Vascular injuries after blunt chest trauma: diagnosis and management

O’Connor, James V.; Byrne, Christopher D.; Scalea, Thomas M.; Griffith, Bartley P.; Neschis, David G.

doi:10.1186/1757-7241-17-42

Cited by 52 publications

(68 citation statements)

References 80 publications

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“…Increased availability in most trauma centers, accurate diagnosis regarding vascular pathology (sensitivities of 97---99.3% and specificities 87.1---99.8%) and detection of associated lesions of the surrounding structures have turned CTA into the diagnostic exam of choice. 15,16 Extreme cases with hemodynamic instability may be transferred to the operating theater and surgically explored, or a diagnostic angiography may be performed on-table, followed by exploration or endovascular repair, as necessary.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

Oliveira

Rodrigues

Gonçalves

et al. 2014

Angiologia e Cirurgia Vascular

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Introduction: Blunt trauma of the axillary and subclavian arteries is uncommon. Conventional surgery presents significant morbidity associated to the need of extensive exposure and challenging dissection through traumatized tissues. Endovascular treatment is an alternative that has increasingly been used in traumatic arterial injuries. This report presents three cases that were managed by endovascular techniques. Methods: We report the cases of three patients with blunt traumatic injuries of the subclavian and axillary arteries who were treated at our Institution in 2013 with endovascular techniques. Each case presented distinctly, resulting from different traumatic mechanisms and the therapeutical approach was adapted accordingly. Results: Case 1: A 68-year-old man was admitted with an acute limb ischemia of the left upper limb after a fall from his own walking height. A computerized tomography angiography demonstrated a dissection of the left subclavian artery. Resource to a proximal angioplasty with stent allowed the recovery of the limb perfusion fixating the flap. Case 2: A 34-year-old male who fell from a height of 8 m, with multiple costal arch fractures and the complete transection of the subclavian artery. In this case, a covered stent excluded the rupture. Case 3: A 45-year-old woman presented to our department with an acutely ischemic left upper limb with 3 days of progression after a distension of the scapuloh-umeral articulation. Although a digital amputation was ultimately necessary, hand-salvage was accomplished through thrombectomy and catheter-directed thrombolysis. Conclusion: Blunt trauma of the axillosubclavian arteries is rare and its diagnosis may be challenging. Endovascular treatment of blunt traumatic injuries of the subclavian and axillary

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of blunt traumatic injuries of the subclavian and axillary arteries

Oliveira

Rodrigues

Gonçalves

et al. 2014

Angiologia e Cirurgia Vascular

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“…The esophagus is rarely injured by a blunt mechanism, as it is a well-protected structure in the posterior mediastinum [41]. Injuries to the great vessels are rare in blunt trauma; however, patients with great vessel injury usually die at the scene, including up to 80-90 % of those with aortic rupture [45]. Blunt diaphragmatic rupture rarely occurs alone and often heralds more severe concomitant injuries with an associated injury rate of 80-100 % [46,47].…”

Section: Blunt Thoracic Injuriesmentioning

confidence: 99%

Blast-related lung injuries

Ferraro

Hiles

2016

Curr Pulmonol Rep

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Blast-related lung injuries are occurring with increased frequency in a variety of circumstances, necessitating that both civilian and military providers across the healthcare spectrum understand how to promptly diagnose and manage these injury patterns. Primary, secondary, and tertiary blast injury mechanisms are most commonly encountered and can result in primary blast lung injury, air embolism, pulmonary contusion, rib fractures, and penetrating lung injuries. Primary blast lung injury occurs when a blast wave injures the lung parenchyma and vasculature and presents as acute dyspnea, cough, and hypoxemia with airspace disease on chest imaging. The treatment of primary blast lung injury, as well as other blast-related lung injuries, involves maintaining oxygenation and using a lung-protective strategy with low tidal volumes and minimal PEEP for patients requiring mechanical ventilation. Pain management, preferably in the form of regional anesthesia, is also crucial in improving outcomes in patients with blast-related lung injury.Keywords Primary blast lung injury . Explosion . Blunt thoracic trauma . Penetrating lung injury A 25-year-old male with no past medical history is transported to a hospital by ambulance after suffering multiple traumatic thoracic injuries when a bomb was detonated within 30 m of him at a sporting event. He has several soft tissue injuries over the torso and extremities. Pressure dressings were applied by first responders with hemostasis achieved. His vital signs include a temperature of 37.8°C, heart rate of 114/min, blood pressure of 92/50 mmHg, respiratory rate of 28/min, and oxygen saturation of 91 % on 15 LPM of oxygen via nonrebreather mask. His thoracic injuries include several leftsided non-displaced rib fractures with associated pulmonary contusion, a left-sided pneumothorax, and primary blast lung injury (PBLI). A chest CT (Fig. 1) in the Emergency Department demonstrates some of these findings. How should his case be managed?

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“…The clinical features may range from no symptoms to these of severe hypovolaemic shock, therefore investigation of these patients should be staged appropriately even in asymptomatic patients after significant thoracic impact to exclude a potentially fatal BTAI [7].…”

Section: Introductionmentioning

confidence: 98%

“…This shift is one of the major advancements in the management of these patients and CT scan is now the preferred screening tool and gold standard for diagnostic confirmation and evaluation [4,7,8]. Features of a CT suggesting a BTAI include mediastinal haematoma and hemopericardium, false aneurysm, irregularity of the aortic contour, aortic dissection and haemothorax [4,7,9].…”

Section: Introductionmentioning

confidence: 98%