Concomitant aortic valve and internal mammary artery injuries in blunt chest trauma: report of a case

Full realization of internal mammary artery injury after blunt chest trauma

Due to the substantial and continual increase in the number of motorized vehicles globally, clinicians are faced with an enormous population at risk for suffering internal mammary artery injuries after blunt chest trauma. Nevertheless, very little attention has been paid to this issue by relevant health practitioners. In addition, there is a scarcity of extant research data, as well as societal guidelines, regarding internal mammary artery injury. In cases with undetected internal mammary artery injury, however, the outcome may be catastrophic or fatal. Thus, investigating and reviewing the anatomy, etiology, diagnostic approaches, and treatment strategies for patients with internal mammary artery injury are urgently needed.

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

The occurrence, bleeding, and treatment of internal mammary artery (IMA) injury after blunt chest trauma have not been well described in the literature. We reviewed articles published from July 1977 to February 2014 describing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriovenous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent surgical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as well as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.

Treatment strategies for chronic expanding hematomas of the thorax

PURPOSE

To investigate retrospectively the treatment strategies for chronic expanding hematoma (CEH) of the thorax.

METHODS

We reviewed the medical records of six patients treated for CEH of the thorax at our institution between October 1996 and October 2006.

RESULTS

All of the patients had a history of thoracic surgery or tuberculosis with a latent period of 12-55 years before onset. One elderly patient with ischemic heart disease and in poor general health demonstrated a substantial improvement of symptoms after undergoing arterial embolization twice instead of surgery. The remaining five patients underwent either pleuropneumonectomy or a total capsule excision, following which their clinical condition improved remarkably. All six patients were discharged from the hospital. Arterial embolization was performed before surgery, and the amount of intraoperative bleeding ranged from 905 ml to 6,590 ml (average: 2,396 ml).

CONCLUSION

Chronic expanding hematoma of the thorax may occur after thoracic surgery and a tuberculosis infection; however, considering the risk of massive bleeding during surgery, the decision to perform surgery should be made with extreme care.