Imaging of Combat-Related Thoracic Trauma – Review of Penetrating Trauma

Lichtenberger, John P.; Kim, Andrew M.; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, Paul; Carter, Brett W.

doi:10.1093/milmed/usx034

Cited by 15 publications

(10 citation statements)

References 39 publications

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“…The penetrating instrument and the force of impact differ greatly between firearm injuries and stabbings resulting in vast trauma energy variation. Extent of injury also depends on the affected tissue type (9–11).…”

Section: Introductionmentioning

confidence: 99%

Imaging of penetrating thoracic trauma in a large Nordic trauma center

Nummela

Thorisdottir

Oladottir

et al. 2019

Acta Radiologica Open

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Background: Penetrating trauma is rarely encountered in Nordic trauma centers, yet the incidence is increasing. Typical imaging findings in penetrating trauma should thus be familiar to all radiologists. Purpose: To evaluate incidence and imaging findings of penetrating chest trauma, gunshot wound (GSW) and stab wound (SW) injury spectrum, imaging protocols, and outcome in a large trauma center. Material and Methods: Trauma registry data from 2013-2016 was retrieved, and imaging accessed through hospital PACS. Retrieved variables included age, gender, injury severity scores, mechanism of injury, time to CT, and 30-day mortality. Depth of thoracic, pulmonary, abdominal and skeletal injury, active bleeding, and use of chest tubes were evaluated. Results: Of 636 patients with penetrating injuries, 443 (69.7%) underwent imaging. Of these, 161 (36.3%) had penetrating thoracic injuries. Of 161 patients with penetrating chest trauma in imaging, 151 (93.8%) were men (mean age ¼ 34.9 years) and 10 (6.2%) were women (mean age ¼ 40.7 years). The majority of patients had SWs (138 SW vs. 15 GSW). Patients with GSWs were more severely injured (mean ISS 17.00 vs. 8.84 [P¼0.0014] and ISS16 in 53.3% vs. 16.7%) than SW patients. In CT, intrathoracic injuries were found in 49.4% (77/156) and active bleeding in 26.3% (41/156). Emergency surgery was performed in 6.2% (10/161) with postoperative CT imaging. Thirty-day mortality rate was 1.2% (2/161). Conclusion: Penetrating thoracic trauma often violates intrathoracic structures and nearby compartments. Arterial phase whole-body CT is recommended as multiple injuries and active bleeding are common. CT after emergency surgery is warranted, especially to assess injuries outside the surgical field.

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Section: Introductionmentioning

confidence: 99%

Imaging of penetrating thoracic trauma in a large Nordic trauma center

Nummela

Thorisdottir

Oladottir

et al. 2019

Acta Radiologica Open

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“…In addition to finding intraluminal filling defects or pseudo-aneurysms, CTA can also detect vessel disruption by showing extravasation of contrast distal to normal vessel location. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

A case report of a polytrauma patient with penetrating iron rods in thorax and head

Tang

Chen

et al. 2018

Medicine

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Introduction:Impalement injury is an uncommon presentation, and penetrating chest injuries account for 1% to 13% of thoracic trauma hospital admissions. The vast majority of patients with penetrating thoracic trauma who survive to reach the hospital alive can be managed nonoperatively. Nevertheless, in 10% to 15% of cases, emergency operation is necessary due to the associated hemorrhagic shock and visceral injury.Case presentation:Here, we report on a 39-year-old male, a construction worker, who fell down from a height of a construction site, landing ventrally on a clump of iron rods with 4 projecting heavy metallic rods penetrating into his thorax and head (scalp pierced only). Emergency surgery was taken, and the patient had an uneventful successful outcome.Conclusions:After massive thoracic impalement, rapid transportation to a tertiary trauma center with the impaled objects in situ can improve the outcome. Video-assisted thoracic surgery (VATS) is recommended to remove the foreign body under direct vision and to reduce the incidence of missed, potentially fatal vascular or visceral injuries.

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“…(Stranch, Zarzaur and Savage, 2017) Other authors have found that no difference whatsoever on mortality among chambers (Asensio et al, 1998) GSW have worst prognosis and higher mortality rates than SW. This difference is mainly explained by the object and the force of impact, (Gunn et al, 2014;Durso, Caban and Munera, 2015;Lichtenberger et al, 2018) and the fact that bullets can affect multiple and deeper structures than sharp objects. Moreover, sharp objects often function as temporary hemostasis, preventing profuse bleeding on the site of injury until the surgical team can approach and correct the defect on a controlled environment.…”

Section: Prognosismentioning

confidence: 99%

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

Vergara-Miranda

Álvarez-Lozada

Leyva-Alamillo

et al. 2021

IJMSS

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For a long time, any heart-based injury was an off-limits area for surgeons; a patient with a traumatic cardiac injury was doomed to die. Little more than one hundred years have passed since the first surgical correction of a penetrating cardiac injury and there is still a high rate of mortality, despite the medical advances. We present the case of 6 patients with penetrating cardiac injuries that were repaired at a third level hospital of Mexico, alongside relevant findings on the literature about the topic. From 2019 to 2020, an incidence of 6 patients with penetrating cardiac injuries was present; all men aged 30 years or older. The etiology of 4 (67%) patients was stab wounds and 2 (33%) gunshot wounds. Left anterolateral thoracotomy was used on 5 (83%) patients and midline sternotomy on 1 (17%) patient. 2 (33%) injuries on the left ventricle presented along with coronary arteries injuries. Left ventricle and right atrium injuries presented each 50% of mortality. The mortality was of 33%, 1 patient died due to intraoperative complications and another one due to massive cerebral infarction and polyuric syndrome because of diabetes insipidus. There is a long path ahead of the surgical field on this topic and further to be analyzed. An excellent tool for cardiac tamponade diagnosis due to penetrating cardiac injuries is cardiac ultrasound, therefore it should be used on every hemodynamic unstable patient in the context of PCI. Definitively, time is of the essence, and the survival of patients depends on immediate transport to a hospital and an opportune surgical intervention.

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Imaging of Combat-Related Thoracic Trauma – Review of Penetrating Trauma

Cited by 15 publications

References 39 publications

Imaging of penetrating thoracic trauma in a large Nordic trauma center

Imaging of penetrating thoracic trauma in a large Nordic trauma center

A case report of a polytrauma patient with penetrating iron rods in thorax and head

Solving the impossible. Penetrating cardiac injuries, a case series of diagnostic workup and management

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