Blunt chest trauma and tube thoracostomy

Abstract

We read with great interest the case report by Janson and colleagues [1Janson J.T. Harris D.G. Pretorius J. Rossouw G.J. Pericardial rupture and cardiac herniation after blunt chest trauma.Ann Thorac Surg. 2003; 75: 581-582Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. It helps all of us to better understand the importance of blunt thoracic trauma and pericardial rupture.Closed tube thoracostomy is a common and very useful procedure in the therapy for acute thoracic injury [2Millikan J.S. Moore E.E. Steiner E. Aragon G.E. Van Way III, C.W. Complications of tube thoracostomy for acute trauma.Am J Surg. 1980; 140: 738-741Abstract Full Text PDF PubMed Scopus (164) Google Scholar]. However, it is not without risk. The indications for, placement of, and management of chest tubes are clear [3Iberti T.J. Stern P.M. Chest tube thoracostomy.Crit Care Clin. 1992; 8: 879-895PubMed Google Scholar]. In the interesting report by Janson and associates, there were multiple rib fractures on the right side with a lung contusion, but there was no hemothorax or pneumothorax. The chest roentgenogram does not provide enough information about the left side. As we understand from the text, the left side of the chest was normal without rib fracture, hemothorax, or pneumothorax. The point about which we are confused is the decision to place chest tubes prophylactically in both sides of thorax. Also, we could not determine whether or not there was any drainage or air leakage from the left chest tube. How do the authors explain the bilateral tube thoracostomies if the left side of the thorax was normal. We read with great interest the case report by Janson and colleagues [1Janson J.T. Harris D.G. Pretorius J. Rossouw G.J. Pericardial rupture and cardiac herniation after blunt chest trauma.Ann Thorac Surg. 2003; 75: 581-582Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar]. It helps all of us to better understand the importance of blunt thoracic trauma and pericardial rupture. Closed tube thoracostomy is a common and very useful procedure in the therapy for acute thoracic injury [2Millikan J.S. Moore E.E. Steiner E. Aragon G.E. Van Way III, C.W. Complications of tube thoracostomy for acute trauma.Am J Surg. 1980; 140: 738-741Abstract Full Text PDF PubMed Scopus (164) Google Scholar]. However, it is not without risk. The indications for, placement of, and management of chest tubes are clear [3Iberti T.J. Stern P.M. Chest tube thoracostomy.Crit Care Clin. 1992; 8: 879-895PubMed Google Scholar]. In the interesting report by Janson and associates, there were multiple rib fractures on the right side with a lung contusion, but there was no hemothorax or pneumothorax. The chest roentgenogram does not provide enough information about the left side. As we understand from the text, the left side of the chest was normal without rib fracture, hemothorax, or pneumothorax. The point about which we are confused is the decision to place chest tubes prophylactically in both sides of thorax. Also, we could not determine whether or not there was any drainage or air leakage from the left chest tube. How do the authors explain the bilateral tube thoracostomies if the left side of the thorax was normal. Blunt chest trauma and tube thoracostomy: ReplyThe Annals of Thoracic SurgeryVol. 77Issue 2Preview Full-Text PDF