Haemothorax

BACKGROUND: Small-bore chest drains are now the most common drains for treating pleural effusion (PE), but knowledge on complications is limited especially in malignant PE and empyema. We aimed to evaluate rate of complications of ultrasound guided small bore chest drains [6-10 French (F)] by PE etiology. METHODS: Retrospective cohort study of 484 chest drains inserted in 330 adults in a Swedish department 2018-2020. Rate of complications (blockage, dislocation, infection, or misplacement) and repeat intervention (new drain within 2 weeks or surgery) was analyzed by effusion type (organ failure, parapneumonic, malignant, empyema, other, unknown), age, sex, seniority of radiologist, and bore size using multivariable logistic regression...

INTRODUCTION: This review aims to provide an overview of diagnosing and managing traumatic haemothorax for young surgeons. CONTENT: Of 27,333 polytrauma patients in Germany in 2021, 35 % were admitted with thoracic trauma. In polytrauma patients, chest injuries are an independent negative predictor of 30-day mortality. These patients should be treated in an evidence-based and standardized manner to reduce mortality and morbidity. There are several methods of immediate diagnosis that should be used depending on hemodynamic stability...

OBJECTIVE: Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard. MATERIALS AND METHODS: Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator...

Penetrating cardiac injuries usually require emergent surgical intervention. Our patient presented to the trauma centre with multiple stab wounds to the neck, chest, epigastric region and abdomen. She arrived haemodynamically stable, and her initial Focused Assessment with Sonography for Trauma exam was negative. Her chest X-ray did not show any evident pneumothorax or haemothorax. Due to her injury pattern, she was taken to the operating room for exploratory laparotomy and neck exploration. Postoperatively, she was taken for CT and found to have a contained cardiac rupture...

A woman in her 80s experienced a life-threatening complication of pacemaker implant consisting of subacute right ventricular lead perforation causing iatrogenic injury to an intercostal artery, resulting in a large haemothorax. A CT scan confirmed active bleeding from the fourth intercostal artery. The patient underwent cardiothoracic surgery via a median sternotomy approach, during which the source of the bleeding was sealed, a new epicardial lead was positioned, and the original lead was extracted. This case emphasises the potentially severe consequences of pacemaker lead perforation and secondary injury to adjacent structures...

The thoracolumbar spine is prone to vertebral compression fractures (VCFs). An injury mechanism known as flexion compression is responsible for thoracolumbar spine compression fractures. Usually, this mechanism affects the longitudinal ligament at the front and the front part of the vertebral body as the first components. Pain is the first and foremost symptom; here we present a case report of a 34-year-old male, who came to the hospital with complaints of back pain, and difficulty in breathing followed by a road traffic accident (RTA)...

We present the case of a woman in her 60s with Child-Pugh C cirrhosis who developed pericardial tamponade during an admission for a haemothorax secondary to a mechanical fall. The patient developed haemodynamic compromise with a rapid decline in renal function. During an open subxiphoid drain tube insertion, a pre-existing peritoneopericardial communication was noted, with ascites in the peritoneal cavity on view. The serum ascites albumin gradient was 14 g/L. Maximal medical therapy was commenced including diuresis and albumin, with adjunctive terlipressin infusion which restored her baseline renal function and resolved the effusion...

Congenital mesoblastic nephroma is considered a tumour with favourable clinical behaviour with only few reported cases of metastases. We report an infant who underwent complete resection and later developed pulmonary metastasis. Ten-month-old baby girl initially presented at 3 weeks of age with macroscopic haematuria, hypertension and a lumbar mass. Contrast-enhanced computed tomography revealed a tumour arising from the left kidney without local invasion or metastasis. She underwent left nephrectomy. Immunohistochemistry confirmed a cellular type of congenital mesoblastic nephroma...

A woman in her 50s was transported to our hospital after experiencing a road traffic crash that led to a massive haemothorax and haemorrhagic shock due to a cervical vascular injury caused by the seat belt. Contrast-enhanced CT of the chest showed extravascular leakage of the contrast medium from the vicinity of the right subclavicular area and fluid accumulation in the thoracic cavity. The patient was intubated, and a thoracic drainage catheter was placed. She underwent angiography and embolisation of the right costocervical trunk, right thyrocervical trunk and right suprascapular artery using a gelatine sponge and 25% N -butylcyanoacrylate-Lipiodol...

PURPOSE: Tension pneumomediastinum is a rare and dangerous complication in children that can be fatal, and timely detection and treatment are critical. The aim of this study was to evaluate the safety and feasibility of computed tomography (CT) imaging-guided parasternal approach drainage for tension pneumomediastinum in children. METHODS: From June 2018 to February 2023, we consecutively enrolled 19 children with tension pneumomediastinum in our institution. A pigtail catheter was inserted into the anterior mediastinum by a CT imaging-guided parasternal approach...

Pulmonary sarcomatoid carcinoma (PSC) is a rare and highly invasive malignant tumour. It has similar clinical manifestations and imaging features to ordinary lung cancer. This current case report describes a 65-year-old male patient who had a mass in the apicoposterior segment of the left upper lobe with haemoptysis. Imaging studies revealed a central parenchymal mass surrounded by areas of ground-glass opacity, strongly indicating the presence of a pulmonary malignancy. Intraoperatively, the tumour was discovered to have invaded the chest wall and exhibited a significant propensity for bleeding...

Common causes of haemorrhagic pleural effusions include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, collagen vascular diseases, trauma and iatrogenic causes. Clinical history along with pathologic, microbiologic and biochemical evaluation of pleural fluid confirms the diagnosis in most cases. However, if there is recurrent haemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then we should think of uncommon causes. Catamenial haemothorax (CHt) is a rare cause of haemorrhagic pleural effusion, which recurs during each menstrual cycle...

BACKGROUND: Alveolar adenoma is a rare benign tumour, usually presenting as a peripherally located solid mass, sometimes mimicking malignancy. CASE PRESENTATION: A 37-year-old woman presented with chronic intermittent vague chest discomfort. The chest x-ray showed a simple cyst in the left lower lung field, and serial computed tomography (CT) over the following 2-year period showed rapid growth of the cyst, from 3.5 to 9.0 cm in diameter. The CT scan suggested bronchiolar communication, which was suspected to be the cause of growth, via check-valve mechanism...

Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US)...

BACKGROUND: Patients on hemodialysis are particularly vulnerable to central venous occlusion (CVO). Endovascular treatment has gained wide acceptance for the treatment of CVO. However, difficulties in crossing the occluded segment can be encountered during conventional endovascular management. Sharp recanalization has been adopted when conventional endovascular methods could not recanalize the obstructed region. This study aimed to assess the outcome of the sharp venous recanalization technique with angioplasty and stenting in the treatment of CVO in Egyptian patients undergoing haemodialysis...

INTRODUCTION AND IMPORTANCE: Arrow injuries are rare in modern surgical practice. However, there are still case reports in tribal and guerrilla conflicts in rural settings were arrows are still used as weapons. Since the discovery of gun powder, guns and explosives have been the preferred effective assault weapons. Most surgeons in metropolitan trauma centers face scarce arrow injuries cases, mostly due to accidents or suicide attempts using the crossbow mechanism. CASE PRESENTATION: We present a case of an 18-year-old boy who sustained penetrating posterior thoracic wall arrow injury leading to haemothorax and review of the management protocols...

BACKGROUND: Haemothorax occurs in approximately 60% of all thoracic and polytrauma cases and is responsible for 15-30% of all trauma mortalities. Penetrating injuries to the thorax are a common presentation in South African hospitals. This study aims to audit the traumatic haemothoraces and their outcomes in regional hospitals in Durban, KwaZulu-Natal, South Africa. METHODS: In this study, patient characteristics were grouped as either continuous or categorical variables...

OBJECTIVES: This study aimed to investigate whether adding glue-injection to three-dimensional computed tomography bronchography and angiography (3D-CTBA) has extra benefits to facilitate anatomical segmentectomy for pulmonary nodules. METHODS: We conducted a randomized controlled trial. The patients undergoing thoracoscopic segmentectomy assisted with 3D-CTBA simulation were enrolled. Then they were divided into the 3D-CTBA group and the glue-labelling group who received additional CT-guided percutaneous glue (2-octyl cyanoacrylate) injection to label the nodules...

Kasabach-Merritt phenomenon (KMP) is a rare condition that is associated with two rare vascular tumours: Kapossiform haemangioendothelioma (KHE) and tufted angioma (TA). A 2-year-old girl presented to our emergency room with a haemangioma and respiratory distress. The patient had a violaceous, palpable mass in the right upper chest since she was 5 months old. Severe anaemia, thrombocytopenia, coagulopathy, and hypofibrinogenemia were found. Chest x-ray revealed massive pleural effusion in the right hemithorax...

BACKGROUND: While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed. METHODS: Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed...