Management of penetrating stab wounds of the chest: an assessment of the indications for early operation.

Abstract

It should have been suspected from the situation of the entry wound, the nature of the weapon used, the size of the haemothorax, and the clinical findings in the others. All 11 deaths occurred in that group in which early operation was indicated, and some could have been averted had the need for operation been suspected early. Seven patients developed an empyema; five were in the group that required immediate surgery and in the other two infection occurred in a clotted haemothorax. Early repair of the associated visceral injuries and complete evacuation of a haemothorax, either fluid or clotted, could reduce the incidence of empyema.

Multidetector CT for Penetrating Torso Trauma: State of the Art

“…Chest tubes may not be effective for draining hemothorax if not positioned dependently. Large hemothoraces (over 1 L) may warrant a thoracotomy, since there is a greater likelihood of an associated major vascular injury and complications from retained hemothorax (82). Minor peripheral lung injury tracks can be oversewn but stapled pulmonary tractotomy may be required if there is a large amount of tissue destruction (83,84).…”

“…Occult injuries of the right atrium or ventricle can occur, primarily from stab wounds within the cardiac box, and are suggested by injury trajectory and hemopericardium, which can be small owing to the low pressure within the right side of the heart (40,83,89) (Fig 9). Active bleeding from pulmonary veins or arteries is initially diagnosed with CT on rare occasions, usually from stab wounds (30), and may require lobectomy or pneumonectomy depending on the centrality of the injury (Fig 10) ( [82][83][84].…”

Imaging Assessment of Gunshot Wounds

“…With the emergence of ultrasonography as an invaluable tool in the evaluation of blunt abdominal trauma, several studies have examined its applicability in penetrating trauma. Most studies [25][26][27][28] have come to the same conclusion: although it may be helpful, it does not exclude injury and may be no better than clinical judgment. CT has emerged as a useful adjunct in the nonoperative management of patients with abdominal GSWs.…”

“…Therefore, thoracotomy is advised in case of stab wounds when the initial drainage from a hemothorax exceeds 1000 mL. 26 The intercostal vessels are at risk in stab wounds that are at right angles to a rib, and the internal mammary artery is liable to injury in parasternal stab wounds. Thoracotomy should be considered with entry wounds in these areas even if the initial blood loss is less than 1000 mL.…”

MDCT of complications and common postoperative findings following penetrating torso trauma

“…These may become infected or may restrict lung volume. A delayed or recurrent accumulation of simple density pleural fluid may also suggest thoracic duct injury, which is associated with chylous thoracostomy tube drainage [59]. VATS may be performed for evacuation of retained hemothorax that fails multiple attempts at thoracostomy drainage, for empyema with tenacious adhesions, or for late-phase fibrothorax [2,57].…”