Penetrating thoracic trauma

Multidetector CT for Penetrating Torso Trauma: State of the Art

“…The "cardiac box" describes a rectangular area bounded by the midclavicular lines laterally, clavicles superiorly, and intersection of the midclavicular lines with the costal margins inferiorly; The area denotes precordium at risk for cardiac, aortic, or central pulmonary vessel injuries from stab wounds (120); Gunshot wounds are more likely to penetrate this area from remote sites, and the concept of the cardiac box is less relevant for these injuries (120) The cardiac diamond is a less commonly used surface region bounded by the sternal notch, nipples, and umbilicus (84); This emphasizes that the heart can be reached from anywhere in this region depending on angle and highlights potential difficulties determining appropriate surgical sequencing (88); Repair of abdominal regions should follow repair of the heart Back and Flanks…”

“…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). Eighty-five percent of pulmonary injuries requiring surgery can potentially be managed with this technique (39).…”

“…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].…”

MDCT of complications and common postoperative findings following penetrating torso trauma

“…18). Retained hemothorax is especially common when there is more than 1 L of blood or if there is a slow bleed from an internal thoracic or intercostal vessel [57,58]. Empyema may also develop from lung abscesses arising within pneumatoceles or lacerations that decompress into the pleural space (Fig.…”

“…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].…”