Presentation
Stabbed in right back. Hypotensive on scene, but responding to fluid challenges. Not hypoxic, normal RR.
Patient Data
Large right pneumothorax, measuring 5 cm at the apex.
Pleural blunting suggesting hemothorax.
Early mediastinal shift to the left.
Right hemopneumothorax. Maximum depth at hilar level 32 mm. Homogenous fluid with no active bleeding into the pleural directly indicated.
The trachea is central. However, there is early displacement of the aortic arch to the left and the suggestion of developing tension between the radiograph and topogram.
Pulmonary lacerations in the right lower lobe at the T7/T8 level. Although these are small they run alongside arterial and venous pulmonary vessels and do contain fluid levels indicating hemorrhage. It is difficult to see an entry wound directly correlating with the lacerations, but the slight upward trajectory suggests the intercostal bundle has been avoided.
No pneumomediastinum. The left lung is clear. No mediastinal abnormality.
No pericardial or hepatic injury. Unremarkable included abdominal structures.
Subcutaneous gas extends along the size of the paraspinal muscles to C7 superiorly and at least L1 inferiorly. No subcutaneous hematoma nor collection.
Normal included skeleton.
Case Discussion
Large right hemopneumothorax, with tensioning developing between CXR and CT.
Posterior chest wall penetrating injury, but no active bleeding demonstrated.
Intercostal drain inserted. Otherwise managed conservatively with no complications.