MyMedR

NICHOLLS J

Med J Malaya, 1962 Mar;16:225-8.

Matched MeSH terms: Thoracic Injuries*

Fulltext Emergency thoracotomy and major lung resection for penetrating chest trauma: Lessons learnt from a review of three cases

Sachithanandan A, Fahmi PA, Faisal I, Badmanaban B, Abdul Muis J, Mohd Arif MN

Med J Malaysia, 2013 Jun;68(3):227-30.

PMID: 23749011 MyJurnal

Emergency lung resection for chest trauma is a rare event with a reported incidence of 0.08-1.3% but is associated with a high morbidity and mortality especially if a pneumonectomy is required, if due to blunt chest trauma or when concomitant injuries are present. We report three cases of young adult males with penetrating chest injuries that required emergency thoracotomy (ET) and anatomical lung resection to achieve definitive control of life threatening pulmonary haemorrhage. All patients survived to hospital discharge and remained well on follow-up. Indications for an ET and what constitutes the optimal operative management of such patients is discussed.

Matched MeSH terms: Thoracic Injuries*

Fulltext The Macklin effect--pneumomediastinum and pneumopericardium following blunt chest trauma

Baharudin A, Sayuti RM, Shahid H

Med J Malaysia, 2006 Aug;61(3):371-3.

PMID: 17240595

Pneumomediastinum and pneumopericardium following blunt chest trauma are rare. Diagnosis is by chest radiograph and CT Scan. They have to be identified and treated accordingly. Usually, pneumomediastinum and pneumopericardium are self-limiting requiring no specific therapy. However, vigilance and a continuous monitoring of the vital signs are necessary.

Matched MeSH terms: Thoracic Injuries/complications*

A case of rupture of a main bronchus from a closed chest injury and its management in a child

Selvarajah N, Krishna SR

Med J Malaysia, 1974 Jun;28(4):276-8.

PMID: 4278977

Matched MeSH terms: Thoracic Injuries/complications*

Fulltext Impact of childhood burn injuries on breastfeeding: a case report

Arabi Z, Md Monoto EM, Bojeng A

Int Breastfeed J, 2019;14:17.

PMID: 31019544 DOI: 10.1186/s13006-019-0210-4

Background: Pre-pubescent girls with chest burns are at risk of complication associated with scarring and impairment in breast development. This case illustrates how burn injuries in childhood in a first-time mother have affected her in terms of breastfeeding.

Case presentation: In May 2015, a 20 year old first-time mother at 36 weeks gestation was seen in a district health clinic in Kuching, Sarawak in regards to her ability to breastfeed. She had a history of a flame burn at the age of 5 years old to her chest, abdomen, upper limb and part of her trunk. A skin graft was done on her whole chest and abdomen. Despite the injuries, she had pubertal and antenatal breast development. Her abdomen was able to stretch to accommodate her pregnancy. Physical examination showed a pregnancy which corresponded to date. The skin over her chest and abdomen appeared tight with areas of hyperpigmentation and hypopigmentation due to scarring from the skin graft. Breast tissues were palpable over her chest. The areola and nipple tissue were completely absent with complete scarring of the nipple-areolar complex. There was no duct opening to the areola for milk expression or leakage. Counselling regarding her breastfeeding issues was done. She delivered her baby at full term via spontaneous vaginal delivery with no complication. Oral cabergoline 1 mg was given on the first day postpartum. The baby was given infant formula via bottle feeding as the feeding method of choice.

Conclusion: Counselling plays an important part in the management of a mother with breastfeeding difficulty. Allaying the possible guilty feelings of not being able to breastfeed will fulfil the emotional gap which may arise in a mother with these challenges.

Matched MeSH terms: Thoracic Injuries/physiopathology*

Computed tomography of the thorax with 3D reconstruction in penetrating chest injury

Michael A, Yahya ZO, Mdrazali I, Hanif H

Med J Malaysia, 2017 02;72(1):75-76.

PMID: 28255150 MyJurnal

Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.

Matched MeSH terms: Thoracic Injuries

Case series of haemothorax secondary to avulsed bullae vessel

Low QJ, Hatta Z, Cheo SW, Syed RSH, Goh KS

Med J Malaysia, 2019 Oct;74(5):431-432.

PMID: 31649221

Haemothorax refer to the bleeding in the pleural space. It is commonly due to iatrogenic, blunt or penetrating chest trauma. Non-traumatic haemothorax is a rare entity that can potentially lead to life threatening complications. The initial management of both traumatic and non-traumatic haemothorax includes resuscitation and stabilisation of the patient. We would like to present two cases of non-traumatic haemothorax secondary to an avulsed bullae vessel.

Matched MeSH terms: Thoracic Injuries

Fulltext Acute myocardial infarction after blunt chest injury

Kannan P, Saradha N, Jeyamalar R

Singapore Med J, 1992 Feb;33(1):86-8.

PMID: 1598616

A 20-year-old male sustained an inferior myocardial infarction following blunt chest trauma, after a motor vehicle accident. Though coronary arteriograms 9 months later were normal, LV angiography revealed severe hypokinesia of the inferobasal and diaphragmatic segments. The literature is reviewed with respect to mechanisms of injury, autopsy and angiographic findings and clinical outcome in this condition.

Matched MeSH terms: Thoracic Injuries/complications*; Thoracic Injuries/radiography

Fulltext Emergency lung-sparing surgical repair of a complete transection of the right mainstem bronchus due to blunt chest trauma

Sachithanandan A, Tan YS, Abdul Muis J, Rapi AR, Mohd Arif MN, Badmanaban B, et al.

Med J Malaysia, 2014 Apr;69(2):92-4.

PMID: 25241820 MyJurnal

Traumatic chest injury with complete tracheo- bronchial disruption is uncommon and occurs in approximately 1% of motor vehicle accidents (MVA) (1,2). Such injuries carry a high mortality and patients rarely survive transfer to hospital. A high index of suspicion facilitates early diagnosis. Early operative intervention is vital for survival. We describe a rare case of traumatic complete disruption of the right mainstem bronchus (RMB) due to blunt chest trauma. The transected airway was reanastomosed emergently avoiding a lung resection.

Matched MeSH terms: Thoracic Injuries

Fulltext Traumatic herniation of the heart into the right hemithorax

Wong PS

Med J Malaysia, 1999 Dec;54(4):523-5.

PMID: 11072475

Pericardial rupture after blunt chest trauma is described in the literature. This case report summarises our experience with a 22-year old male patient who suffered blunt chest trauma during a motor vehicle accident. On admission no serious injuries could be detected, but 3 hours later, displacement of the heart to the right hemithorax combined with sudden cardiac failure appeared. Emergency thoracotomy revealed a right-sided rupture of the pericardium with complete herniation of the heart into the right pleural cavity and consequent strangulation by the margins of the pericardial defect.

Matched MeSH terms: Thoracic Injuries/complications*

Fulltext Trapped heart in heavily calcified pericardium

Zaimi MA, Mamat AZ, Ghazali MZ, Zakaria AD, Sahid NA, Hayati F

Oxf Med Case Reports, 2020 Oct;2020(10):omaa083.

PMID: 33133617 DOI: 10.1093/omcr/omaa083

Constrictive pericarditis is a disabling disease of the heart, which causes cardiac diastolic dysfunction. We present a case of a 44-year-old gentleman with a history of blunt chest trauma who presented with constrictive pericarditis with right-sided heart failure. Imaging studies revealed a calcified pericardium. He underwent an uneventful pericardiectomy. Calcification is common yet rare if it involves the pericardium. It normally occurs following fibrosis and adhesion which are associated with the chronicity of the disease, hence creating more challenge to the operating surgeon in the pericardiectomy procedure.

Matched MeSH terms: Thoracic Injuries

Fulltext Isolated Pancreatic Tail Injury in Paediatrics; A Case Report and Literature Review

Al Kuddoos NM, Ismail AK, Shen KWC, Shibraumalisi NA, Yunus AY

Bull Emerg Trauma, 2020 Oct;8(4):249-252.

PMID: 33426141 DOI: 10.30476/beat.2020.85719

Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.

Matched MeSH terms: Thoracic Injuries

Fulltext Cardiac A-lines in fast scan as a sign of pneumopericardium

Md Noor J, Eddie EA

Ultrasound J, 2019 Apr 25;11(1):7.

PMID: 31359168 DOI: 10.1186/s13089-019-0123-x

BACKGROUND: Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium.

CASE PRESENTATION: A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.

CONCLUSIONS: Although FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.

Matched MeSH terms: Thoracic Injuries

Fulltext Anterior penetrating chest injury with left ventricular thrombus

Ruth Sabrina, S., Nik Azlan, N.M., Adi, O.

Medicine & Health, 2013;8(1):28-32.

MyJurnal

Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved.

Matched MeSH terms: Thoracic Injuries

Thoracic aortic dissection. Death may not always be due to rupture with haemorrhage. Unusual complications which can be missed at autopsy

Subramaniam K, Sheppard MN

J Forensic Leg Med, 2018 Feb;54:127-129.

PMID: 29413954 DOI: 10.1016/j.jflm.2018.01.005

OBJECTIVES: Aortic dissection (AD) can be a challenging diagnosis. At autopsy, the aorta may not be dilated and intimal tears may be missed or found without obvious rupture or haemorrhage. We report our experience of AD at a tertiary referral centre with review of 32 cases and discuss 2 unusual complications.

METHODS/RESULTS: 32 cases of which 12 females and 20 male and 18 out of 32 cases were aged below 40. All of the cases were examined macroscopically and microscopically. 30 out of 32 cases (93%) died due to rupture associated with the AD. Two unusual complications were proximal extension of AD into left coronary artery (CA) with intramural haematoma blocking the vessel and AD involving the ostium of the right CA resulting in avulsion of the right CA from the aorta. Mode of death in both these cases were myocardial ischemia. Sections of the aorta in all cases confirmed extensive cystic medial degeneration with disorganisation, fragmentation and disappearance of the elastin fibres with increased collagen and smooth muscle nuclear degeneration.

CONCLUSION: Pathologists should be thorough when examining the aorta, the aortic valve and root in AD. When a rupture site cannot be found it is important to look for unusual complications involving the CAs. Histology plays an important role to corroborate the cause of death.

Matched MeSH terms: Aorta, Thoracic/injuries

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