Holger Rupprecht; Katharina Gaab
Volume 6, Issue 1 , January 2018, , Pages 1-7
Abstract
A penetrating chest trauma, a myocardial contusion or a myocardial infarction can lead to a cardiac rupture, which is linked to an extreme high death rate. Only few cases with delayed perforation of the myocardium have been reported in literature. We report about a penetrating gunshot injury, which led ...
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A penetrating chest trauma, a myocardial contusion or a myocardial infarction can lead to a cardiac rupture, which is linked to an extreme high death rate. Only few cases with delayed perforation of the myocardium have been reported in literature. We report about a penetrating gunshot injury, which led to a myocardial contusion with secondary delayed rupture of the left ventricle and the left inferior lobe of the lung. The leakage of the lesion in the left ventricle could be sealed sufficiently with fibrin-coated collagen fleeces after adapting stitches with Prolene 2-0. For additional stabilization of the vulnerable myocardium area, a bovine patch has been placed on the damaged ventricle. Fibrin fleeces are used successfully in cardiac surgery, as in our case, to seal the leakage of the lesion in the left ventricle. The implantation of a bovine patch in the pericardium could prevent a cardiac compartment syndrome with a fatal pericardial tamponade. To prohibit a thoracic compartment syndrome a modified Bogota bag could be sewed in for temporarily closure of the chest. In most cases penetrating cardiac injuries can be treated without heart-lung-machines. An immediate transfer to a cardio-surgical center is, due to the acute situation, not possible. If a surgeon with thoraco-surgical expertise is present a transfer is not absolutely necessary.
Holger Rupprecht; Marius Ghidau; Katharina Gaab
Volume 5, Issue 3 , July 2017, , Pages 212-214
Abstract
Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of ...
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Fracture and intrathoracic dislocation of the humeral head are extremely rare and often the result of a severe trauma. We herein report a case of humeral head fracture and dislocation with displacement into the chest cavity. A 75-year-old man fell down the stairs at home, landing on the right half of his body. Clinical impressive was a massive skin emphysema on the right hemithorax. A chest x-ray was performed. Conspicuous was a dubious opacity in the right subfield of the lung. The following CT-scan showed an additional fracture of the right scapula, a lung contusion and as “corpus delicti” a right intrathoracic dislocated humeral head fracture. The current case is extremely rare pattern of injury and the surgical emergency management is discussed. In most patients, a thoracotomy, which is related to a higher lethality and higher morbidity, can be avoided, if after stabilization a video assisted thoracoscopy is performed for revision of the pleural cavity and extraction of the humeral head.