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.     

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.     

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.     

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.     

Pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents

Pneumopericardium is the presence of air in the pericardial space. In adults, it may be seen in the context with severe blunt chest trauma, pneumothorax, pneumoperitoneum, or other causes of pneumomediastinum. The diagnosis is made by computed tomography scan of the thorax and abdomen that allows the additional detection of concomitant injuries. Possible causes of the pneumopericardium such as tracheobronchial or oesophageal tears have to be excluded by bronchoscopy or esophagogastroduodenoscopy. Usually, pneumopericardium is self-limiting requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. Tension pneumopericardium causing a life-threatening cardiac tamponade requires an immediate pericardial aspiration, the subsequent pericardial drainage via a pericardial window or emergent open subxyphoid approach to the pericardium.     

儿童钝性胸部创伤后主支气管断裂临床分析

目的　探讨儿童钝性胸部创伤后主支气管断裂的临床特点和早期诊治。方法　本组 11例 ,年龄 3～ 7岁 ,平均 (5 1± 1 4 )岁。患者均为闭合性损伤后主支气管完全性断裂 ,左侧 7例 ,右侧 4例。 4例伤后 2 4h内急诊行支气管断裂吻合术 ;7例延误诊断患儿于伤后 2～ 12个月内晚期手术 ,其中 3例行支气管断裂吻合术 ,4例行全肺切除术。结果　本组无手术死亡 ,7例行支气管断裂吻合术 ,恢复顺利 ,术后1个月胸片复查 ,肺组织复张良好。结论　认识儿童钝性胸部创伤后气管支气管断裂的临床特点 ,可提高早期诊断水平 ,明显降低其并发症和病死率。     

Diagnostic dilemmas and current controversies in blunt chest trauma

Blunt chest injuries are common encounters in the emergency department. Instead of a comprehensive review of the management of all chest injuries, this review focuses on injuries that can be difficult to diagnose and manage, including blunt aortic injury, cardiac contusion, and blunt diaphragmatic injury. This review also discusses some recent controversies in the literature regarding the use of prophylactic antibiotics for tube thoracostomy and the optimal management of occult pneumothorax. The article concludes with a discussion of the management of rib fractures in the elderly.     

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.     

Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review

Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.     

Pulmonary contusion: the hidden danger in blunt chest trauma

Pulmonary contusion, known as the most common potentially lethal chest injury seen in this country, necessitates aggressive nursing assessment and diagnosis if treatment is to be effective and prognosis improved. Initial chest x-rays will usually not display the severity of the contusion. The nurse maintains a high index of suspicion for pulmonary contusion when assessing chest trauma patients. By monitoring ventilatory parameters to assess oxygenation, the nurse acknowledges that hypoxemia is the hallmark clinical sign. Through comprehension of the different mechanisms of injury, the role of chest compliance, and the pathologic alterations, the critical care nurse delivers skillful and knowledgeable care to the patient with a pulmonary contusion.     

Robotic mitral valve plasty for mitral regurgitation after blunt chest trauma in Barlow's disease

We successfully treated a case of mitral regurgitation due to chest trauma in Barlow's disease. A 71‐year‐old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo‐chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posterior mitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlow's disease was achieved safely with good clinical and excellent cosmetic results.     

Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

Late gadolinium enhanced (LGE) cardiovascular magnetic resonance (CMR) has proven to be the gold standard for viability assessment. LGE CMR is also useful for identifying the nature of cardiac masses or lesions. We report a case of a rare primary cystic tumor of the atrioventricular node, in which CMR proved to be valuable.     

Delayed rupture of the mitral valve complicating blunt chest trauma.

A case is described of acute torrential mitral regurgitation resulting from avulsion of both papillary muscles 12 hours after a blunt chest and abdominal injury. The intensive care and surgical management are discussed.