Presentation
Alleged assault. Tachypneic.
Patient Data
Whiteout of the right hemithorax in keeping with a hemothorax in this clinical setting with mediastinal shift to the left. Increased lucency in the right lower zone may indicate a pneumothorax.
There is a right sided ICC which appears to traverse the lung parenchyma of the right lower lobe, tip projected towards the apex. A large hemothorax. Small anterior right pneumothorax in the anterior base.
The stab wound appears in the right parasternal region where there is a small irregularity in the skin and a small amount of gas adjacent to the right mediastinum between the right third and fourth ribs anteriorly. Internal thoracic artery on the right appears intact although there is no delayed imaging.
No hemopericardium and the left lung is clear. Aorta and mediastinal structures appear intact.
Conclusion
Right hemothorax and right small pneumothorax (hemopneumothorax). The right chest tube appears to transverse the lung parenchyma and may cause some of the changes noted in the right lower lobe (not at the site of the stab wound). No specific damage to the mediastinal structures.
Case Discussion
In penetrating trauma, patients who survive the initial assault may present with hemodynamic compromise from:
Each organ in the chest should be actively assessed for injury, including subdiaphragmatic structures, as sometimes the length of the blade is not known and the diaphragm can be injured, especially if the stab wound is in the lower-third of the chest.
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