Penetrating thoracic trauma (pulmonary lacerations)

Case contributed by RMH Core Conditions

Presentation

Stabbing.

Patient Data

Age: 50 years
Gender: Female

Right pneumocath in situ. Moderately extensive right medial mid and lower zone airspace opacity.

The superior mediastinal contour is enlarged and indistinct at its right aspect. Left lung is clear. Left 8th and 9th lateral rib fractures identified.

Subcutaneous soft tissue laceration at the right anterior, parasternal chest, courses diagonally from the level of the 1st right anterior rib, extending through the anterior 2nd rib (which is fractured), and into the right lung, where there is a linear track of haematoma/consolidation extending anteroposteriorly through the right upper and lower lobes (with possible involvement of the middle lobe), crossing the pleural surfaces at the junction of the horizontal and oblique fissures medially.

Associated large loculated right haemopneumothorax and right dependent atelectasis, with right ICC and right anterior pneumocath in situ.

Likely anterior right upper lobe pleural defect. Right chest wall and upper limb subcutaneous emphysema.

Some of the segmental and subsegmental branches of the right pulmonary artery and vein, predominantly at the right upper lobe, anterior segment, have been disrupted.

Retro-oesophageal aberrant right subclavian artery noted.

Left 8th - 11th rib fractures, with the 9th rib fractured in two positions.

Right IJV CVC and ETT in situ.

Conclusion:

  • Lacerations through the right anterior chest, with laceration involving the right upper and lobe lobes, with possible involvement of the middle lobe.
  • Likely anterior right upper lobe pleural defect.
  • Loculated right haemopneumothorax.
  • Interruption of pulmonary vessels at the segmental and subsegmental level, predominantly involving the right upper lobe.
  • Fracture right 2nd and left 8th - 11th ribs. Left pleural effusion.

Case Discussion

CT is the most sensitive modality for detecting injuries from penetrating chest trauma as well as defining the path and assessing for any retained foreign bodies. 

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Case information

rID: 34257
Case created: 12th Feb 2015
Last edited: 21st Jul 2017
Systems: Chest, Trauma, Forensic
Inclusion in quiz mode: Included

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