Blunt intrapericardial superior vena cava injury – A trap for the unwary

Abstract

Wepresent a case of haemodynamically unstable blunt thoracic injury that required emergency mediastinal exploration and vascular repair for rupture of the intrapericardial superior vena cava and innominate artery. In addition, on further imaging after operation the patient was found to have a third great vessel injury and this was managed non-operatively. The case reinforces the need for all emergency surgeons to: be able to approach and repair the great vessels of the chest, employ re-examination and re-evaluation and the use of advanced imaging to diagnose all injuries and to assure long-term follow-up for those lesions managed conservatively. Workup of blunt thoracic vascular injuries is directed by the physiology of the patient. Unstable patients have limited preoperative management and treatment relies on rapid surgical exploration and repair. Stable patients can undergo further radiographic workup and the intervention selected based on the imaging results. This intervention may range from open repair, endovascular stenting, or observation in patients with lesser injuries.