Bilateral Thoracic Impalement Through Mediastinum

Abstract

Fig 2. Adepartment, after falling from the balcony of a second-floor-apartment, on a projecting iron bar. The bar impaled her chest, bilaterally, and was carefully left in situ. The patient was conscious, oriented, and hemodynamically stable. The entrance wound site was at the fourth intercostal space, midaxillary line of the right lateral chest wall, and exit wound site at the tenth intercostal space, posterior axillary line of the left lateral chest wall, as shown by the arrows (Fig 1). Due to the patient’s stable condition, preoperative x-ray and computed tomography scan (Figs 2, 3) were performed. A metallic bar (yellow arrows in Figs 1, 2 and 3) penetrated the chest from the right side to the left, through the mediastinum, leaving intact the major structures of the thoracic cavity. The patient was transferred to the operating room. A right thoracotomy, middle lobe wedge rejection, and right lower lobectomy were initially performed and followed by a left thoracotomy and parenchymal lacerations repair. The iron bar was extracted under direct vision with careful manual control. The patient made an uneventful recovery. Impalement injuries limited to the chest are quite rare [1]. Mortality rate is extremely high, especially when the heart or great vessels are impaled, while factors like young age and injuries restricted to lungs, may contribute to a favorable outcome.