Acute Aortic Valve Rupture Secondary to Blunt Chest Trauma

Abstract Cardiac valve injury after blunt chest trauma is rare. We present a case of blunt chest trauma resulting in an isolated aortic valve rupture treated with aortic valve replacement . (J Card Surg 2010;25:381‐382)     

Acute Chordae Rupture of the Mitral Valve Following Moderate Blunt Chest Trauma

Abstract Acute mitral regurgitation following traumatic rupture of the tendinous cords is very rare. A young woman is reported who suffered acute mitral regurgitation following moderate blunt chest trauma during cross-country skiing. She was successfully operated on with a mitral valve repair. Although historically, acute mitral regurgitation following traumatic papillary muscle rupture or rupture of tendinous cords is most commonly treated with a mitral valve prosthesis, mitral valve repair is possible in selected cases.     

Tracheobronchial Rupture due to Blunt Chest Trauma: Report of a Case

Tracheobronchial injuries following blunt chest trauma are uncommon in children. The involvement of both the trachea and right main bronchus separately is highly unusual. We herein report the case of a 13-year-old boy who presented with both a tracheal and right main bronchial rupture following blunt chest trauma. While the tracheal laceration required a tracheotomy, a delayed repair of right main bronchial disruption was performed with a complete preservation of the right lung. The features of this uncommon entity are discussed, with special emphasis on early diagnosis and surgical management.     

The Incidence of Myocardial Contusion in 160 Patients with Blunt Chest Trauma

The incidence of myocardial contusion after blunt chest trauma has been reported in 8.2 to 75% of trauma patients. We performed this study to report on the incidence of myocardial contusion in order to determine the frequency and to describe the type of complications in these patients. We conducted a retrospective analysis over a period of 4 years. There were 160 patients with a blunt chest trauma which were admitted to our hospital. Myocardial contusion occurred in 27 of our patients with blunt chest trauma (16.9%). In all these patients typical ECG-changes could be found during hospitalization (100%). The incidence of further pathological findings in the 27 patients was 30% for the auscultation, 37% for cardiac enzymes (MB-fraction), and 41% for the echocardiography. Cardiac complications like arrhythmias, cardiac failure and tamponade occurred in 20 patients (74%). Early diagnosis of myocardial contusion in patients with blunt chest trauma is important to prevent and to treat possible complications. ECG-controls have the highest sensitivity to detect a myocardial contusion, whereas cardiac enzymes and echocardiograms seem to be poor markers of blunt myocardial injury.     

Tracheal Rupture After Blunt Trauma

Tracheal injuries are uncommon after blunt trauma. Early diagnosis and urgent treatment are primordial to reduce both mortality and morbidity. We describe the case of a 45-year-old man who met with a traffic accident and was brought to the emergency department. Progressively, he developed dyspnoea and coughing. The diagnosis of a tracheal rupture was established and the rupture was closed surgically. The management of the patient with suspected tracheal rupture is discussed.     

Pneumoscrotum After Blunt Chest Trauma

Pneumoscrotum, the accumulation of air inside the scrotum, is a rare complication associated with blunt chest trauma. We report a case of severe subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumopericardium, and pneumoscrotum after blunt chest trauma in a 44-year-old man. He presented with progressive swelling of the neck that descended to the chest, abdomen, both legs, and scrotum. Radiography and computed tomography of the chest and abdomen confirmed the diagnosis of a tracheal injury complicated by severe subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumopericardium, and pneumoscrotum. Primary repair of the tracheal injury was performed, and he was weaned successfully from the ventilator by day 5. He was discharged on day 7.     

Determining Which Patients Require Evaluation for Blunt Cardiac Injury following Blunt Chest Trauma

The objective of this study was to determine prospectively which risk factors require cardiac monitoring for blunt cardiac injury (BCI) following blunt chest trauma. All patients who sustained blunt chest trauma had an electrocardiogram (ECG) on admission to our urban level I trauma center. Those with ST segment changes, dysrhythmias, hemodynamic instability, history of cardiac disease, age >55 years, or a need for general anesthesia within 24 hours (group 1) were admitted to the intensive care unit (ICU) for 24 hours where they were subjected to serial ECGs, creatinine phosphokinase (CPK) assays, and echocardiography (ECHO). Those with only mechanism for BCI, i.e., none of the above risk factors (group 2), were admitted to a nonmonitored bed and had a follow-up ECG 24 hours later. A series of 315 patients were admitted with blunt chest trauma during a 17-month period; 144 patients were in group 1 and 171 in group 2. Overall, 22 patients were diagnosed as BCI (+BCI), defined as evolving ST segment changes, dysrhythmias, a CPK-MB index of >2.5, or hemodynamic instability. Of the 18 +BCI patients in group 1, all were symptomatic (i.e., none was included solely for a cardiac history, age, or need for general anesthesia). Six of these patients required treatment for dysrhythmias, hypotension, or pulmonary edema; one of whom died. Four patients with +BCI were in group 2 and had ECG changes at 24 hours; none of these four had any sequelae from their +BCI. None of the ECHOs demonstrated abnormal wall motion. Patients who sustain blunt chest trauma with a normal ECG, normal blood pressure, and no dysrhythmias on admission require no further intervention for BCI. Patients with ST segment changes, dysrhythmias, or hypotension following blunt chest trauma should be monitored for 24 hours, as this subgroup occasionally requires further treatment for complications of BCI. ECHO adds nothing as a screening test.     

Delayed Chylothorax Following Blunt Chest Trauma

Chylothorax is a very rare disease, and its diagnosis following blunt chest trauma is exceptional. Only a small number of cases have been reported in the literature. We report a case of a male patient involved in a car accident presenting a delayed chylothorax after blunt chest trauma with a bilateral serial rib fracture and fracture of the ninth thoracic vertebrae. The therapy includes thorax drainage, dietary modifications with total parenteral nutrition and, in severe cases, PEEP ventilation. Hematological monitoring is mandatory to detect metabolic abnormalities resulting from chyle loss. Surgical treatment is only required in cases of persistent or increasing intrathoracal chyle flow. Thoracoscopic ligation of the thoracic duct is then required.     

Diagnostics and Scoring in Blunt Chest Trauma

Background: Blunt chest trauma is frequently present in patients with multiple trauma. In polytraumatized patients thoracic injuries have significant influence on the treatment strategy, not only in the emergency room but also in the intensive care unit. They also affect the decision-making concerning fracture management. The vital role played by blunt chest trauma in the outcome after multiple injuries is highlighted by the fact that polytraumatized patients with severe thoracic trauma have a higher mortality rate than patients with the same injury severity without thoracic trauma. Diagnostics and Injury Severity: Within the broad category of thoracic trauma, there are many different types of injuries. Therefore it is crucial for the treating physician to promptly make the correct diagnosis and to quantify the severity of the injury. This will allow the selection of an appropriate treatment protocol and ensure the best possible outcome for the patient. Scoring Systems: Additionally, various treatment protocols for management can only be evaluated scientifically if the assessment of the trauma severity is standardized. Thus, a reliable CT-independent classification of the severity of thoracic trauma is essential. The "Thoracic Trauma Severity Score" (TTS) is a CT-independent classification of thoracic trauma that is reliable and an be performed quickly in the emergency room. This will allow for adequate treatment of thoracic trauma and the prevention of secondary complications.     

Tracheoesophageal Fistula with Severe Mediastinitis Following Blunt Chest Trauma

Abstract Tracheoesophageal fistula (TEF) following nonpenetrating injury is a very rare traumatic condition but serious complication that needs an immediate surgical intervention after making an accurate diagnosis. A case of TEF with severe mediastinitis that is rarely accompanied with TEF is reported. An 18-year-old man who had a traffic accident was admitted to the intensive care unit. After 2 days following admission and intubation, bile juice was suctioned from the trachea. TEF was suspected and promptly confirmed by contrast esophagogram. The patient was taken to surgery and underwent a right posterolateral thoracotomy. The tracheal defect was repaired by primary suture with reinforcement of the pedicled intercostal muscle flap and esophageal exclusion and diversion with drainage was performed because of severe mediastinitis. A second-stage esophageal reconstruction with a right colon conduit was performed when he was completely stabilized in the aspects of infection, nutrition and respiration. His postoperative course was uneventful.     

Quality of Life in Multiply Injured Patients

Abstract Background: Health-related Quality of Life (QoL) has gained increased attention in medicine but a specific QoL instrument for trauma patients does not yet exist. Following the recommendations of a recent international consensus conference, the Polytrauma Outcome (POLO) Chart, a modular (generic plus disease-specific) instrument was developed for systematic outcome assessment of multiply injured patients as part of the German Trauma Registry. The development of the disease- specific module, the Trauma Outcome Profile (TOP), is described. Methods: Phase I—item collection, including a pilot study; phase II—item reduction; phase III—pre-testing in 70 polytraumatized patients and 70 controls with minor injuries. The instrument covers the four domains of QoL: physical, psychological, social, and functional capacity. Factor analysis and inter-item correlation was used to investigate relationships between items. Results: The initial phase generated 175 questions. In phase II the number of items was reduced to 64 by statistical analysis and clinical experts. Pre-testing with factor analysis generated a final instrument with eight dimensions: depression, anxiousness, post-traumatic stress disorder, social interactions, daily activities, mental functioning, pain and physical functioning. Two questions on body image and satisfaction were added. The TOP is currently being validated (phase IV). Conclusions: Together with the Glasgow Outcome Scale (GOS), the EuroQoL, and the SF-36, the TOP module is part of the POLO-Chart. It is the first disease-specific instrument for QoL assessment in patients with multiple injuries. The extended development process has enabled all relevant aspects of a patient’s status after trauma to be considered. This instrument will be used by the German Trauma Registry for systematic follow-up investigations. The TOP can also be used as a standardized stand-alone screening measurement in followup investigations for individual trauma patients. *Members of the Working Group “Polytrauma” of the German Society for Trauma Surgery (DGU): B. Bouillon, K. Grimme, S. Grote, M. Grotz, M. Hering, S. Huber, G. Kanz, M. Kleiner, C. Krettek, C. Kühne, C. Lackner, R. Lefering, W. Mutschler, D. Nast-Kolb, E. Neugebauer, H. J. Oestern, T. Paffrath, H. C. Pape, N. Pirente, C. Probst, M. Raum, D. Rixen, S. Ruchholtz, S. Sauerland, O. Steitz, C. Waydhas, J. Westhoff, M. Wittke.     

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.     

The Incidence of Myocardial Contusion in 160 Patients with Blunt Chest Trauma Diagnostic Criteria and Outcome

The incidence of myocardial contusion after blunt chest trauma has been reported in 8.2 to 75% of trauma patients. We performed this study to report on the incidence of myocardial contusion in order to determine the frequency and to describe the type of complications in these patients. We conducted a retrospective analysis over a period of 4 years. There were 160 patients with a blunt chest trauma which were admitted to our hospital. Myocardial contusion occurred in 27 of our patients with blunt chest trauma (16.9%). In all these patients typical ECG-changes could be found during hospitalization (100%). The incidence of further pathological findings in the 27 patients was 30% for the auscultation, 37% for cardiac enzymes (MB-fraction), and 41% for the echocardiography. Cardiac complications like arrhythmias, cardiac failure and tamponade occurred in 20 patients (74%). Early diagnosis of myocardial contusion in patients with blunt chest trauma is important to prevent and to treat possible complications. ECG-controls have the highest sensitivity to detect a myocardial contusion, whereas cardiac enzymes and echocardiograms seem to be poor markers of blunt myocardial injury.     

The Prognostic Significance of Pulmonary Contusions on Initial Chest Radiographs in Blunt Trauma Patients

Objective:  

The importance of immediate versus delayed pulmonary contusions among severely injured blunt trauma patients is unknown. We hypothesized that patients with pulmonary contusions apparent on initial chest radiographs have higher rates of mortality and acute respiratory distress syndrome than patients who have delayed radiographic changes of pulmonary contusions.