RESUMEN
Pulmonary artery pseudoaneurysm is an unusual complication of surgically implantable central venous port catheters. We experienced a case of a 57-year-old man with gastric malignancy, in which a port catheter had been previously implanted for chemotherapy. Because of a puncture site that was also medial for the subclavian vein, the catheter tip fractured between the first rib and the clavicle, and embolized in the left pulmonary artery, which caused a 5 x 4 cm pseudoaneurysm that mandated surgical resection with a lobectomy. The diagnostic work-up and a review of the literature are presented.
Asunto(s)
Aneurisma Falso/etiología , Cateterismo/efectos adversos , Catéteres de Permanencia/efectos adversos , Migración de Cuerpo Extraño/diagnóstico , Arteria Pulmonar , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Angiografía , Quimioterapia Adyuvante , Terapia Combinada , Falla de Equipo , Estudios de Seguimiento , Migración de Cuerpo Extraño/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Medición de Riesgo , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
PURPOSE: The chest injury pattern after a major earthquake is not well understood because data on the type of trauma and surgical intervention are limited. This study was conducted to analyze patients who sustained chest injury during the Marmara earthquake that struck Turkey on August 17, 1999 registering 7.4 on the Richter scale. METHODS: The medical reports of 528 patients transported to a military hospital in the first 48 h after the earthquake were reviewed. Two chest surgeons examined these 528 patients, 19 of whom (4%) had suffered a major chest injury. We retrospectively evaluated the injury pattern, Abbreviated Injury Score (AIS), and Injury Severity Score (ISS) in these 19 patients. RESULTS: Eight patients (42%) had isolated chest injuries and 11 (58%) had suffered injury to more than one organ system, including chest trauma. The mean AIS and ISS were assigned as 2.9 (SD: 1) and 22 (SD: 7), respectively. Three (16%) of the 19 patients died, all of whom had suffered multiple injuries. The mean ISS of these three patients was 28.7 (range 25-34). Chest injury after a major earthquake was associated with an overall mortality rate of 16%, but chest injury with multiple injuries and an ISS over 25 was associated with a mortality rate of 60%. All patients with isolated chest injuries survived. CONCLUSION: Coexistent trauma with chest injury and an ISS over 25 were defined as poor prognostic factors for patients rescued after a major earthquake.