Traumatic rupture of diaphragm with splenic injury

A 56-year-old woman admitted to our hospital because of injury by a road accident. A chest X-ray film and computed tomography (CT) scan showed multiple left rib fractures, hemothorax in the left pleural cavity, and obscurity of the left diaphragm. The stomach and injured spleen were also shown to shift to the left thoracic cavity. The patient was diagnosed as having diaphragmatic rupture with hemothorax in the left pleural cavity due to splenic injury. Emergent surgery was performed and massive bleeding was observed in the thoracic and abdominal cavities. After performing splenectomy and replacing the stomach in the abdominal cavity, the diaphragm was repaired. The patient was discharged 66 days after the surgery. Since traumatic diaphragm rupture can lead to hemorrhagic shock associated with injuries to adjacent organs, it is important to establish an accurate diagnosis and to performed appropriate surgical treatment without delay.     

Massive spontaneous hemothorax associated with Von Recklinghausen's disease

A 30-year-old woman with Von Recklinghausen's disease was admitted to our hospital because of sudden onset of dyspnea and syncope. A chest roentgenogram showed a massive right pleural effusion and insertion of an intercostal tube drained 1,600 cc of blood. A computed tomographic chest scan with contrast revealed a hyperdense mass in the right paravertebral area. At thoracotomy, retained clotted hemothorax and continued bleeding from tumor vessels was noted. The apex of the right hemithorax and the tumor location was packed. The pathologic diagnosis was ganglioneuroma and follow-up of the patient for 2 years after re-thoracotomy and removal of the packs revealed no complication and morbidity. We report this case to emphasize the importance of early recognition and prompt surgical intervention in spontaneous hemothorax associated with Von Recklinghausen's disease.     

Intralobar sequestration presenting as a large intrapulmonary hematoma and massive hemothorax

Intralobar sequestration is a relatively rare anomaly that is usually diagnosed with symptoms of cough, expectoration, or recurrent pneumonia. We experienced a case of a 27-year-old man with a symptom of massive hemoptysis. His chest computed tomography (CT) scan revealed a large intrapulmonary hematoma and massive hemothorax, mimicking a benign lung tumor ruptured into the pleural cavity. We should keep the possibility of this anomaly in mind if a patient with hemoptysis has a cystic lung tumor and hemothorax on CT scan.     

Angiosarcoma of the chest wall in a patient with fibrous dysplasia.

We have experienced a case of angiosarcoma of the chest wall in a patient with fibrous dysplasia. The patient was a 64-year-old man and had large bilateral thoracic masses. Each tumor, resected metachronously with the chest wall, was diagnosed as angiosarcoma. One of these tumors had a histological component of fibrous dysplasia. The patient died from brain metastasis 19 months after the first operation. Angiosarcoma associated with fibrous dysplasia of the chest wall is very rare.     

A case of pulmonary rupture with primary pulmonary leiomyosarcoma--management by emergency surgical intervention]

We report a case of 18-year-old boy who was admitted to our hospital for hemoptysis and hemothorax caused by rupture in the pulmonary tissue. A tumoral mass was found protruding from the inferior aspect of the left lower lobe towards the diaphragma. A large hematoma was seen in the vicinity of the tumoral mass. An emergency left lower lobectomy was performed and the hematoma was removed. The tumor was yellow in color, soft and 7 cm in diameter. The histological diagnosis was that of primary pulmonary leiomyosarcoma. The resected lobe had a liver-like hard consistency due to extended infiltration of blood resulting from hemorrhages within the tissue located in and around the tumoral mass. Microscopically, the tumor was composed of the spindle-shaped cells with multinucleation along with some clear cell patterns. Recurrence of the tumor appeared six months after the operation, and a second resection of the recurrent leiomyosarcomatous tissue was performed. The patient is still alive for 1 year and 6 months after the first operation.     

Malignant fibrous histiocytoma of the diaphragm — a case report —

A 56-year-old woman was admitted to our hospital with the chief complaint of left back pain. We detected left pleural effusion on chest X-ray and performed chest drainage. No malignant cells were detected in the effusion. Chest CT demonstrated a tumor shadow over the left diaphragm and left pleural effusion 6 months later. She underwent en bloc resection of the tumor and left diaphragm. Histological evaluation revealed malignant fibrous histiocytoma (MFH). Recurrent tumors were found in the abdomen 8 months after the operation, and she underwent resection of the abdominal recurrent tumors. Histological evaluation of the recurrent tumors also showed MFH. The patient died 28 months after the first operation.     

Massive hemothorax resulting from erosion of the left internal thoracic artery by an anterior chest wall tubercular abscess

A 20-year-old male presented to the hospital with discharging pus from anterior chest wall region for 15 days. He had a past history of left-sided pleural effusion for which he was put on ATT by a private practitioner on an empirical basis. In view of an excessive bleeding from the chest wall abscess, the patient was taken up for emergency exploratory thoracotomy. Intra-operatively, it was found that the abscess had ruptured in the thorax eroding the left internal mammary artery which was ligated at its origin, and hemothorax was drained. Post-operatively, the patient had an uneventful recovery.     

Right delayed traumatic diaphragmatic hernia; report of a case

An 80-year-old woman was admitted to our hospital with abnormal shadow on chest X-ray 8 years after a chest trauma during which multiple ribs on the right side were fractured causing hemothorax. A diagnosis of right delayed traumatic diaphragmatic hernia was based on the findings on plain X-ray and multislice computed tomography. We performed surgery via thoracic approach with thoracoscopic assist. The transverse colon, liver, and omentum were dislocated into the right thoracic cavity and hardly adhered to the lung. We successfully repaired the ruptured diaphragm. The postoperative course was uneventful and the patient was discharged on the 33rd postoperative day.     

Videothoracoscopy in the diagnosis and treatment of hemothorax

Video assisted thoracic surgery (VATS) has assumed greater importance in the management of pleural diseases. From 1994 to 1998 the Authors report their experience about 11 cases of hemothoraces depending on various causes: 6 hemothoraces and 3 hemopneumothoraces, some spontaneous or iatrogenic, others in patients with chest trauma; 2 clotted hemothoraces. All patients were studied by VAT detecting the source of bleeding in 6 cases of acute hemothorax and in 3 cases of acute hemopneumothorax; in 5 cases the lesions were successfully repaired with thoracoscopic technique. In others 4 patients the VATS approach was converted to thoracotomy for the seriousness of lesions: 3 acute hemothoraces (1 patient with penetrating thoracic firearms injury, 1 patient with extended lung laceration, 1 patient with iatrogenic lesion of right subclavian artery); 1 acute hemopneumothorax in one patient with penetrating thoracic firearms injury and left hemidiaphragmatic double perforation: in this case laparotomy was also operated in order to exclude others abdominal lesions. 2 cases of clotted hemothorax were operated by VATS performing the removal of clots after their fragmentation by endobabcock and pleural irrigation-aspiration with physiological solution. No procedure related complications were occurred. The authors conclude that the video-thoracoscopic approach is certainly advantageous for the management of spontaneous, traumatic or iatrogenic acute hemothoraces. This technique permits, with minimal traumatism and very little complications, the correct therapeutic programming (VATS operation or conversion to thoracotomy). However some hemothoraces (hemothoraces in patients with serious cranial trauma, with spleen rupture, with great vessels rupture, with heart rupture or with massive post-operating hemothorax) contro-indicate the thoracoscopic treatment: immediate thoracotomy and/or laparotomy, in these cases, is indispensable. In the treatment of clotted hemothoraces the VATS is a favourable alternative to thoracotomy, reforming the pleural cavity with minimal traumatism and avoiding tardive complications.     

Rupture of the Descending Thoracic Aorta Caused by Blunt Chest Trauma: Report of a Case

A 66-year-old man fell from a tree and was diagnosed to have multiple fractured ribs and hemopneumothorax based upon the chest roentogenogram findings. He underwent chest tube drainage and evacuation using video-assisted thoracic surgery. One week after the operation, he exhibited recurrent hemothorax. He underwent a thoracotomy, and the hemothorax was found to be due to a penetration of the lower descending thoracic aorta by a fractured rib. We performed a direct closure of the penetrated portion of the descending thoracic aorta. The patient has remained well for 1 year following the second operation.     

Localized fibrous mesothelioma with bloody pleural effusion; report of a case

Diffuse malignant mesothelioma with bloody pleural effusion is not rare, but a localized fibrous mesothelioma with bloody pleural effusion is relatively rare. A 45-year-old woman presented with a localized fibrous mesothelioma causing a bloody pleural effusion. Her chief complaint was right-sided lateral chest pain. A chest roentgenogram demonstrated a right-sided pleural effusion, so a chest tube was inserted, and the bloody fluid drained. A preoperative diagnosis of localized fibrous mesothelioma was made based on chest computed tomography and examination of computed tomographic guided percutaneous needle biopsy specimen. At operation, the tumor seemed to have originated from the right lung parenchyma or had invade the right lower lobe because tumor had penetrated deeply in the lung. Tumor and part of the parietal pleura were resected by right lower lobectomy. Final pathology established that the tumor was adherent to the right lung and was only encapsulated by the lung.     

Idiopathic hemothorax associated with shock during transporting in an ambulance; report of a case

A 37-year-old man was admitted to our hospital. The patient noted sudden right back pain after coughing before 1 hour. Loss of consciousness was occurred in an ambulance. Chest X-P revealed whole fluid in the right chest. Enhanced chest computed tomography (CT) revealed extravasation of contrast media into the pleural cavity from the right chest wall. Thoracentesis was performed to relieve dyspnea and 2,000 ml of blood was removed. Then hemoglobin count was dropped to 3.8 g/dl. At thoracotomy whole blood was sucked about 3,900 ml. Bleeding point was found at third intercostal vein. The vein was knotted and sutured by prolene thread. The bleeding lesion was no inflammation and no string like tissue. We report a case of idiopathic hemothorax and enhanced chest CT was useful for diagnosis of bleeding lesion of pleural cavity.     

Blood reflux through the catheter when trying catheterization of the subclavian vein is not a reliable sign in case of hemothorax

A 36-year-old man suffered chest and neurovascular trauma, soft-tissue injury to the left arm, and trauma to facial bones and extremities. He was hemodynamically unstable and responded poorly to blood transfusion and vasoactive medication. Pneumothorax was suspected. When a tube was inserted into the left hemithorax, 1500 mL of blood was drained. A chest film revealed hemothorax and a contusion on the left lung, but no rib fractures. An attempt to catheterize the left subclavian vein yielded reflux, and blood was then transfused. The patient continued to be highly unstable and an additional 1000 mL of blood was drained. Exploratory thoracotomy revealed a ruptured subclavian vein, location of the venous catheter in the pleural cavity, and a fracture of the first left rib. After chest injury leading to hemothorax, reflux upon catheterization of the ipsilateral subclavian vein is not a sure sign of correct tip placement. Additional means for checking placement, such as assessing pressure wave morphology, should be used. A fracture of the first rib, which may not be evident on a chest x-ray, often causes a vascular lesion and thoracic hemorrhage. Incorrect insertion of a subclavian catheter may then follow.     

A case of multiple synchronous localized fibrous tumor of the pleura.

We report a patient with two synchronous distinct masses in the same hemithorax both of which got the diagnosis of benign localized fibrous tumor of the pleura. The plain chest X-ray was rather obscured due to a large left-sided pleural effusion, but her subsequent computerized chest tomography revealed a heterogeneous hypodense soft tissue mass, which was pleural in origin, sitting on the diaphragm bathed in fluid. At thoracotomy, we detected two distinct masses in the left hemithorax, both arising from the visceral pleura via their vascular pedicles.     

Bedside ultrasonography in the differential diagnosis of pulmonary pathologies in the intensive care unit

Among critically ill patients, opacification of a part or whole lung field on chest radiography may pose a challenge in the differential diagnosis of acute pulmonary pathologies (eg, pneumothorax, hemothorax, pleural effusion, atelectasis, and solid organ in thoracic cavity) and selection of treatment modalities. In cases in which clinical findings, history, and imaging studies are not conclusive, bedside ultrasonography may be invaluable in achieving a diagnosis. We present two cases in which portable ultrasonography at the bedside was critical to the diagnosis and subsequent management of the patient.     

胸腔镜手术在胸部创伤治疗中的应用

目的探讨胸腔镜在胸部创伤手术中的应用价值。方法 2004年8月～2011年6月对225例胸部创伤施行电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)或胸腔镜辅助小切口手术进行血胸清除、止血、肺修补、心包开窗、膈疝修补、胸内异物取出等操作。结果 206例行VATS,19例行胸腔镜辅助小切口手术。手术时间25～125 min,平均58min。术后24 h胸腔引流液30～320 ml,平均179 ml。术后胸腔闭式引流管放置时间1～5 d(2例脓胸胸管放置时间分别为16、21 d,未计算在内),平均2.7 d。术后住院时间5～45 d,平均9.8 d。223例术后随访3个月,无中等量以上(>1000 ml)胸腔积液,无再次胸部手术者,恢复良好。结论胸腔镜诊断和治疗胸部创伤,创伤小,术后恢复好,疗效满意。     

Mature teratoma combined with schizophrenia: report of a case

A 20-year-old woman was admitted to another hospital due to schizophrenia in July 2003. The patient felt chest pain and palpitation in August, and she was referred to our hospital. Chest computed tomography (CT) showed a mass in the left thoracic cavity and a pleural/pericardial effusion. Since general condition did not improved in spite of aggressive supportive treatment, surgical treatment was chosen. An operation was performed via median sternotomy in September. The tumor was found to have adhered firmly to the surrounding organs. Pericardial fenestration was performed; then the tumor was resected with the left phrenic nerve due to tight adhesion. The patient received respiratory support in the intensive care unit for 5 days after surgery, uneventfully. Twenty-three months after surgery, she is surviving and free from schizophrenic symptoms without medication.     

Electronic endoscope insertion into a thoracic drainage tube is a new technique in the treatment and diagnosis of pleural diseases

Background  Pleural disease remains a commonly encountered clinical problem for both physician and surgeon. This study describes a new way to better diagnose and treat pleural diseases (hemothorax, empyema, and pleural effusion) using an electronic endoscope (gastroscope or bronchoscope). Methods  We conducted a retrospective study of the use of an electronic endoscope in the treatment and diagnosis of pleural diseases. From November 2006 to February 2008, a total of 17 patients (3 women, 14 men; mean age = 41.8 years; range = 18–62 years) underwent procedures for thoracic empyema (13 patients), traumatic clotted hemothorax (3 patients), and undiagnosed pleural effusion (1 patient). The electronic endoscope was inserted via the thoracic drainage tube for the treatment or diagnosis of pleural diseases after regular treatments, including thoracentesis, tube thoracostomy, and biopsy, failed. Results  All patients were cured and discharged from hospital and were followed up for 6 months. The patients recovered well and there was no recurrence. Conclusion  The technique of inserting an electronic endoscope into the thoracic drainage tube for diagnosis and treatment of pleural diseases is simple, effective, minimally invasive, and cost-effective.     

Spontaneous bleeding of an Abrikossoff's tumor - a case report

Abrikossoff tumors are a rare tumor entity. The complication of a hemothorax has not been described in the literature so far. A 24-year-old patient presented with repeated hemoptysis and right thoracic pain. The initial CT-scan revealed a solid tumor mass in the right lower bronchus. After further diagnostics, the patient was discharged and surgical intervention was planned. He was readmitted 4 days after discharge with a spontaneous hemothorax. After the right lower lobectomy and an uneventful course the patient recovered well.     

A case of localized pleural mesothelioma

A case of localized pleural mesothelioma is reported. A 49-year-old man was operated for coin lesion detected on routine chest X-ray. A tumor arose from the visceral pleura of right lower lobe and was pedunculated. Size of the tumor was 4 x 3 x 3 cm. Cut surface of the tumor was solid and yellowish white. Pathological diagnosis was fibrous type of the pleural mesothelioma. The patient is well and has no sign of recurrence for three years. There are 123 cases of localized pleural mesothelioma including our case in Japan. Five in 78 cases which was diagnosed to be benign histologically at operation, had recurrence later. It is important to follow up strictly for long term.