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Case Reports
Extra-Pericardial Tamponade due to Internal Thoracic Artery Rupture after Blunt Trauma: A Case Report
Dongsub Noh, Sung Wook Chang, Dae Sung Ma
J Trauma Inj. 2021;34(3):183-186.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0045
  • 3,101 View
  • 106 Download
  • 1 Citations
AbstractAbstract PDF

Cardiac tamponade is an acute life-threatening condition that predominantly involves the intra-pericardial space; however, an expanding mediastinal hematoma can also sometimes cause cardiac tamponade. Here we describe the case of a 45-year-old male driver in whom a traffic accident resulted in rupture of the left internal thoracic artery (ITA), extra-pericardial hematoma, and sternal fracture. After resuscitation, he was scheduled to undergo angio-embolization to repair the ruptured left ITA, but he suddenly developed cardiac tamponade that required a decompressive sternotomy. Nevertheless, the patient had an uncomplicated recovery, and this case suggests that extra-pericardial cardiac tamponade should be considered as a possible consequence of retro-sternal hematoma due to traumatic ITA rupture.

Summary

Citations

Citations to this article as recorded by  
  • Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention
    Kayla A. Aikins, Zoé N. Anderson, Timothy M. Koci
    Diagnostics.2023; 14(1): 63.     CrossRef
Celiac Artery Compression After a Spine Fracture, and Pericardium Rupture After Blunt Trauma: A Case Report from a Single Injury
Joongsuck Kim, Hyun Min Cho, Sung Hwan Kim, Seong Hoon Jung, Jeong Eun Sohn, Kwangmin Lee
J Trauma Inj. 2021;34(2):130-135.   Published online June 10, 2021
DOI: https://doi.org/10.20408/jti.2020.0053
  • 3,034 View
  • 68 Download
AbstractAbstract PDF

Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.

Summary
Delayed Diagnosis of Traumatic Rupture of Anterior Papillary Muscle of Tricuspid Valve; Importance of Trans-Esophageal Echocardiogram in the Evaluation of Major Blunt Chest Trauma
Ryan Bylsma, Mustafa Baldawi, Bruce Toporoff, Matthew Shin, Meghan Cochran-Yu, Davinder Ramsingh, Purvi Parwani, David G. Rabkin
J Trauma Inj. 2021;34(2):136-140.   Published online June 4, 2021
DOI: https://doi.org/10.20408/jti.2020.0060
  • 2,573 View
  • 63 Download
AbstractAbstract PDF

We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial postoperative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.

Summary
Large Focal Extrapleural Hematoma of Chest Wall: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):115-117.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.001
  • 4,911 View
  • 46 Download
AbstractAbstract PDF

Although hemothorax and pneumothorax are common complications seen in rib fractures, focal extrapleural hematoma is quite rare. We report a 63-year-old female patient that developed large focal extrapleural hematoma after falling off a second floor veranda. The patient had sustained 3, 4, 5th costal cartilage rib fractures and a sternum fracture. She had developed suspected empyema with loculations with small amount of hemothorax. She underwent a planned early decortication/adhesiolysis by video assisted thoracoscopic surgery at the 12th post-trauma day due to failed drainage. Unexpectedly, she had no adhesions or any significant retained hematoma mimicking a mass, but was found with the focal extrapleural chest wall hematoma. She was discharged on postoperative 46th day for other reasons and is doing fine today.

Summary
Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):107-110.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.050
  • 3,270 View
  • 55 Download
  • 1 Citations
AbstractAbstract PDF

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

Summary

Citations

Citations to this article as recorded by  
  • Thoracic duct injury: An up to date
    JoséLuis Ruiz Pier, MohebA Rashid
    The Journal of Cardiothoracic Trauma.2021; 6(1): 15.     CrossRef
Traumatic Bilateral Diaphragmatic Ruptures in a 6-Year-Old Boy
Sung Jin Kim, Hyuck Kim, Jun Ho Lee
J Trauma Inj. 2018;31(1):19-23.   Published online April 30, 2018
DOI: https://doi.org/10.20408/jti.2018.31.1.19
  • 2,878 View
  • 41 Download
AbstractAbstract PDF

Traumatic diaphragmatic rupture is an unusual finding that may occur after blunt trauma. In addition, diaphragmatic rupture occurring bilaterally is extremely rare. We experienced a 6-year-old boy with bilateral diaphragmatic rupture, whom survived after surgical treatment by open thoracotomy but, complicated with spinal cord injury discovered after surgery.

Summary
Original Article
The Surgical Outcome for Patients with Tracheobronchial Injury in Blunt Group and Penetrating Group
Chang Wan Kim, Jung Joo Hwang, Hyun Min Cho, Jeong Su Cho, Ho Seok I, Yeong Dae Kim, Do Hyung Kim
J Trauma Inj. 2016;29(1):1-7.   Published online March 31, 2016
DOI: https://doi.org/10.20408/jti.2016.29.1.1
  • 2,137 View
  • 28 Download
  • 2 Citations
AbstractAbstract PDF
PURPOSE
Tracheobronchial injuries caused by trauma are rare, but can be life threatening. The objective of this study was to evaluate the surgical outcome for patients with tracheobronchial injuries and to determine the difference, if any, between the outcomes for patients with penetrating trauma and those for patients with blunt trauma.
METHODS
From January 2010 to June 2015, 40 patients underwent tracheobronchial repair surgery due to trauma. We excluded 14 patients with iatrogenic injuries, and divided the remaining 26 into two groups.
RESULTS
In the blunt trauma group, injury mechanisms were motor vehicle accident (9 cases), free falls (3 cases), flat falls (1 case) and mechanical injury (1 case). In the penetrating trauma group, injury mechanisms were stab wounds (10 cases), a gunshot wound (1 case) and a stab wound caused by metal pieces (1 case). The mean RTS (Revised Trauma Score) was 6.89±1.59 (range: 2.40-7.84) and the mean ISS (Injury Severity Score) was 24.36±7.16 (range: 11-34) in the blunt group; the mean RTS was 7.56±0.41 (range: 7.11-7.84), and the mean ISS was 13±5.26 (range: 9-25) in the penetrating trauma group. In the blunt trauma group, 9 primary repairs, 1 resection with end-end anastomosis, 2 lobectomies, 1 sleeve bronchial resection and 1 pneumonectomy were performed. In the penetrating trauma group, 10 primary repairs and 2 resections with end-end anastomosis were performed. Complications associated with surgery were found in one patient in the blunt trauma group, and one patient in the penetrating trauma group. No mortalities occurred in either groups.
CONCLUSION
Surgical management of a traumatic tracheobronchial injury is a safe procedure for both patients with a penetrating trauma and those with a blunt trauma.
Summary

Citations

Citations to this article as recorded by  
  • A Case of Total Laryngectomy after Severe Penetrating Laryngeal Trauma
    Youngjin Cho, Sung-Chan Shin, Byung-Joo Lee, Yong-Il Cheon
    Journal of Clinical Otolaryngology Head and Neck .2022; 33(4): 250.     CrossRef
  • Damage Control of Laryngotracheal Trauma: The Golden Day
    Mario Alain Herrera, Luis Fernando Tintinago, William Victoria, Carlos Alberto Ordoñez, Michael Parra, Mateo Betancourt-Cajiao, Yaset Caicedo, Monica Guzman, Linda M. Gallego, Adolfo Gonzalez Hadad, Luis Fernando Pino, Jose Julian Serna, Alberto García, C
    Colombia médica.2020;[Epub]     CrossRef
Case Report
A Case of Tension Viscerothorax: A Rare Complication of Diaphragmatic Rupture after Blunt Abdominal Trauma
Maeng Real Park, Jae Ho Lee, Ji Yoon Ahn, Bum Jin Oh, Won Kim, Kyoung Soo Lim
J Korean Soc Traumatol. 2006;19(2):201-205.
  • 1,037 View
  • 3 Download
AbstractAbstract PDF
Tension viscerothorax (gastrothorax) is rare life-threatening disease which is caused by air trapped in viscera. A distended viscera in the hemi-thorax shifts the mediastinal structures and causes extra-cardiac obstructive shock. A defective diaphragm is caused by abdominal trauma or a congenital anomaly. Traumatic diaphragmatic injury can be missed until herniation develops several years after blunt trauma. In our case, a 10-year old boy developed hemodynamic compromise in the emergency department. Three years earlier, he had suffered blunt abdominal trauma during a pedestrian traffic accident, but there was no evidence of diaphragmatic injury at that time. He was successfully resuscitated by gastric decompression and an emergent thoracic operation. The operation finding revealed a traumatic diaphragmatic injury. Tension viscerothorax is a rare, but catastrophic, condition, so we suggest that addition of tension viscerothorax to the Advanced Trauma and Life Support (ATLS) guidelines may be helpful.
Summary
Original Articles
FAST Reappraisal: Cross-sectional Study
Sang Hyun Ha, Chong Kun Hong, Jun Ho Lee, Seong Youn Hwang, Seong Hee Choi
J Korean Soc Traumatol. 2012;25(3):67-71.
  • 1,010 View
  • 8 Download
AbstractAbstract PDF
PURPOSE
Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard.
METHODS
The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department.
RESULTS
There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively.
CONCLUSION
Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.
Summary
Relationship of Mean Arterial Pressure with the Adverse Outcomes in Adult Blunt Trauma Patients: Cross-sectional Study
Seung Yong Cha, Yong Hwan Kim, Chong Kun Hong, Jun Ho Lee, Kwang Won Cho, Seong Youn Hwang, Kyoung Yul Lee, Younghwan Lee, Seong Hee Choi
J Trauma Inj. 2013;26(2):39-46.
  • 1,274 View
  • 11 Download
AbstractAbstract PDF
PURPOSE
Non-invasive blood pressure measurement is widely used as a pre-hospital triage tool for blunt trauma patients. However, scant data exits for using the mean arterial pressure (MAP), compared to the systolic blood pressure, as a guiding index. The aim of this study was to determine the association between adverse outcomes and mean arterial pressure (MAP) and to exhibit the therapeutic range of the MAP in adult blunt trauma patients.
METHODS
The electronic medical records for all trauma patients in a single hospital from January 2010 to September 2012 were retrospectively reviewed. Patients below 17 years of age, patients with penetrating injuries, and patients with serious head trauma (injuries containing any skull fractures or any intracranial hemorrhages) were excluded. Adverse outcomes were defined as one of the following: death in the Emergency Department (ED), admission via operating theater, admission to the intensive care unit, transfer to another hospital for emergency surgery, or discharge as hopeless.
RESULTS
There were 14,537 patients who met entry criteria. Adverse outcomes occurred for MAPs in range from 90 to 120 mmHg. Adverse outcomes were found, after adjusting for confounding variables, to occur increasingly as the MAP declined below 90 mmHg or rose above 120 mmHg.
CONCLUSION
Not only lower but also higher mean arterial pressure is associated with increased adverse outcomes in adult blunt trauma patients. Thus, patients with a MAP above 120 mmHg should be considered as a special group requiring higher medical attention, just as those with a MAP below 90 mmHg are.
Summary

J Trauma Inj : Journal of Trauma and Injury