A case report of thoracic compartment syndrome in the setting of penetrating chest trauma and review of the literature

While abdominal compartment syndrome is a well-recognized clinical entity in the trauma population, the thoracic cavity is a significantly less frequent site of compartment syndrome. Thoracic compartment syndrome (TCS) has been primarily reported in relation to cardiac/mediastinal procedures [1-5]. Although TCS has been reported outside of the cardiac surgery population, it is exceedingly rare in the trauma population and no case has been reported without cardiac involvement. Here, we present a case of TCS where initiation and pathogenesis were entirely non-cardiac in origin following surgical repair of a stab wound injury that necessitated decompressive thoracotomy and peri-operative open-chest management.A 46-year-old male was brought to the emergency department at Northwestern Memorial Hospital with multiple stab wounds to the neck and chest. He was hypotensive upon arrival and a right needle thoracostomy returned blood and air, resulting in improvement in blood pressure. Secondary survey demonstrated a stab wound to Zone I of the right neck, approximately 2 cm above the right clavicular head, and a second stab wound to the right thoraco-abdominal area 3 cm above the costal margin and 2.5 cm lateral to the mid-clavicular line. A portable chest x-ray performed at Patient Arrival Time (PAT) + 10 min revealed a right hemothorax. A right thoracostomy tube was placed, which returned 800 mL of blood. By this time the patient had responded to resuscitation of 2 L of Lactated Ringers (PAT + 20 min). The patient did not at this time meet criteria for an emergent thoracotomy (< 1500 mL thoracostomy output and hemodynamic stability), therefore planning the workup for potential surgical sources of bleeding incorporated 3 areas of concern: 1) intra-thoracic injury resulting from the lower right thoraco-abdominal wound, 2) intra-abdominal injury from the lower right thoraco-abdominal wound that was decompressing through a diaphragm injury into the right thoracic cavity and 3)