic, cyanotic and hypotensive. This is the second case of spontaneous tension haemopneumothorax in English literature, according to our knowledge. We present this case because of being a rare condition.
Asunto(s)
Hemoneumotórax/diagnóstico , Adulto , Dolor en el Pecho/etiología , Drenaje , Disnea/etiología , Hemodinámica , Hemoneumotórax/terapia , Humanos , MasculinoRESUMEN
Spontaneous hemopneumothorax is a rare situation that can be life-threatening in young patients presenting hemodynamic instability due to hypovolemic shock. One of the extraordinary causes of hemopneumothorax is rupture of an apically located aberrant artery after pneumothorax, which is noticed as a third etiological factor in the literature. This case is presented in order to highlight this uncommon etiological factor together with the literature.
Asunto(s)
Hemoneumotórax/diagnóstico , Malformaciones Vasculares/complicaciones , Adulto , Diagnóstico Diferencial , Hemoneumotórax/diagnóstico por imagen , Hemoneumotórax/etiología , Hemoneumotórax/patología , Hemoneumotórax/cirugía , Humanos , Masculino , Rotura Espontánea , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos XRESUMEN
Data of 379 patients with penetrating thoracic wounds were analyzed. The pathologic changes on X-ray of the thoracic cavity were registered 239 (63,1%) patients: the hemothorax was diagnosed in 44,3%, pneumothorax - in 26,8% and hemopneumothorax - in 28,9%. 154 patients had videothoracoscopic surgery and 225 patients were operated on using traditional open methods. Operative findings were compared with X-ray data. The sensitivity of plain chest radiography in diagnostics of hemothorax was 52,1%, the specificity - 92,1%. Mistakes of interpreting X-ray data in diagnosing of low-volume hemo- or pneumothorax were defined. The computed tomography of the thorax proved to be the most precise means of intrapleural injuries diagnostics. The optimal algorithm of preoperative thoracic X-ray was suggested.
Asunto(s)
Hemoneumotórax/diagnóstico , Hemotórax/diagnóstico , Neumotórax/diagnóstico , Cuidados Preoperatorios/métodos , Traumatismos Torácicos , Tomografía Computarizada por Rayos X/métodos , Adulto , Algoritmos , Errores Diagnósticos/prevención & control , Femenino , Hemoneumotórax/etiología , Hemoneumotórax/cirugía , Hemotórax/etiología , Hemotórax/cirugía , Humanos , Masculino , Neumotórax/etiología , Neumotórax/cirugía , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirugía , Cirugía Torácica Asistida por Video/métodos , Toracotomía/métodos , Tórax/patología , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/cirugíaRESUMEN
Results of diagnostic and treatment of 156 patients with pulmonary hemorrhage, caused by the closed thoracic trauma, were analyzed. All patients had lung bruise, 101 of them had lung rupture. 115 (73.7%) patients demonstrated hemopneumothorax, bleeding was diagnosed in 86 (55.1%) cases and mediastinal emphysema was diagnosed in 52 (33.3%). Pulmonary hemorrhage developed more often by polytrauma of the chest, rather then by solitary lesions. Spiral computed tomography proved to be the best diagnostic means of thoracic trauma. Surgical tactics was defined mainly by the severity of intrapleural or pulmonary bleeding. Conservative treatment allowed successful recovery in the majority of patients. Only 5.1% of patients required surgery. High level of septic complications of pulmonary hemorrhage was registered/ Pneumonia developed in 28.8% and lung abscess was diagnosed in 14.1% of patients. The lethality rate was 9.6%.
Asunto(s)
Hemoneumotórax/etiología , Hemoptisis/etiología , Lesión Pulmonar/complicaciones , Traumatismos Torácicos/complicaciones , Procedimientos Quirúrgicos Torácicos/métodos , Heridas no Penetrantes/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Broncoscopía , Diagnóstico Diferencial , Drenaje/métodos , Femenino , Estudios de Seguimiento , Hemoneumotórax/diagnóstico , Hemoneumotórax/cirugía , Hemoptisis/diagnóstico , Hemoptisis/cirugía , Hemostasis Quirúrgica/métodos , Humanos , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Traumatismo Múltiple , Estudios Retrospectivos , Rotura , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/cirugía , Adulto JovenRESUMEN
Spontaneous hemopneumothorax is a rare encountered entity in clinical practice. It can be life threatening, so a prompt diagnosis and therapeutic intervention are required. We report a case of a right spontaneous hemopneumothorax in a 31-year-old man, complicated with hemorrhagic shock. Conservative therapy with only thoracic drainage with close monitoring of outflow and hemodynamic parameters was performed. In front of hemodynamic instability, an emergency video-assisted thoracoscopic surgery was performed. An apical bulla adhering to the parietal pleura has been identified as the source of the bleeding. The resection of the bullae and electrocauterization of the bleeding adhesion were effectuated. The hemostasis was easily achieved. The actual experience suggests that video-assisted thoracoscopic surgery should be performed as soon as possible after the diagnosis of spontaneous hemopneumothorax. Indeed, conservative therapy with chest drainage should only be performed as bridge to recovery for the stabilization before the video-assisted thoracoscopic surgery.
Asunto(s)
Hemoneumotórax/terapia , Choque Hemorrágico/terapia , Cirugía Torácica Asistida por Video/métodos , Adulto , Drenaje/métodos , Electrocoagulación/métodos , Hemoneumotórax/diagnóstico , Humanos , Masculino , Choque Hemorrágico/diagnóstico , TúnezRESUMEN
BACKGROUND: Tension pneumothorax is one of the leading causes of preventable death on the battlefield. Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination. These techniques are not fully applicable in field conditions and on the battlefield, where situational and environmental factors may impair clinical capabilities. We aimed to assemble a device able to sample, analyze, and classify the unique acoustic signatures of pneumothorax and hemothorax. METHODS: Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model. Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation. The thoracic cavity was injected with increasing volumes of 200, 400, 600, 800, and 1000 ml of air or saline to simulate pneumothorax and hemothorax, respectively. The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution, a cutting-edge approach in the artificial intelligence discipline. RESULTS: The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy, sensitivity and specificity ranging from 64 to 100%, 63 to 100%, and 63 to 100%, respectively, in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more, and regardless of background noise. CONCLUSIONS: We present a novel, objective device for rapid diagnosis of potentially lethal thoracic injuries. With further optimization, such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.
Asunto(s)
Inteligencia Artificial/normas , Auscultación/instrumentación , Hemoneumotórax/diagnóstico , Estetoscopios/normas , Animales , Inteligencia Artificial/tendencias , Auscultación/métodos , Auscultación/normas , Modelos Animales de Enfermedad , Estudios de Factibilidad , Hemoneumotórax/fisiopatología , PorcinosRESUMEN
PURPOSE: Spontaneous hemopneumothorax (SHP) is a rare life threatening disorder. We retrospectively investigated patients with SHP who were treated with video- assisted thoracic surgery (VATS), and report our results. METHODS: From January 1993 to July 2006, 239 patients with spontaneous pneumothorax were treated, among whom 11 (4.6%) were diagnosed with SHP. RESULTS: All 11 patients had a collapsed lung condition worse than moderate and a chest tube inserted, of whom 10 underwent an emergency operation. The points of hemorrhaging, each of which were in the apical portion of the lung, were easily revealed during VATS, and we were able to distinguish between brisk flow and seepage. Hemostasis was acquired using VATS in all surgery cases, while the other was treated with tube drainage. The single patient who did not undergo surgical treatment had recurrent spontaneous pneumothorax 3 months later. CONCLUSION: It is important to perform surgery for SHP at the appropriate time. VATS was found to be an easily performed and safe procedure for initial treatment in patients with active hemorrhaging and massive blood clotting in the thorax. The long-term outcome of our patients with early surgical indication was excellent and we recommend early surgical treatment for SHP.
Asunto(s)
Hemoneumotórax/diagnóstico , Hemoneumotórax/cirugía , Cirugía Torácica Asistida por Video , Adolescente , Adulto , Tubos Torácicos , Estudios de Cohortes , Drenaje , Urgencias Médicas , Femenino , Hemoneumotórax/etiología , Hemostasis Quirúrgica , Humanos , Masculino , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Thoracic trauma is positioned at the third place of occurrence in Multiple Trauma patient. The correct position of thoracic drainages are fundamental for a good resolution and restore of pulmonary function in our mechanical ventilated patients. METHODS: This retrospective analysis of a prospective database on a consecutive series of patients who had haemo-pneumothorax drained immediately or into 3 hours from trauma was conducted over a period of 24 months. RESULTS: Of 600 of thoracic procedures we have considered 67 chest drainages positioned from 2002 to 2004 in patients with thoracic trauma. Technical aspects of the thoracic drainage were analyzed. Outcome,pulmonary function and clinical complications were recorded. CONCLUSIONS: The Management of drains and thoracic tubes after many surgical procedures is highly variable. This procedure is easy, feasible, secure and we have recorded a reduction of costs and related complications.
Asunto(s)
Drenaje/métodos , Traumatismo Múltiple/cirugía , Traumatismos Torácicos/cirugía , Interpretación Estadística de Datos , Bases de Datos como Asunto , Hemoneumotórax/diagnóstico , Hemoneumotórax/diagnóstico por imagen , Hemoneumotórax/epidemiología , Hemoneumotórax/cirugía , Humanos , Incidencia , Traumatismo Múltiple/diagnóstico , Neumotórax/diagnóstico por imagen , Neumotórax/fisiopatología , Neumotórax/cirugía , Estudios Prospectivos , Radiografía Torácica , Estudios Retrospectivos , Programas Informáticos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/diagnóstico por imagen , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Fijación Interna de Fracturas/métodos , Traumatismo Múltiple , Fracturas de las Costillas , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Hemoneumotórax/fisiopatología , Hemoneumotórax/cirugía , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/fisiopatología , Traumatismo Múltiple/cirugía , Cuidados Preoperatorios/métodos , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/diagnóstico por imagen , Fracturas de las Costillas/fisiopatología , Fracturas de las Costillas/cirugía , Tomografía Computarizada por Rayos X , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
A male infant with oesophageal atresia and distal tracheo-oesophageal fistula (TEF type C) underwent right thoracotomy and transpleural repair of TEF on day 4 of life. He did not have a family history of coagulation disorders. A preoperative finding of prolonged partial thromboplastin time (PTT)>200 s was overlooked, and he went to surgery. There were no concerns with haemostasis prior to and even during the operation. The prolonged PTT was treated with one 10 mL/kg dose of fresh frozen plasma in the immediate postoperative period. On the fourth postoperative day, the infant developed a right haemopneumothorax, requiring fresh frozen plasma and packed cell transfusions. He was subsequently diagnosed with severe haemophilia A due to intron 22 inversion in the factor VIII gene, with factor VIII level <0.01 IU/mL.
Asunto(s)
Atresia Esofágica/cirugía , Hemofilia A/complicaciones , Hemofilia A/diagnóstico , Hemoneumotórax/etiología , Fístula Traqueoesofágica/cirugía , Transfusión Sanguínea , Diagnóstico Diferencial , Hemofilia A/terapia , Hemoneumotórax/diagnóstico , Hemoneumotórax/terapia , Humanos , Recién Nacido , Masculino , Plasma , ToracotomíaRESUMEN
We report 5 cases of penetrating chest wounds caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm.
Asunto(s)
Traumatismos Torácicos/cirugía , Toracotomía/métodos , Heridas Punzantes/cirugía , Adolescente , Adulto , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Hemoneumotórax/cirugía , Humanos , Masculino , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Tomografía Computarizada por Rayos X , Armas , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnóstico , Adulto JovenRESUMEN
Video of video-assisted thoracoscopic surgery (VATS) on a 16-year old who had been stabbed. The knife penetrated the diaphragm, lung and intercostal pedicle causing a haemopneumothorax. A chest drain was inserted by the trauma team. VATS was performed entirely through the stab and chest drain pre-existing wounds without extension.
Asunto(s)
Diafragma/lesiones , Urgencias Médicas , Hemoneumotórax/cirugía , Cirugía Torácica Asistida por Video/métodos , Heridas Punzantes/cirugía , Adolescente , Tubos Torácicos , Diafragma/diagnóstico por imagen , Diafragma/cirugía , Drenaje/métodos , Hemoneumotórax/diagnóstico , Hemoneumotórax/etiología , Humanos , Masculino , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirugía , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnósticoRESUMEN
BACKGROUND: Traumatic pulmonary pseudocysts (TPP) are underreported cavitary lesions of the pulmonary parenchyma that can develop following blunt chest trauma. Although the occurrence of traumatic pulmonary pseudocyst is rare, this condition should be considered in the differential diagnosis of any cavitary lesion. Awareness of this injury and its clinical significance is important for successful management in order to avoid medical errors in the course of treatment. METHODS: A literature search was conducted through Medline using the key phrases "traumatic pulmonary pseudocyst" and "traumatic pneumatocele." Relevant articles, especially those with focus on diagnosis and management of traumatic pneumatocele in adults, were selected. Due to the scarcity of literature and lack of Level I evidence on this subject, studies published in any year were considered. RESULTS: A search of "traumatic pulmonary pseudocyst" and "traumatic pneumatocele" yielded 114 studies. Most of these were excluded based on inclusion and exclusion criteria. Thirty-five articles were reviewed. The majority of these were individual case studies; only eight articles were considered large case studies (greater than eight patients). CONCLUSION: Traumatic pulmonary pseudocysts are lesions that occur secondary to blunt chest trauma. Diagnosis is based on a history of trauma and appearance of a cystic lesion on CT. Accurate diagnosis of traumatic pulmonary pseudocyst is imperative to achieve successful outcomes. Failure to do so may lead to unnecessary procedures and complications.
Asunto(s)
Quistes/diagnóstico , Hemoneumotórax/diagnóstico , Lesión Pulmonar/diagnóstico por imagen , Traumatismos Torácicos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Quistes/terapia , Diagnóstico Diferencial , Humanos , Lesión Pulmonar/patología , Lesión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Traumatismos Torácicos/patología , Traumatismos Torácicos/terapia , Heridas no Penetrantes/patología , Heridas no Penetrantes/terapiaRESUMEN
Bronchial rupture due to tracheobronchial trauma is a very rare condition. Early evaluation is necessary in order to avoid irreversible changes such as fibrosis and bronchial stenosis. Cases with post-traumatic hemo-pneumothorax, pneumomediastinum, subcutaneous emphysema and atelectasis require consideration of bronchial laceration with urgent bronchoscopy and early surgery, if needed. A 15 year-old patient with a history of blunt chest trauma two years ago presented with symptoms of pulmonary infection. Radiological and bronchoscopic evaluation revealed right upper lobe atelectasis secondary to fibrosis. Patient underwent right upper lobectomy.