Thoracic aortography following blunt chest trauma

The records of 314 patients who suffered blunt chest trauma and underwent thoracic aortography between 1968 and 1986 were retrospectively reviewed. The patients ranged in age from 7 to 84 years (mean, 37.7 years). There were 255 male and 59 female patients. The majority of injuries were the result of motor vehicle accidents. The most common indication for aortography was a widened mediastinum on chest roentgenogram (83.4%). The aortogram was positive for cardiovascular injury in 19.7% of cases. There were 47 patients with aortic rupture, 15 with subclavian artery disruption, and 1 with traumatic aortic insufficiency. Complications occurred in 1.7% of patients. Two patients sustained groin hematomas and one patient suffered an intimal tear of the ascending aorta from the angiographic catheter. None of the complications required treatment. Aberrant origin of the arch vessels occurred in 0.96% of patients, and ductus diverticulum occurred in 0.64%. There were two false-positive and no false-negative aortograms. It was concluded that thoracic aortography after trauma is accurate and safe.     

Cardiac contusion following blunt chest trauma.

Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.     

Unusual cardiac injury following blunt chest trauma.

Cardiac injury following blunt chest trauma is known to occur, but traumatic rupture of ventricular septum is a rare injury, especially following blunt chest trauma. A case of a 20-year-old male is presented who fell on his back from a 9th-floor window and was resuscitated for 3 hours to no avail. Post-mortem examination confirmed a fracture of the pelvis, pulmonary contusion and rupture of ventricular septum of the heart.     

Clinical assessment and radiograph following blunt chest trauma.

This study was undertaken to assess the accuracy of clinical examination in predicting significant injury following blunt chest trauma and to determine whether more selective use of frontal chest radiography could be achieved.     

Sudden cardiac death following blunt chest trauma: commotio cordis

BACKGROUND:

There have been numerous reports of sudden cardiac death attributable to the condition of commotio cordis. Primarily, these are reports from the USA. Although three Australian cases have been mentioned in the published literature, the present case appears to be the first described Australian case.

METHODS:

A man was brought to the Emergency Department after sudden collapse while playing cricket. His medical history was suggestive of hitting by a cricket ball while batting.

RESULTS:

The epidemiology and mechanism of arrhythmia induction in commotio cordis are discussed. The emergency management of commotio cordis is outlined.

CONCLUSIONS:

Commotio cordis is rare in sports (and Emergency Medicine). However it has a high mortality rate, and rapid recognition of the condition allows early defibrillation, generally with a good outcome. The improvement of participant care is recommended at community and other sport events.KEY WORDS: Arrhythmia, Sudden cardiac death, Commotio cordis, Cricket     

Pneumoscrotum after blunt chest trauma

A case of pneumoscrotum after a suicide jump with blunt chest trauma and chest tube placement is reported. Pneumoscrotum itself has little clinical importance, but it is essential for the clinician to determine the origin of the air, and a careful search for the source of air is necessary. Three possible routes of air in the pneumoscrotum are reviewed. Many reported cases, including this case, had a cause distant from the pelvis: air dissected subcutaneously to the scrotum because of pneumothorax, tube thoracostomy, and air leak combined with ventilatory resuscitation efforts.     

胸部钝性创伤的CT诊断

目的评价CT对胸部钝性创伤的诊断价值及临床意义。方法回顾分析349例胸部钝性创伤的胸部CT征象。结果CT检查有阳性诊断270例，阳性率77．36％。发现肺挫伤67例，支气管断裂3例，胸膜腔创伤143例，纵隔血肿5例，心包积血3例，膈肌破裂5例，骨折117例，皮下气肿19例。17例伴有腹部损伤。结论CT对胸部钝性创伤的检查具有诊断价值。     

Cardiac injuries in blunt chest trauma

Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.     

Late cardiac arrhythmias after blunt chest trauma

Objective: Case reports of two patients who developed fatal cardiac arrhythmias several days after blunt chest trauma.¶Design: Case reports.¶Setting: Surgical intensive care unit of a university hospital.¶Patients: A 23-year-old man and a 9-year-old girl with blunt chest trauma and multiple further injuries following car crashes were transferred to our institution. Although ECG on admission was normal, both patients developed fatal cardiac arrhythmias after 6 and 4 days, respectively. In both patients, post-mortem analysis confirmed myocardial contusion without coronary artery lesions. Histological findings included severe interstitial oedema, haemorrhages and infiltration of lymphocytes and neutrophils, fresh myocardial necrosis and fatty degeneration.¶Conclusion: Blunt chest trauma with myocardial contusion may lead to fatal cardiac arrhythmias even after several days, particularly when other severe injuries are present. Thus, a normal ECG on admission and absence of cardiac arrhythmias during the first 24 h of intensive care treatment do not necessarily exclude the occurrence of life-threatening arrhythmias in the further course.     

Bronchial tear consecutive to blunt chest trauma

Tracheobronchial injuries following blunt chest trauma are rare and can be lethal. CT scan can help to diagnose it when a defect to the tracheobronchial wall is visible or to suspect it in front of indirect signs.     

Tension pneumopericardium following blunt trauma

Tension pneumopericardium is uncommon after thoracic trauma and generally occurs following penetrating injury. Survivors of tension pneumopericardium secondary to blunt thoracic trauma are rare. We present the case of a 41 year old woman with multiple injuries after a high speed motor vehicle crash, who developed tension pneumopericardium shortly after endotracheal intubation and positive pressure ventilation. Aspiration of 110 mls of air from the pericardium in the Emergency Department produced a dramatic improvement in her condition and she was discharged 28 days later.     

Traumatic tricuspid regurgitation following equine related blunt chest trauma and review of the literature

Myocardial injury following blunt chest trauma may be difficult to detect. We advocate for cardiac screening in such scenarios. Observation versus intervention should be based on symptoms and the degree of intracardiac disease.     

Isolated myocardial contusion in blunt chest trauma.

The objective of this case report was to document a rare case of isolated myocardial contusion in the setting of blunt thoracic trauma. Although demonstrated by electrocardiogram and myocardium-specific enzymes, the trauma had no clinical relevance and the patient was discharged uneventfully from the intensive care unit. The clinical significance of blunt myocardial contusion is then discussed.     

Late clotted haemothorax after blunt chest trauma.

A clotted haemothorax can develop any time after blunt chest trauma. Two cases are described in which late clotted haemothoraces developed which were treated by limited thoracotomy and evacuation of clots. Late clotted haemothorax may occur even in the absence of any abnormal initial clinical findings. Early detection and treatment is important to avoid the complications of fibrothorax and empyema with permanent pulmonary dysfunction. After blunt chest trauma patients should be advised to return to the accident and emergency department for assessment on development of any new chest symptom. Under these circumstances a chest x ray is mandatory to exclude a haemothorax.     

Left ventricular aneurysms caused by blunt chest trauma

This report describes the case of a 25-year-old man who suffered blunt chest trauma with resultant development of an asymptomatic left ventricular aneurysm which was successfully resected. A review of the literature reveals 25 reported cases of left ventricular aneurysm due to blunt trauma since 1892. The clinical findings and complications are similar to those of left ventricular aneurysm from other causes. The prognosis is not clear, but it is not necessarily benign even in asymptomatic cases. Aneurysmectomy has been generally successful and may be the treatment of choice. The surgical risk and prognosis is expected to be better than in left ventricular aneurysm due to myocardial infarction because of the relative infrequency of coexisting coronary artery disease.     

Subtle abdominal aortic injury after blunt chest trauma

This case report describes a patient with an intimal flap of the abdominal aorta after a motor vehicle crash. The patient was an unrestrained driver with minimal anterior chest wall pain. This is a rare injury and one that is difficult to find due to its rarity. The lower cut of the chest CT scan found the injury. Its treatment with endovascular stenting is discussed.     

Right atrial rupture due to blunt chest trauma

Violent injury currently accounts for the majority of deaths among young people. Cardiac trauma is responsible for 15% of deaths from thoracic injury, and the incidence of cardiac injury in blunt chest trauma is as high as 76% in some clinical series. Many of these cardiac injuries consist of myocardial contusions. Recently, however, there has been increasing recognition of chamber disruption caused by blunt chest trauma. Cardiac injury is usually the result of direct compression of the heart between the sternum and the dorsal spine. These patients are frequently in extremis, with signs of pericardial tamponade, hypotension, and/or massive hemothorax. Successful management is dependent upon prompt diagnosis and surgical repair. To date there have been only 28 survivors (including the three patients in this report) of this catastrophic and frequently unrecognized injury.