Traumatic aorto-right atrial fistula after blunt chest injury

A extremely rare case of traumatic fistula between the aortic root and the right atrium is reported. The patient was involved in a traffic accident 18 months before admission. Aortogram demonstrated a fistulous tract from the noncoronary sinus into the right atrium. Operation revealed a traumatic dissection of the aortic root with rupture into the right atrium. The aortic dissection was repaired and the patient was discharged from the hospital in good condition.     

Conservative surgical treatment of valvular injury after blunt chest trauma

BACKGROUND: Blunt injury to the cardiac valves leads to progressive ventricular failure often requiring surgical management. Most frequently, prosthetic replacement is the chosen management. METHODS: Three consecutive patients presenting to one surgeon with blunt traumatic valve lesions formed the study group. RESULTS: At operation, the valvular pathology was assessed, and reparative techniques were used to correct the defects. All the patients had an excellent outcome at follow-up periods of 2 to 3 years. CONCLUSIONS: Conservative operation to repair traumatic valve lesions is feasible and has potential advantages over replacement.     

Chylothorax after blunt chest trauma

An unusually lately discovered and successfully treated case with right sided chylothorax after blunt chest trauma is presented. Pathogenesis of chylothorax, diagnostic and treatment modalities are summarised.     

Ventricular aneurysm due to blunt chest injury

A left ventricular aneurysm developed in 3 patients sustaining blunt chest injury. Evidence of an acute myocardial infarction on the electrocardiogram and enzyme analysis prompted cardiac catheterization, which revealed total occlusion of the left anterior descending coronary artery in 2 of the 3 patients. Ventricular aneurysmectomy was performed in each patient. A review of the literature revealed 32 previously reported patients with left ventricular aneurysm caused by blunt trauma. Clinical features, catheterization or autopsy findings, and outcome are examined.     

Management of chylothorax after blunt chest trauma

Chylothorax following blunt chest trauma is rare; we found only 19 cases reported. We describe an unusual patient with chylothorax from closed chest injury. The diagnosis is made from thoracentesis or tube thoracostomy fluid. Thoracostomy in the definitive therapeutic modality. Nonoperative or, when necessary, operative treatment of chylothorax after blunt trauma can lead to a successful outcome in 90% of cases.     

Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis

Angiographic embolization of bleeding pelvic vessels is increasingly used in patients with pelvic injuries. Temporary angiographic embolization of bilateral internal iliac arteries (TAEBIIA) is occasionally necessary. From November 1991 to March 1998, 30 consecutive patients (mean age of 43 years, mean Injury Severity Score of 25) with complex pelvic fractures underwent TAEBIIA to control severe hemorrhage not responding to subselective embolization. Angiography revealed multiple sources of pelvic bleeding in 28 (93%) patients. In the two remaining patients, no bleeding was identified but TAEBIIA was done empirically. Thirteen patients had laparotomies before TAEBIIA with unsuccessful bleeding control, and the remaining 17 had TAEBIIA as the primary treatment. After TAEBIIA 90 per cent of patients had successful clinical (27 of 30) and radiographic (25 of 28) control of bleeding. Of the three patients who continued to bleed after TAEBIIA two were successfully re-embolized and one died of acute cardiac failure before any further intervention was attempted. TAEBIIA had a success rate of 97 per cent (29 of 30) in controlling pelvic hemorrhage without significant complications related to it. TAEBIIA is a safe and effective alternative to subselective embolization in controlling retroperitoneal bleeding in selected patients with blunt pelvic trauma.     

Multiple intracardiac lesions after blunt chest trauma

Closed chest trauma can cause rupture of intracardiac structures. We report the case of a 17-year-old boy whose chest was trodden by a horse. He sustained rupture of tricuspid and aortic valve leaflets and rupture of the interventricular septum. He underwent surgical repair of these lesions, but aortic insufficiency developed 2 years later and the aortic valve was replaced with a mechanical prosthesis.     

Two cases of tension pneumopericardium following blunt chest injury

Tension pneumopericardium is uncommon in blunt trauma, and only rare survivors have been reported. We report two patients who survived tension pneumopericardium following blunt trauma. Both patients experienced signs and symptoms of cardiac tamponade that were corrected by insertion of a subxyphoid pericardial tube. Both survived all injuries and returned to normal activities with normal neurologic function.     

Left ventricular thrombosis after blunt chest trauma

A 22-year-old man was admitted to our observation with left ventricular thrombus arising after blunt chest trauma occurring during a ski accident one year before. None was obtained from a review of instrumental and laboratory data at trauma time. Transesophageal echocardiography showed an intraventricular thrombus and severe hypokinesia at the apex. Standard cardiac surgery procedure was performed and postoperative period was uneventful. Echocardiography controls at 6/12 months showed a normal apex kinesia. This case shows the importance of hospitalization, hemodynamics monitorization and late serial echocardiographic controls for timely diagnosis and management of myocardial contusion and consecutive ventricular thrombus formation to prevent life-threatening complications.     

Tension pneumopericardium after blunt chest trauma.

We present a case of tension pneumopericardium in a patient involved in a motor vehicle crash. This patient was treated initially with a percutaneously placed drain and then definitively by a video assisted thoracoscopic pericardial window.     

Pulmonary disability after severe blunt chest trauma

Twenty-eight patients surviving severe chest injury were studied prospectively (Group I) to assess the timing of recovery and the degree of residual pulmonary dysfunction. Pulmonary function tests (PFT) were obtained within 2 weeks of discharge and serially at intervals of 3 to 6 months. In addition, 16 patients injured 1 to 11 years previously (mean, 33 months) were recalled to determine long-term respiratory disability (Group II). Standard spirometric pulmonary function measurements were obtained. The mean age (36 yrs) and ISS (34) were the same in both groups. The majority of patients required intubation and mechanical ventilation, averaging 21 days in Group I and 18 days in Group II. PFTs were markedly abnormal soon after injury, averaging 40 to 50% of predicted values for all tests performed. Rapid improvement in all parameters was noted by 4 months after discharge and pulmonary function had almost returned to normal by the last followup exam (average, 65 to 90% of predicted). Results in Group II demonstrated continued improvement over long periods of followup. All patients who were employed preinjury had returned to work by 6 months after discharge except one. Long-term respiratory disability was present in less than 5% of patients studied. We conclude that recovery from severe chest injury occurs rapidly in most patients and serious long-term respiratory disability is uncommon. These results justify the commitment of major resources to the intensive care of patients with severe chest injuries.     

Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury

The spleen is the most commonly injured solid organ following blunt abdominal trauma. Over recent decades, splenic artery embolization (SAE) has become the mainstay treatment for haemodynamically stable patients with high-grade blunt splenic trauma, with splenectomy the mainstay of treatment for unstable patients. Splenic function is complex but the spleen has an important role in immune function, particularly in protection against encapsulated bacteria. Established evidence suggests that following splenectomy immune function is impaired resulting in increased susceptibility to overwhelming post-splenectomy infection, however, immune function may be preserved following SAE. This review will discuss the current state of the literature on immune function following different treatments of blunt splenic injury, and the controversies surrounding what constitutes a quantitative test of splenic immune function.