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Intercostal artery laceration

Mio Kanai, Hiroshi Sekiguchi
Thoracentesis is considered a relatively safe and well-established procedure commonly done at the bedside with minimal risk of complication. Thoracentesis-related hemothorax is uncommon; however, it may be life-threatening. We describe a case of a 19-year-old woman with persistent fever and pleural effusion, in which thoracentesis resulted in tension hemothorax due to intercostal artery laceration. It is important for proceduralists to understand not only the tortuosity of the intercostal artery covering 25% to 50% of the intercostal space, but also the presence of traversing collateral arteries...
January 2015: Chest
Kiyoshi Chiba, Hiroyuki Abe, Yosuke Kitanaka, Takeshi Miyairi, Haruo Makuuchi
OBJECTIVE: Traumatic rupture of the thoracic aorta is a life-threatening injury requiring urgent surgical intervention. Despite recent improvements in resuscitation and emergency operative techniques, the outcomes of patients with multiple injuries are still associated with a high mortality rate. We retrospectively examined the preoperative demographic data, associated complications and mortality rate of these patients. MATERIALS AND METHODS: We analyzed the data (1991-2009) of 18 patients with acute traumatic rupture of the thoracic aorta...
December 2014: General Thoracic and Cardiovascular Surgery
Ulrike Stampfl, Christof-Matthias Sommer, Nadine Bellemann, Nikolas Kortes, Daniel Gnutzmann, Theresa Mokry, Theresa Gockner, Anne Schmitz, Katja Ott, Hans-Ulrich Kauczor, Boris Radeleff
To evaluate embolotherapy for the emergency management of acute bleeding from intercostal arteries. Between October 2003 and August 2012, 19 consecutive patients with hemorrhage from intercostal arteries were scheduled for emergency embolization. The primary study endpoints were technical and clinical success, which were defined as angiographic cessation of bleeding, and cessation of clinical signs of hemorrhage. The secondary study endpoints were periprocedural complications and 30-day mortality rate. In most patients (74 %), hemorrhage was caused by iatrogenic procedures with subsequent intercostal artery laceration...
December 2014: Emergency Radiology
Matthew Salamonsen, Karen Dobeli, David McGrath, Craig Readdy, Robert Ware, Karin Steinke, David Fielding
BACKGROUND AND OBJECTIVE: Laceration of the intercostal artery during pleural procedures is a rare but serious complication. This study evaluates the utility of thoracic ultrasound (US) to screen for a vulnerable vessel compared with the gold standard computed tomography (CT). METHODS: Before undergoing contrast-enhanced CT chest, thoracic US was performed on 50 patients with a high-end and portable machine, and an attempt made to visualize the vessel at three positions across the back to the axilla...
August 2013: Respirology: Official Journal of the Asian Pacific Society of Respirology
Giovanni B Forleo, Jacob Zeitani, Tommaso Perretta, Domenico G Della Rocca, Luca Santini, Giovanni Simonetti, Francesco Romeo
Perforation and migration of pacemaker electrodes into the pleural cavity is a rare event. We report the clinical course and surgical treatment of massive acute hemothorax resulting from intercostal artery laceration, caused by a retained active-fixation pacing lead implanted 10 months earlier.
March 2013: Annals of Thoracic Surgery
Pedro Dammert, Melvin Pratter, Ziad Boujaoude
BACKGROUND: The safety of small-bore chest tubes insertion with ultrasound (US) guidance has been well demonstrated in patients not receiving antiplatelet therapy. Given the current widespread use of these agents, pulmonologists frequently encounter patients on this therapy and requiring drainage of the pleural space. The use of these agents clearly increases the risk of bleeding, but it is not always possible to stop this therapy before the procedure, especially in patients requiring urgent drainage and those with coronary stents...
January 2013: Journal of Bronchology & Interventional Pulmonology
Matthew Salamonsen, Samantha Ellis, Eldho Paul, Karin Steinke, David Fielding
BACKGROUND: Ultrasound (US) guidance is advocated to reduce complications from thoracocentesis or intercostal catheter (ICC) insertion. Although imaging of the intercostal artery (ICA) with Doppler US has been reported, current thoracic guidelines do not advocate this, and bleeding from a lacerated ICA continues to be a rare but serious complication of thoracocentesis or ICC insertion. OBJECTIVES: It was the aim of this study to describe a method to visualise the ICA at routine US-guided thoracocentesis and map its course across the posterior chest wall...
2012: Respiration; International Review of Thoracic Diseases
Mary L Yacovone, Ritha Kartan, Manuel Bautista
Intercostal artery laceration is an unusual complication following thoracentesis, and has been reported only in elderly patients. We report a case of a 78-year-old man who developed a massive hemothorax following thoracentesis. Post-thoracentesis radiograph revealed a substantial increase in pleural fluid, and emergency chest tube insertion identified the hemothorax. He underwent right thoracotomy for repair of the intercostal artery laceration.
November 2010: Respiratory Care
Yao-Tsung Chuang, Teng-Fu Tsao, Chun-Hung Su, Ming-Cheng Lin
Puncture or laceration of the pulmonary, intercostal, or peripheral vessels is an uncommon, but potentially life-threatening, complication of thoracentesis, which has been reported to result in severe haemothorax in 75% of patients. Damage to these vessels typically requires surgical intervention or intra-arterial embolisation. We report the successful non-surgical management of an unusual case of pulmonary artery perforation without concomitant haemothorax in an 82-year-old man who underwent thoracentesis.
July 2010: Annals of the Royal College of Surgeons of England
Hiroshi Yoneyama, Masahisa Arahata, Rie Temaru, Shinji Ishizaka, Shinji Minami
OBJECTIVE: Our study was undertaken to determine the location of the tortuous intercostal artery in elderly patients by using 3D-CT angiography in order to prevent laceration during thoracentesis. METHODS: We evaluated the data of 3D-CT angiography of the intercostal artery in consecutive patients who had undergone contrast chest CT scan in our hospital from December 2007 to April 2008. We considered the "percent safe space" (the shortest lower rib-to-intercostal artery distance/the upper rib-to-lower rib distance) to be an index of safety that can be used to prevent laceration of the intercostal artery during thoracentesis...
2010: Internal Medicine
Kei Aizawa, Chihiro Iwashita, Tsutomu Saito, Yoshio Misawa
A 48-year-old man with neurofibromatosis type 1 (NF1) presented with a right pleural effusion. A 3D computed tomography (CT) angiogram showed an aneurysm of the right 11th intercostal artery. He had no history of chest trauma so we diagnosed a spontaneous rupture of the aneurysm causing a massive effusion. We opened his pleural cavity and found lacerated pleura and active bleeding in the posterior 11th intercostal space. After controlling the active bleeding, we treated a persistent oozing from the region of the 10th-12th vertebrae with pressure hemostasis by absorbable oxidized cellulose packing...
January 2010: Interactive Cardiovascular and Thoracic Surgery
Kinjal N Sethuraman, David Duong, Supriya Mehta, Tara Director, Darcey Crawford, Jill St George, Niels K Rathlev
BACKGROUND: Emergency medicine residents frequently perform invasive procedures, including tube thoracostomy (TT), that inherently place patients at risk for complications. OBJECTIVES: The purpose of the study was to assess the prevalence and types of complications from TT in an academic emergency department (ED). METHODS: A combined prospective and retrospective, observational study of all patients who had TT between December 2002 and January 2006 was performed...
January 2011: Journal of Emergency Medicine
Akiyoshi Hagiwara, Youichi Yanagawa, Naoyuki Kaneko, Akira Takasu, Kousuke Hatanaka, Toshihisa Sakamoto, Yoshiaki Okada
BACKGROUND: To confirm the usefulness of contrast-enhanced computed tomography (CECT) and the efficacy of transcatheter arterial embolization (TAE) in patients, who undergo tube thoracostomy for hemothorax secondary to blunt chest trauma. MATERIALS: CECT was performed at admission in patients, who suffered blunt chest trauma but did not require an emergent thoracotomy. Pulmonary injuries with intrapulmonary hematomas or traumatic pneumatoceles or both on computed tomography images were diagnosed as pulmonary lacerations (PL)...
September 2008: Journal of Trauma
Massimiliano Paci, Guglielmo Ferrari, Valerio Annessi, Salvatore de Franco, Guido Guasti, Giorgio Sgarbi
BACKGROUND: Penetrating chest injuries account for 1-13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18-30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4-23% of chest injury patients present persistent pneumothorax and 15-59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity...
2006: World Journal of Emergency Surgery: WJES
R Porto Da Rocha, A Vengjer, A Blanco, P Traballi de Carvalho, M Leal Dias Mongon, G J Medeiros Fernandes
No detailed descriptions exist of the collateral intercostal artery which can provide an accurate anatomical basis for ensuring a low rate of vascular complications during thoracocentesis and thoracoscopy. Consequently the present study was undertaken to provide information on the origin, size and topographic relationships of the collateral intercostal artery. Ninety cadaveric adult intercostal spaces were dissected using standard procedures. The collateral intercostal arteries were exposed throughout their full length and measured at the points within the intercostal spaces considered to be the most important for clinical purposes...
February 2002: Surgical and Radiologic Anatomy: SRA
Massimiliano Paci, Valerio Annessi, Salvatore de Franco, Guglielmo Ferrari, Giorgio Sgarbi
Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. Indications for videothoracoscopy included suspected diaphragmatic injury (8 patients), persistent pneumothorax (8), continued haemorrhage (6) and clotted haemothorax (20)...
May 2002: Chirurgia Italiana
F Pons, L Lang-Lazdunski, X de Kerangal, O Chapuis, P M Bonnet, R Jancovici
OBJECTIVES: To report on the value of diagnostic videothoracoscopy in patients with possible penetrating cardiac wounds. METHODS: Thirteen patients admitted over a 4 year period with hemodynamic stability and a penetrating injury in cardiac proximity had exploratory videothoracoscopy. All data related to those patients were retrospectively reviewed. RESULTS: Eighty-five percent of patients had videothoracoscopy within 8 h of trauma. In most cases (eight of 13), operations were performed on patients in the supine position with the chest slightly rotated...
July 2002: European Journal of Cardio-thoracic Surgery
S Chisena
Percutaneous US guided nephrostomy is the simplest and most direct technique to drain an obstructed kidney. The indications are included in two groups: temporary drainage and permanent drainage; the former is indicated in the non endoscopically superable ureteral obstruction, in pyonephrosis, in pregnant women and in transplanted kidneys (due to the easier access), the latter is exclusively reserved to neoplastic obstructions. The only real contraindication to the method, besides a documented allergy to local anaesthetics, is represented by a severe coagulopathy...
June 1998: Archivio Italiano di Urologia, Andrologia
J F Mathé, I Richard, J C Roger, C Potagas, W S el Masry, B Perrouin-Verbe
Paraplegia is one of the major complications following repair of aortic aneurysms or congenital malformations and from trauma of the aorta. In a series of 12 surviving patients we describe the clinical features as well as the evolution and pathophysiology of ischaemic lesions of the spinal cord. The clinical characteristics: loss of tendon reflexes, preservation of light touch sensation and bladder function, and the special topography of pin prick impairment, suggest involvement of the central grey matter. This lesion of the grey matter is incomplete in most of the patients and tends to extend for 2-10 segments...
February 1998: Spinal Cord
R G Fisher, M Sanchez-Torres, C J Whigham, J W Thomas
Laceration of the thoracic aorta or brachiocephalic vessels due to blunt trauma is relatively common. In such cases, prompt and accurate diagnosis followed by timely surgery is essential. These injuries typically occur at the aortic isthmus and can usually be readily identified at aortography, which remains the standard of reference for diagnosis. However, numerous anatomic variants that manifest as "lumps" or "bumps" on aortograms can mimic true vascular injury, thereby leading to false-positive or false-negative diagnosis...
July 1997: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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