ABSTRACT
BACKGROUND: Penetrating thoracic injuries have a significant risk of morbi-mortality. Despite the advancements in damage control methods, a subset of patients with severe pulmonary vascular lesions and bronchial injuries persists. In some of these cases, post-traumatic pneumonectomy is required, and perioperative extracorporeal membrane oxygenation (ECMO) support may be required due to right ventricular failure and respiratory failure. CASE DESCRIPTION: A male was brought to the emergency department (ED) with a penetrating thoracic injury, presenting with massive right hemothorax and active bleeding that required ligation of the right pulmonary hilum to control the bleeding. Subsequently, he developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his condition and facilitate recovery. CONCLUSIONS: Penetrating thoracic injuries with severe pulmonary vascular lesions may need pneumonectomy to control bleeding. ECMO support reduces the associated mortality by decreasing the complications rate. A multidisciplinary team is essential to achieve good outcomes in severe compromised patients.
Subject(s)
Extracorporeal Membrane Oxygenation , Pneumonectomy , Humans , Extracorporeal Membrane Oxygenation/methods , Male , Lung Injury/surgery , Lung Injury/etiology , Adult , Thoracic Injuries/surgery , Thoracic Injuries/complications , Wounds, Penetrating/surgery , Hemothorax/etiology , Hemothorax/surgery , Postoperative Care/methodsABSTRACT
BACKGROUND: Late hemothorax is a rare complication of blunt chest trauma. The longest reported time interval between the traumatic event and the development of hemothorax is 44 days. CASE PRESENTATION: An elderly patient with right-sided rib fractures from chest trauma, managed initially with closed thoracostomy, presented with a delayed hemothorax that occurred 60 days after initial management, necessitating conservative and then surgical intervention due to the patient's frail condition and associated complications. CONCLUSIONS: This case emphasizes the clinical challenge and significance of delayed hemothorax in chest trauma, highlighting the need for vigilance and potential surgical correction in complex presentations, especially in the elderly.
Subject(s)
Hemothorax , Rib Fractures , Thoracic Injuries , Wounds, Nonpenetrating , Humans , Hemothorax/etiology , Hemothorax/surgery , Wounds, Nonpenetrating/complications , Thoracic Injuries/complications , Rib Fractures/complications , Rib Fractures/surgery , Male , Thoracostomy , Time Factors , Aged, 80 and over , Tomography, X-Ray Computed , AgedABSTRACT
A 47-year-old male patient was referred to a level 1 trauma center with refractory acute respiratory distress syndrome, bilateral lung contusions, and flail chest after initial management for injuries sustained 5 days prior from an 8-m fall from a tower crane. Surgical stabilization of the rib fractures was achieved under extracorporeal membrane oxygenation support, with successful decannulation 4 days after surgery. The patient was discharged after 42 days and following multidisciplinary interventions. Use of extracorporeal membrane oxygenation support in blunt chest trauma patients presents a valuable opportunity as it may enable earlier surgical intervention and reduce in-hospital complications.
ABSTRACT
Introducción: El neumoperitoneo espontáneo es aún una entidad de patogenia poco clara; sin embargo, es importante sospecharla en ciertos casos, con lo que se evitarán intervenciones quirúrgicas innecesarias. Objetivo: Conocer las causas, los mecanismos de producción y los factores asociados del neumoperitoneo espontáneo para dar herramientas que ayuden a enfrentar estos casos y orientar el manejo. Método: Se reporta el caso de una paciente con aire libre intraabdominal como hallazgo imaginológico incidental y posterior manejo quirúrgico. Resultados: No se encontró una causa quirúrgica del neumoperitoneo durante la exploración por laparotomía. Conclusión: Existen causas no quirúrgicas de neumoperitoneo que pueden tener un tratamiento conservador.
Subject(s)
Incidental Findings , Laparotomy , Pneumoperitoneum , Tomography, X-Ray ComputedABSTRACT
En este artículo se presentan 13 casos de pacientes con trauma óseo que, en el momento de la consulta, se presentó oculto a los rayos X y se hizo evidente en imágenes por resonancia magnética (IRM ), practicadas después. Se revisaron las historias clínicas de estos pacientes, en casos en los cuales las radiografías o escanografías habían sido reportadas como normales. La persistencia del dolor osteomuscular con limitación funcional sin mejoría con el manejo médico es el determinante más común que lleva a la solicitud de estudios de mayor complejidad y hacen de ésta una indicación para la realización de IRM.