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Lange-Herr N, Tschui J, Klaus J, Baglivo M, Schlottke E, Zech WD. A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign? Int J Legal Med 2024:10.1007/s00414-024-03261-9. [PMID: 38861166 DOI: 10.1007/s00414-024-03261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024]
Abstract
The authors present the case of a 58-year-old man found hanging from a radiator by his shoelaces. The time of death was approximately 6 h before the body was discovered. An autopsy was performed approximately 24 h after the body was found, which revealed hemorrhages in the thoracic aorta at the junctions of the posterior intercostal arteries. Before autopsy, a routine whole-body CT scan was performed. Histologic examination of the aorta and the posterior intercostal arteries revealed a fresh hemorrhage into the tunica adventitia of the aorta. To our knowledge, there is no case description of such findings in hanged persons in the literature. Conclusion: Hemorrhages into the tunica adventitia of the junction of the posterior costal arteries may occur in association with suicidal hanging. The significance of these hemorrhages as a sign of vitality may be debated.
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Affiliation(s)
- Nicolas Lange-Herr
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Joëlle Tschui
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Medics Pathologie AG, Bern, Switzerland
| | - Jeremias Klaus
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Dr. Kurz Röntgeninstitut AG, Thun, Switzerland
| | - Manuela Baglivo
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Emilie Schlottke
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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Matsuo A, Matsuyama S, Kurisu K, Ueno Y, Oishi Y, Shiose A. Endovascular Aortic Repair for Thoracic Aortic Compression Resulting From Chance Fracture of the Thoracic Spine. Tex Heart Inst J 2023; 50:491653. [PMID: 36944119 PMCID: PMC10178656 DOI: 10.14503/thij-22-7891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Blunt aortic injury is a serious condition with a high mortality rate. Although rare, blunt aortic injury associated with spinal fracture has also been reported, and appropriate management of aortic disease is key to a good outcome. This report is a case of a 78-year-old man who was found to have a transverse fracture (Chance fracture) in the ninth thoracic vertebra, with a sharp bone fragment compressing the thoracic aorta. Early spinal surgery was needed; however, there was concern about the possibility of bleeding from the aorta and surrounding small arteries associated with the bone fragment during spinal surgery. Therefore, thoracic endovascular aortic repair was performed before spinal surgery. The next day after thoracic endovascular aortic repair, posterior spinal instrumentation was performed, and the postoperative course was uneventful. Because aortic injury associated with vertebral fracture can lead to massive bleeding and spinal cord injury, endovascular repair before spinal surgery is reasonable.
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Affiliation(s)
- Akinobu Matsuo
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Sho Matsuyama
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Kazuhiro Kurisu
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Yasutaka Ueno
- Department of Cardiovascular Surgery, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyusyu University Hospital, Fukuoka, Fukuoka Prefecture, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyusyu University Hospital, Fukuoka, Fukuoka Prefecture, Japan
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Miyake T, Okada H, Kanda N, Mizuno Y, Suzuki K, Doi T, Yoshida T, Yoshida S, Ogura S. Spinal injury with spinal ankylosing disorders as a primary cause of death: report of two cases. Int J Emerg Med 2023; 16:7. [PMID: 36797663 PMCID: PMC9933250 DOI: 10.1186/s12245-023-00488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Spinal ankylosing disorders (SADs) refer to a group of conditions resulting in spontaneous or postsurgical ossification and fusion of the spinal segments. The spine becomes increasingly susceptible to injury over time such that even low-energy trauma can cause a spinal injury. We report two cases of SADs, associated with massive thoracic hemorrhage. CASE PRESENTATION The first patient was an 85-year-old male, who suffered from a vehicular crash. He was diagnosed with a fracture of the first lumbar vertebra, accompanied by SADs. Intubation was required, and thoracic drainage tubes were inserted. The patient underwent a massive transfusion and thoracotomy with packing. Despite prompt treatment, the hemorrhage from the vertebral fracture was uncontrolled, and the patient died 180 min after the injury. The second case features an 88-year-old male who fell from a height. He was diagnosed with flail chest, hemothorax, pneumothorax, and a fracture of the eighth thoracic vertebra with SADs. After intubation, four thoracic drainage tubes were placed, and a massive transfusion was conducted. He died after 3 days due to hypoxemia secondary to persistent bleeding of the vertebral fracture for 24 h. CONCLUSIONS The patients died of persistent thoracic hemorrhage, and the sources of bleeding were the fracture site of the spine fractures. Controlling spinal hemorrhage is difficult due to the absence of a bleeding artery, which is managed via trans-arterial embolization. This report emphasized that fracture of SADs could be a fatal disease that requires prompt intervention.
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Affiliation(s)
- Takahito Miyake
- Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hideshi Okada
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Norihide Kanda
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yosuke Mizuno
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Kodai Suzuki
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tomoaki Doi
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Takahiro Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Shozo Yoshida
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Abuse Prevention Emergency Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194 Japan
| | - Shinji Ogura
- grid.411704.7Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
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Matsunaga N, Okada T, Ono Y, Matsushiro K, Sasaki K, Gentsu T, Ueshima E, Sofue K, Yamaguchi M, Sugimoto K, Murakami T. Transcatheter arterial embolization for hemothorax caused by spinal fracture without arterial injury: a case report and review of the literature. J Med Case Rep 2022; 16:332. [PMID: 36056381 PMCID: PMC9440552 DOI: 10.1186/s13256-022-03568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Spinal fractures rarely cause hemothorax, and no treatment consensus has been reached. Conservative treatment is generally selected in cases without arterial injury, but there have been some reports of uncontrolled bleeding. Here we report a case of hemothorax caused by spinal fracture without arterial injury treated with transcatheter arterial embolization. Case presentation An 88-year-old Japanese woman with back pain was diagnosed with hemothorax due to bleeding from an unstable fracture of the tenth thoracic vertebra. Contrast-enhanced computed tomography revealed no obvious arterial injury. We performed transcatheter arterial embolization of the bilateral tenth intercostal arteries to prevent rebleeding. The hemothorax did not worsen until surgical spinal fixation 9 days post-transcatheter arterial embolization, and she was discharged 30 days after admission. Conclusion Transcatheter arterial embolization for hemothorax caused by spinal fractures without obvious arterial injury may be a useful bridge to spinal fixation.
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Affiliation(s)
- Naoki Matsunaga
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuya Okada
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuko Ono
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keigo Matsushiro
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Sasaki
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Gentsu
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Eisuke Ueshima
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Keitaro Sofue
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masato Yamaguchi
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Sugimoto
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takamichi Murakami
- Department of Diagnostic and Interventional Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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