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Penetrating thoracic trauma

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Trauma call. Haemodynamically stable.

Patient Data

Age: 30 years
Gender: Female
x-ray

Right pneumothorax without mediastinal shift. No left pneumothorax. No large pleural effusion. Metallic density projects over the left humeral head

ct

Soft tissue attenuation and gas from the midline of the back consistent with stabbing tract, with presumed penetration of the pleura at the right 6th intercostal space posteriorly. Moderate-large right hemopneumothorax (mainly pneumothorax) without evidence of tension. Right chest wall and axilla subcutaneous emphysema. Right lung is partially collapsed, there is no distinct parenchymal injury. Left lung and pleural space are clear.

Metallic density consistent with a broken blade traverses the left deltoid muscle and is wedged within the left humeral head. Distal point enters into the left glenohumeral joint with a separate fragment in the inferior joint space. No adjacent arterial injury.

Case Discussion

This is the case of not being distracted by the obvious abnormality (blade in the left humeral) and assessing the entire chest x-ray - there is a right pneumothorax and soft tissue changes from a stab wound. In stabbings, there can be multiple penetrating injuries with internal injuries often a distance from the skin entry point. 

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