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Kang D, Fredericks C, Bokhari F, Kaminsky M. Retained Bullet of the Mediastinum. Am Surg 2018; 84:e517-e518. [PMID: 30606361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Loudon A, Mattes M, Smith H, Harrera L, Bhullar IS. Survival of Left Chest and Mediastinal Impalement with a Fence Post. Am Surg 2016; 82:e225-e226. [PMID: 27657578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Naomi A, Oyamatsu Y, Narita K, Nakayama M. [Thoracic and abdominal and limb wounds by gun shot]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2015; 68:98-101. [PMID: 25743351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Japan, we are permitted to own fire arms only for hunting and clay pigeon shooting, but gunshot wound victims have neen rarely seen due to the strict laws against owing guns, and the lack of related crimes. Therefore, surgeons should be familiar with ballistics, practical gunshot wound management, and the possibility of delayed lead poisoning ssociated with bullet residue. A 69-year-old man was brought to our hospital because he was accidentally shot by his companion's shotgun during hunting. On admission, although he had stable vital sign and multiple gunshot wounds on his right forearm and femur, chest X-ray and computed tomography (CT) revealed a few of bullets and its flagments on his back, into spleen and pericardium. Following local debridment after removal of the bullets in his right forearm and femur at an emergency room, broken heart muscle and diaphragm were repaired and hematoma in the anterior mediastinum was removed at the operating room. The patient was discharged on the 25th post-operative day and his post-operative course was uneventful. In case of gunshot injuries, in addition to prompt diagnosis and evaluation of organ injuries, careful follow up for possible delayed lead poisoning is important.
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Vinbæk M, Sommer T. [Conservative treatment of oesophageal perforation in a child caused by a toothbrush]. Ugeskr Laeger 2014; 176:V05130338. [PMID: 25350813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Traumatic perforation of the oesophagus is a condition with high morbidity and mortality. We report a case of a one-year-old girl with traumatic oesophageal perforation caused by a fall with a toothbrush. She underwent a conservative regimen consisting of drainage of the mediastinum by a naso-cavitary drain, antibiotics and a feeding tube. No sign of mediastinitis was found on a follow-up computed tomography 19 days later, and she was discharged in good condition.
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Levine M, O'Connor AD, Tasset M. Methemoglobinemia after a mediastinal stab wound. J Emerg Med 2013; 45:e153-e156. [PMID: 23896056 DOI: 10.1016/j.jemermed.2013.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/25/2013] [Accepted: 05/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Methemoglobinemia is a relatively common, potentially fatal syndrome resulting from oxidative stress. Of the numerous causes identified, toxins are the most common precipitating event. OBJECTIVES Describe methemoglobinemia after a stab wound in a man with previously undiagnosed cytochrome b5 reductase deficiency. CASE REPORT In this case report, we describe a 27-year-old man with no past medical history who developed clinically significant methemoglobinemia after a mediastinal stab wound. After an extensive toxicologic work-up failed to reveal the etiology of the symptoms, genetic testing was performed, which revealed the individual to have a previously undiagnosed cytochrome b5 reductase deficiency. It is hypothesized that the physiologic stress from the expanding mediastinal stab wound resulted in enough oxidative stress to cause methemoglobinemia in this predisposed individual. A discussion of methemoglobinemia ensues. CONCLUSION This case describes an uncommon presentation of a common toxicologic condition and presents a discussion regarding the evaluation, management, and pathophysiology of methemoglobinemia.
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Gutierrez IM, Ben-Ishay O, Mooney DP. Pediatric thoracic and abdominal trauma. MINERVA CHIR 2013; 68:263-274. [PMID: 23774091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Thoracic and abdominal injuries in children are commonly the result of blunt trauma, making their diagnosis difficult. Unidentified injuries can cause significant morbidity and mortality and must be identified early. Understanding the anatomic and physiologic differences between children and adults is important to adequately manage children with these injuries. The following review provides salient points in the recognition and management of both thoracic and abdominal injuries in children from blunt trauma.
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Mizumoto M, Oizumi H, Kato H, Sadahiro M. [Thoracoscopic surgery for traumatic mediastinal hematoma]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2013; 66:374-378. [PMID: 23674034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a rare case of traumatic mediastinal hematoma treated by thoracoscopic surgery. A 78-year-old man accidentally fell down from the roof, and he was urgently transferred to our hospital. Soon after the arrival, he showed breathlessness followed by cardiopulmonary arrest, necessitating tracheal intubation and resuscitation. Computed tomography (CT) showed a large cervical hematoma extending to the tracheal bifurcation level of mediastinum, causing tracheal obstruction. Five days later, the large mediastinal hematoma was removed by thoracoscopic surgery. The patient recovered without any complications after our treatments.
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Iwashita T, Yasuda I, Uemura S, Doi S, Yamauchi T, Kawaguchi J, Toda K, Adachi S, Moriwaki H. Infected mediastinal cyst following endoscopic ultrasonography-guided fine-needle aspiration with rupture into the esophagus. Dig Endosc 2012; 24:386. [PMID: 22925302 DOI: 10.1111/j.1443-1661.2012.01287.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ronen O, Uri N. A case of nasogastric tube perforation of the nasopharynx causing a fatal mediastinal complication. EAR, NOSE & THROAT JOURNAL 2009; 88:E17-E18. [PMID: 19750464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Iatrogenic nasopharyngeal perforations secondary to improper nasogastric tube insertion probably occur more frequently than has been reported. Our review of the literature found very few cases. We report the case of a 79-year-old woman who died of mediastinal complications following the improper insertion of a nasogastric tube that resulted in a nasopharyngeal perforation. We also review the proper technique for inserting these tubes.
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Bayram AS, Biçer M, Ercan A, Gebitekin C. [Therapeutic approach in hemodynamically stable transmediastinal gunshot wounds]. ULUS TRAVMA ACIL CER 2009; 15:194-197. [PMID: 19353327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Transmediastinal gunshot wounds may result in damage to the heart, large blood vessels, esophagus or lung. In hemodynamically stable patients, diagnostic examinations have critical importance and the preferred therapies still have unresolved points. In this paper, we present our experience with five patients, three of whom were operated for transmediastinal gunshot wounds after diagnostic tests; all were hemodynamically stable. Before deciding on operation, diagnostic tests should be performed in hemodynamically stable patients with transmediastinal gunshot wounds.
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Simmons JD, Haraway AN, Schmieg RE, Burgdorf M, Duchesne J. Is there a role for secondary thoracic ultrasound in patients with penetrating injuries to the anterior mediastinum? Am Surg 2008; 74:11-14. [PMID: 18274421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Pericardial tamponade (PT) after penetrating thoracic injury can be lethal if not diagnosed and treated promptly. Most patients present with PT shortly after their injuries occur, but delayed presentation of PT (delayed pericardial tamponade [DPT]) has occurred as late as 73 days after initial injury. Initial evaluation of patients with an anterior mediastinal penetrating injury includes physical examination, chest x-ray, and echocardiography. CT scans of the chest can clarify the tracts of penetrating injuries in stable patients. With increased accessibility to these radiographic modalities, PT has been diagnosed in a more timely fashion, and the incidence of DPT has decreased. However, the absence of pericardial effusions on all of these studies at initial presentation does not clear the patient from risk for developing DPT.
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Komanapalli CB, Tripathy U, Slater M. Survival after simultaneous blunt injury to the ascending aorta and transverse arch. THE JOURNAL OF TRAUMA 2007; 62:1042-4. [PMID: 17426566 DOI: 10.1097/01.ta.0000246883.46190.6a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Burack JH, Kandil E, Sawas A, O'Neill PA, Sclafani SJA, Lowery RC, Zenilman ME. Triage and Outcome of Patients with Mediastinal Penetrating Trauma. Ann Thorac Surg 2007; 83:377-82; discussion 382. [PMID: 17257952 DOI: 10.1016/j.athoracsur.2006.05.107] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 05/16/2006] [Accepted: 05/18/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND A retrospective study was conducted detailing an experience with echocardiography and contrast-enhanced helical computed tomographic angiographic (CTA) scans in the evaluation of stable patients with mediastinal penetrating trauma (MPT). METHODS Unstable patients underwent emergent operative intervention, and stable patients underwent chest roentgenogram, transthoracic echocardiography (TTE), and CTA. Further testing (angiogram, bronchoscopy, esophagoscopy, esophagogram) was done only if one of these studies revealed evidence of a trajectory in the vicinity of major vasculature or viscera. RESULTS Between 1997 and 2003, 207 patients had MPT. Seventy-two (35%) were unstable (45 gun shot wounds, 27 stab wounds) and 19 died in the emergency department. Fifty-three had emergent intervention and 32 survived. Work-up was done on 135 stable patients (65%) consisting of 46 gunshot wounds and 89 stab wounds, of which 5 had a positive TTE result and underwent a repair of a cardiac injury. CTA evaluation was normal in almost 80% of patients, who subsequently did not require further evaluation or treatment. In the stable patients, endoscopy or esophagography confirmed one tracheal injury and no esophageal injury. In the entire group, 10 patients (7%) had occult injury, and there were no deaths or missed injuries. CONCLUSIONS In cases of MPT, unstable patients require surgery, and in stable patients, TTE and chest CTA are effective screening tools. Patients with a negative TTE and CTA results can be observed and may not require further testing or endoscopy, whereas patients with positive TTE or CTA results require further assessment to exclude occult injury.
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Ibirogba S, Nicol AJ, Navsaria PH. Screening helical computed tomographic scanning in haemodynamic stable patients with transmediastinal gunshot wounds. Injury 2007; 38:48-52. [PMID: 17054956 DOI: 10.1016/j.injury.2006.07.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 07/17/2006] [Accepted: 07/24/2006] [Indexed: 02/02/2023]
Abstract
AIM The purpose of this study was to review and evaluate the efficacy of contrast-enhanced helical computed tomographic (CT) scanning in evaluating potential mediastinal injuries in stable patients with transmediastinal gunshot wounds (TMGSWs). METHODS During the review period, 01 January 2002-31 May 2005, the medical records of all haemodynamically stable patients with TMGSWs were retrieved and reviewed for demographics, diagnostic workup, treatment and complications. Screening CT was considered inconclusive in the presence of a mediastinal haematoma, pneumomediastinum or a missile track in proximity of major mediastinal structures. Inconclusive CT scans were further evaluated with angiography, and/or oesophography, and/or cardiac ultrasound. RESULTS Fifty consecutive haemodynamically stable patients with TMGSWs were identified. Thirty-five CT scans were performed, of which 29 (82.9%) were conclusive. Further diagnostic evaluation in the remaining six patients showed no injury. All patients were observed in a high-care unit and there were no missed injuries. The hospital charges generated with the CT scan based protocol were significantly less than with standard evaluation. CONCLUSION Contrast enhanced helical CT scanning is a safe, efficient and cost effective screening tool for evaluating haemodynamically stable patients with TMGSWs.
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Goette A, Binias KH, Schenkengel JP. Pneumomediastinum, subcutaneous emphysema and respiratory arrest after "mediastinal intubation". Resuscitation 2006; 72:340-1. [PMID: 17161899 DOI: 10.1016/j.resuscitation.2006.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 07/13/2006] [Accepted: 07/13/2006] [Indexed: 11/22/2022]
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Henriet B, Alexiou J, Akalay A, De Cooman S, Legendre H, Pector JC, Liberale G. Venous thrombosis associated with catheter-related mediastinal perforation due to catheter mispositioning. Acta Chir Belg 2006; 106:741-2. [PMID: 17290714 DOI: 10.1080/00015458.2006.11680000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen SY, Chang H, Lee SC, Hsu HH, Tzao C. Traumatic pseudoaneurysm from the aorta to the left common carotid artery presenting as widened mediastinum. Saudi Med J 2006; 27:1591-3. [PMID: 17013490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Diagnosis of pseudoaneurysm of the aorta or its main branches is a challenge in patients with blunt chest trauma. Computed tomography helps to demonstrate intrathoracic hemorrhage and suspected great vascular injury when a chest radiograph reveals widening of the mediastinum. Aortic angiography remains the gold standard in the determination of the site, and severity of vascular injury for definitive surgical intervention. Timing of surgical repair is controversial. Delayed repair of traumatic pseudoaneurysm of the aorta after primary control of associate injuries decreases mortality significantly, thus improving prognosis. We report a case of successful repair of a traumatic pseudoaneurysm of the aortic arch with extension to the left common carotid artery in an 18-year-old female patient. The diagnosis, surgical approaches, and timing of operation are discussed along with case presentation.
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Abstract
This article discusses the radiologic and clinical features of nonvascular mediastinal trauma, and focuses on the tracheobronchial tree, the esophagus, and the thoracic duct. Blunt chest and penetrating trauma account for most of the causes of such nonvascular injuries, but iatrogenic and inhalation injuries are other well-known causes. The injury distribution and clinical manifestations are different for each structure. In our combined experience at a level 1 trauma center, the overall prevalence of injury in each organ is low compared with vascular injuries. As such, and given the frequent nonspecific nature of clinical signs and symptoms of nonvascular mediastinal injuries, the diagnosis often is delayed and results in poor treatment outcome.
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Ray CE, Bauer JR, Cothren CC, Turner JH, Moore EE. Occult mediastinal great vessel trauma: the value of aortography performed during angiographic screening for blunt cervical vascular trauma. Cardiovasc Intervent Radiol 2005; 28:422-5. [PMID: 16001143 DOI: 10.1007/s00270-004-0117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the value of aortography in the assessment of occult aortic and great vessel injuries when routinely performed during screening angiography for blunt cerebrovascular injury (BCVI). METHODS One hundred and one consecutive patients who received both aortography and screening four-vessel angiography over 4 years were identified retrospectively. Angiograms for these patients were evaluated, and the incidence of occult mediastinal vascular injury was determined. RESULTS Of the 101 patients, 6 (6%) had angiographically documented traumatic aortic injuries. Of these 6 patients, one injury (17%) was unsuspected prior to angiography. Four of the 6 (67%) also had BCVI. One additional patient also had an injury to a branch of the subclavian artery. CONCLUSION Routine aortography during screening angiography for BCVI is not warranted due to the low incidence (1%) of occult mediastinal arterial injury. However, in the setting of a BCVI screening study and no CT scan of the chest, aortography may be advantageous.
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Wong RF, Davis TV, Peterson KA. Complications involving the mediastinum after injection of Enteryx for GERD. Gastrointest Endosc 2005; 61:753-6. [PMID: 15855987 DOI: 10.1016/s0016-5107(04)02645-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Chiti-Batelli S, Vaz F, Coman S. Traumatic retropharyngeal haematoma in an anticoagulated patient: Case report and proposal for a clinical protocol. Acta Otolaryngol 2005; 125:443-5. [PMID: 15823820 DOI: 10.1080/00016480410017233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Retropharyngeal haematomas (RPHs) are rare but potentially life-threatening conditions that require a prompt diagnosis. However, the clinical scenario is not always straightforward as their presentation may be insidious, with no specific signs or symptoms. Treatment of RPH is conservative in the majority of cases, with close observation. Nevertheless, surgical intervention is sometimes indicated for large, non-resolving haematomas. We present the case of a 53-year-old woman on anticoagulant therapy who required evacuation of a traumatic RPH. We also propose a clinical protocol for the management of these entities according to our experience and previous literature reports.
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Sohn MH, Kim MW, Lim ST, Yim HY, Lee S, Kim W, Park SK, Yim CY. Compression of the Anterior Mediastinum by Uremic Tumoral Calcinosis Unusually Involving the Sternoclavicular Joint. Clin Nucl Med 2005; 30:196-8. [PMID: 15722829 DOI: 10.1097/00003072-200503000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lemenev VL, Mikhaĭlov IP, Iofik VV, Zhulin DV, Abakumov MM. [Flap transverse sternotomy during operations on the vessels and organs of the upper mediastinum and the first cervical zone]. Khirurgiia (Mosk) 2005:19-23. [PMID: 16247402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A surgical approach to vessels and organs of the upper mediastinum was grounded, developed and tested. An experimental study of flap transverse sternotomy was carried out in 20 cadavers. A wide approach with throwing of the presternum was the best for manipulations in proximal parts of the aortic branches. This approach was also less traumatic.
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Melo ASAD, Marchiori E, Moreira LBM, Souza AS. [Traumatic chest lesions. Computed tomography findings]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2004; 10:393-403. [PMID: 15622435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Trauma is nowadays one of the most common causes of death and traumatic thoracic lesions are important agravant to trauma patients. In this work the aspects of computed tomography from 200 cases of thoracic trauma were studied. Lung lesions predominated, found in 192 cases (96%), manifested as contusions in 178 cases (89%), atelectasis in 41 cases (20.5%), lacerations in 15 cases (7.5%) and hematomas in 6 cases (3%). Pleural lesions were showed in 140 cases (70%), among them in 121 cases (60.5%) there were hemothorax and in 84 cases (42%), pneumothorax. Mediastinal lesions were observed in 28 cases (14%), with pneumomediastinum in 18 cases (9%), mediastinal hematoma in 7 cases (3.5%), hemopericardium in 4 cases (2%) and aortic lesions in 3 cases (1.5%). Diaphragmatic rupture was seen in 8 patients (4%). Soft tissue emphysema was demonstrated in 36 cases (18%).
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Khoynezhad A, Barrett L, Hayn E, Shaftan GW. Total mediastinal traverse with isolated internal mammary artery transection. J Card Surg 2004; 19:136-8. [PMID: 15016050 DOI: 10.1111/j.0886-0440.2004.04026.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Transmediastinal gunshot wounds are infrequent but life-threatening injuries. The course of the projectile and the bullet track often is unpredictable. Prompt and specific diagnostic and therapeutic interventions are necessary to quickly identify and repair potentially life-threatening injuries to the heart, great vessels, and the aerodigestive tract. Multiple diagnostic algorithms exist for work-up of these injuries, and the therapeutic interventions are diverse and challenging. We describe a patient with total mediastinal traverse, who presented with right-sided hemopneumothorax. The work-up revealed surprisingly an isolated left internal mammary artery transection with a significant hemorrhage that mandated surgical intervention in left chest.
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