Stove-in chest

Case contributed by Dr Craig Hacking

Presentation

Multitrauma.

Patient Data

Age: 50 years
Gender: Male
CT

Small left pneumothorax. Bilateral dependent atelectasis. No hemothorax. Heart and mediastinal structures are normal.

Bone injuries:

X-ray

Day 7 post trauma - sudden desaturation

Partial left lower lobe collapse. A moderately large left hemothorax is present on the left on a background of multiple rib fractures. Left claviclular and scapular fractures noted.

X-ray

Day 8 post trauma - worsening dyspnea

Further collapse and consolidation of the left lower lobe. Large left hemothorax is enlarging. Multiple left rib fractures are further displaced. Left claviclular and scapular fractures noted.

X-ray

Day 10 post trauma - worsening pain

No notable changes.

CT

Day 11 post trauma - for pleural catheter, loculated collection

Minor passive collapse/consolidation at the left lower lobe. Mild collapse/consolidation at the right lung base. The lungs are otherwise clear. No pneumothorax. Moderate sized left-sided pleural effusion extending to the apical region - new finding compared to previous CT. No effusion on the right.

Heart and mediastinal structures are normal.

The anterior fractures of left ribs 2-5 are now displaced when compared with the previous CT, particularly ribs 2-3. The posterior fractures of left ribs 2-9 also show mild new displacement, particularly ribs 7-9.

Known comminuted fractures of the distal left clavicle and scapular body, neck and glenoid are unchanged.

X-ray

Post op VAT and rib plating

Plating of the left 3rd and 4th rib fractures anteriorly with restoration of the normal shape of the left chest wall. Left pleural effusion has almost completely resolved post-VATS.

Case Discussion

Progressive internal collapse of the left chest wall flail segment represents stove-in chest, a complex type of flail chest injury that confers worse morbidity and mortality.

After video-assisted thoracoscopic surgery (VATS) and rib plating, ventilation markedly improved and analgesic requirement decreased.

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Case information

rID: 65939
Published: 5th Feb 2019
Last edited: 13th Jun 2019
Inclusion in quiz mode: Included

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