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Rupture of the Right Coronary Cusp of the Aortic Valve Caused by Blunt Chest Trauma
Asuman B. Yesilay,Ozcan Ozeke,Kerim Cagli,Bulent Deveci Kumral Ergun,Mehmet Dogan,Veli Kaya,Erdem Guler
The Cardiology , 2011,
Abstract: Although cardiac trauma is one of the leading causes of death among victims of blunt injury, it is frequently ovelooked. or missed because of other obvious injuries. Therefore, it is very important to specifically look for heart-related injuries in these patents. We present a patient with aortic valve insufficiency due to rupture of the right coronary cusp caused by blunt chest trauma.
Rupture of the Right Coronary Cusp of the Aortic Valve Caused by Blunt Chest Trauma
Asuman B. Yesilay,Ozcan Ozeke,Kerim Cagli,Bulent Deveci Kumral Ergun
The Cardiology , 2005,
Abstract: Although cardiac trauma is one of the leading causes of death among victims of blunt injury, it is frequently ovelooked. or missed because of other obvious injuries. Therefore, it is very important to specifically look for heart-related injuries in these patents. We present a patient with aortic valve insufficiency due to rupture of the right coronary cusp caused by blunt chest trauma.
Late Onset Traumatic Rupture of the Diaphragm with a Minor Blunt Trauma: A Case Report  [cached]
Nazik A??l?o?lu,Atay ?zkal,Burak Tander
Journal of Academic Emergency Medicine , 2011,
Abstract: Rupture of the diaphragm after blunt trauma is uncommon in children but it is usually associated with life-threatening complications. A delay in diagnosis may result in an increased mortality and morbidity. A case of a ten month old girl with diaphragmatic rupture and gastric herniation presenting one month after a minor blunt trauma is reported in this article Diagnosis of isolated diaphragmatic rupture is difficult during the preoperative period. Following blunt or penetrating traumas, this possibility should be considered in order to diagnose diaphragmatic ruptures.
Extracorporeal Life Support in a Severe Blunt Chest Trauma with Cardiac Rupture  [PDF]
Launey Yoann,Flecher Erwan,Nesseler Nicolas,Malledant Yannick,Seguin Philippe
Case Reports in Critical Care , 2013, DOI: 10.1155/2013/136542
Abstract: This report presents a case of severe blunt chest trauma secondary to a horse riding accident with resultant free-wall rupture of the left ventricle in association with severe lung contusion. We describe the initial surgical and medical management of the cardiac rupture which was associated with a massive haemoptysis due to severe lung trauma. Extra corporeal membrane oxygenation (ECMO) support was initiated and allowed both the acute heart and lung failure to recover. We discuss the successful use and pitfalls of ECMO techniques which are sparsely described in such severe combined cardiac and thoracic trauma. 1. Introduction Traumatic cardiac rupture rarely complicates blunt chest trauma but is almost always fatal due to sudden and massive bleeding. A rare proportion of victims who reach the hospital alive benefits from emergency cardiac surgery. However, heart rupture is often associated with severe heart failure in the postoperative period often resulting in death [1]. Extra corporeal life support (ECLS) has been utilized for the last 15 years, and its indications are now rapidly spreading [2]. With permission from our local Institutional Review Board, we are publishing an original case report of heart and lung traumatic injuries requiring urgent surgery and ECLS implantation during the surgical procedure and the postoperative course. 2. Case Report A 37-year-old woman was admitted to our emergency department for thoracic blunt trauma caused by chest trampling after a fall from a horse. Her medical history includes a Guillain-Barré syndrome without sequelae and a previous traumatic brain injury responsible of rare mnesic disorders. At the initial evaluation, the patient was conscious without any motor deficit. Clinical examination revealed severe hypoxia with pulse oximetry (SpO2) at 89% increasing to 98% breathing under O2 at 15?liters/min, a tachycardia of 120?bpm without hypotension (arterial blood pressure = 110/78?mmHg). The patient was complaining, however, of dorsal and left-sided chest pain. At admission, the respiratory status promptly deteriorated with increased hypoxemia. Initial chest X-ray revealed a left pneumothorax with bilateral lung contusions. Despite chest tube insertion, respiratory failure worsened, and trachea was intubated with immediate bradycardia, ventricular fibrillation, and finally asystole. Cardiopulmonary resuscitation with chest compression associated with intravenous (iv) adrenaline (total amount = 2.6?mg) was necessary for recovery of an effective circulatory activity. FAST-ultrasound scan identified pericardial
Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report
Mirko Muroni, Giuseppe Provenza, Stefano Conte, Andrea Sagnotta, Niccolò Petrucciani, Ivan Gentili, Tatiana Di Cesare, Andrea Kazemi, Luigi Masoni, Vincenzo Ziparo
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-289
Abstract: We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired.This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.Traumatic rupture of the diaphragm is an uncommon condition. It occurs in 0.8 to 5% of patients admitted to hospital with thoracoabdominal trauma. The etiologic factors are blunt trauma (for example, in motor vehicle accidents) and penetrating trauma [1]. The organs most commonly involved in right-sided diaphragmatic hernias are the colon, omentum, small intestines and liver.Chest radiography and computerized tomography is the most effective method for diagnosis of traumatic diaphragmatic rupture [2]. Treatment is surgical, with reduction of the viscera and simple repair of the diaphragm with non-absorbable suture.A 59-year-old Italian man presented with abdominal pain localized in the right upper quadrant, constipation and vomiting for longer than one week. The patient had inconstant symptoms including shortness of breath and dyspnea. His medical history included right-sided rib fractures in a moto
Intrathoracic esophageal rupture following blunt trauma chest in a ten months old girl  [cached]
Ghritlaharey Rajendra,Jain Ajay,Gupta Gaurav,Kushwaha Anand
Journal of Indian Association of Pediatric Surgeons , 2006,
Abstract: A 10 months old girl child was admitted on June 05 2005, with a history of blunt injury of chest and respiratory distress for 2 days. Chest skiagram showed effusion on right side of chest, with shift of mediastinum to opposite side. Right intercostal chest drainage was done for pyopneumothorax. Rupture of esophagus was suspected, when the chest drain showed milk. Water-soluble contrast study confirmed rupture of thoracic esophagus. Conservative management was successful in the form of intercostal chest drainage, broad-spectrum antibiotics, nasogastric feeding, parenteral nutrition, etc. A repeat contrast study showed no stricture or leak. At a follow up of 3 months, she is doing well. To the best of our knowledge, this is the youngest patient with blunt injury of chest, leading to intrathoracic esophageal rupture.
Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma  [PDF]
H. Hoffmann,D. Oertli,O. Heizmann
Minimally Invasive Surgery , 2010, DOI: 10.1155/2010/109062
Abstract: Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture. 1. Introduction Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence of 0.8%–1.6% in blunt trauma [1–3]. The closure of the diaphragm rupture must be performed immediately. The diagnosis often happens to be late due to the absence of typical symptoms or other major injuries dominating the clinical aspect [4]. An isolated BTDR is rare and thus might be followed by a period of weeks or months not revealing any symptoms [2, 5]. Most BTDR are located on the left side in the musculotendinous intersection [1, 3, 4]. Right BTDR are rarely described and less frequent [6]. Herniation of colon, small bowel, or liver may occur and result in ileus, necrosis, and perforation [4, 7]. 2. Narrative We present a rare case of a 68-year-old female hospitalized in the neurological department due to Parkinson disease. She fell onto a chair hitting her right hemithorax. Initially, subjective symptoms have been missing. The examination showed a slightly reduced breath without any signs of pneumothorax or dyspnea, a decent pressure pain and a bruise. 4 days after trauma, she developed a progressive pulmonal decompensation with desaturation. Additionally, there have been signs of ileus. The chest radiograph displayed a herniation of bowel into the right hemithorax with consecutive ileus signs (Figure 1). Figure 1: Chest radiograph shows bowel herniation into right hemithorax. We performed a laparoscopic approach and found a ?cm rupture of the right diaphragm with herniation of 1 meter small bowel. The bowel appeared vital after reposition. The transdiaphragmatic thoracoscopy displayed a collapsed lung and a dislocated rib fracture (Figure 2). After irrigation of the thoracic cavity we made a direct laparoscopic strainless running suture with
Rotura extensa de septo interventricular por traumatismo torácico cerrado Interventricular septum rupture following blunt chest trauma  [cached]
Francisco Gandía-Martínez,David Andaluz-Ojeda,I?igo Martínez-Gil,Alberto Campo-Prieto
Medicina Intensiva , 2009,
Abstract: La rotura del septo interventricular por traumatismo cerrado de tórax es una rara lesión cardíaca cuyo diagnóstico puede ser pasado por alto y que muestra una elevada mortalidad en los casos con inestabilidad hemodinámica que requieren cirugía correctora precoz. Presentamos el caso de un joven de 18 a os con traumatismo toracoabdominal cerrado y shock hemorrágico que precisó cirugía abdominal urgente en tres ocasiones. Fue diagnosticado de rotura traumática del septo interventricular no detectada en el ecocardiograma inicial, que se sospechó tras cateterismo cardíaco derecho y se intervino quirúrgicamente de urgencia a las 72 h de su ingreso. Interventricular septum rupture following blunt chest trauma is a rare cardiac injury that sometimes is difficult to diagnose. It has a high mortality rate, especially when in cases of hemodynamic instability requiring early surgical repair. We report the case of an 18-year old man who suffered blunt thoracoabdominal trauma and hemorrhagic shock who required emergency abdominal surgery on three occasions. He was diagnosed of traumatic rupture of interventricular septum that had not been detected in the initial echocardiography, but was suspected after the right heart catheterism. Urgent cardiac surgery was performed 72 hours later because of hemodynamic instability.
Anaesthetic management of a patient with complete tracheal rupture following blunt chest trauma
Sengupta Saikat,Saikia Anjol,Ramasubban Suresh,Gupta Shaikat
Annals of Cardiac Anaesthesia , 2008,
Abstract: Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.
Right-sided diaphragmatic rupture after blunt trauma. An unusual entity
Ramon Vilallonga, Vicente Pastor, Laura Alvarez, Ramon Charco, Manel Armengol, Salvador Navarro
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-3
Abstract: Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery. Sennertus, in 1541, performed an autopsy in one patient who had died from herniation and strangulation of the colon through a diaphragmatic gap secondary to a gunshot wound received seven months earlier [1]. However, these cases remain rare, and difficult to diagnose and care for. This has highlighted some of the aspects related to these lesions, especially when they are caused by blunt trauma and injuries of the right diaphragm [1,2].We report the case of a man of 36 years of age, thrown from a height of 12 meters and was referred to our centre. The patient arrived conscious and oriented, and we began manoeuvring the management of the patient with multiple injuries according to the guidelines of the ATLS (Advanced Trauma Life Support) recommended by the American College of Surgeons. The patient had an unstable pelvic fracture (type B2) with hemodynamic instability and respiratory failure. Patient's Injury Severity Score (ISS) was 38. Pelvis and chest X-rays were performed which confirmed the pelvic fracture and pathological elevation of the right hemidiaphragm was observed (Figure 1). We proceeded to stabilise the pelvic fracture and replace fluids, improving hemodynamic status. The patient continued with respiratory failure. For this reason, a chest tube was placed and Computerised Tomography (CT) was performed (Figure 2), showing a ruptured right hemidiaphragm, including chest drain in the right hepatic lobe and occupation of the lesser sac by blood. The patient underwent surgery, finding a right hemidiaphragm transverse rupture with a hepatothorax and an intrahepatic thoracic tube. We performed the suture of the diaphragm and liver packing, moved the patient to the intensive care unit, and after 48 hours, the liver packing was removed without problems. The patient evolved favourably.Currently, traumatic injuries of the diaph
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