Pneumothorax - stabbing

Case contributed by Dr Paul Simkin

Presentation

Three stab wounds to right chest.

Patient Data

Age: 75
Gender: Female
X-ray

There is a knife projected through the right scapula between the posterolateral right third and fourth ribs extending into the right thorax with an associated large pneumothorax.

CT

The blade of a knife is seen extending through the right posterior chest wall, through the body of the scapula with the tip at the outer rib edge. A right intercostal catheter is in situ, with minimal residual pneumothorax. 2 pulmonary lacerations are seen, one involving the right upper lobe, the other the posterior right lower lobe. A small to moderate haemothorax is seen, located anteriorly against the heart and in the oesophageal recess as the patient was scanned semi-prone. Subcutaneous emphysema is noted.

Fracture of the undersurface of the right fourth rib is consistent with direct blow from the knife. No further right rib fracture is identified.

The intercostal arteries are not well seen at all levels, however no evidence of a vascular injury is demonstrated. No great vessel injury. No pericardial effusion. Left lung atelectasis due to the scan position.

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Case information

rID: 30454
Case created: 11th Aug 2014
Last edited: 6th Apr 2017
System: Chest
Inclusion in quiz mode: Included

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