Blunt Chest Trauma Research Articles

Streamlining management in thoracic trauma: radiomics- and AI-based assessment of patient risks

BackgroundIn blunt chest trauma, patient management is challenging because clinical guidelines miss tools for risk assessment. No clinical scale reliably measures the severity of cases and the chance of complications.AimThe objective of the study was to optimize the management of patients with blunt chest trauma by creating models prognosticating the transfer to the intensive care unit and in-hospital length of stay (LOS).MethodsThe study cohort consisted of 212 cases. We retrieved information on the cases from the hospital’s trauma registry. After segmenting the lungs with Lung CT Analyzer, we performed volumetric feature extraction with data-characterization algorithms in PyRadiomics.ResultsTo predict whether the patient will require intensive care, we used the three groups of findings: ambulance, admission, and radiomics data. When trained on the ambulance data, the models exhibited a borderline performance. The metrics improved after we retrained the models on a combination of ambulance, laboratory, radiologic, and physical examination data (81.5% vs. 94.4% Sn). Radiomics data were the top-accurate predictors (96.3% Sn). Age, vital signs, anthropometrics, and first aid time were the best-performing features collected by the ambulance service. Laboratory findings, AIS scores for the lower extremity, abdomen, head, and thorax constituted the top-rank predictors received on admission to the hospital. The original first-order kurtosis had the highest predictive value among radiomics data. Top-informative radiomics features were derived from the right hemithorax because the right lung is larger. We constructed regression models that can adequately reflect the in-hospital LOS. When trained on different groups of data, the machine-learning regression models showed similar performance (MAE/ROV≈8%). Anatomic scores for the body parts other than thorax and laboratory markers of hemorrhage had the highest predictive value. Hence, the number of injured body parts correlated with the case severity.ConclusionThe study findings can be used to optimize the management of patients with a chest blunt injury as a specific case of monotrauma. The models we built may help physicians to stratify patients by risk of worsening and overcome the limitations of existing tools for risk assessment. High-quality AI models trained on radiomics data demonstrate superior performance.

Mitral valve regurgitation followed by blunt chest trauma in a paediatric patient: a case report.

We report a paediatric case where severe mitral valve regurgitation occurred led by blunt chest trauma. Medical treatment was undertaken, and surgical mitral valve repair was postponed until half a year after the initial injury, followed by an uneventful postoperative recovery. We highlight the importance of echocardiographic evaluation for traumatic valve insufficiency. The medical strategy and timing of surgical intervention should be individualised.

Case Report: Aspirated Airway Foreign Body Mimicking Endobronchial Mass: A Diagnostic Challenge

Abstract Introduction/Objective Despite advancements in imaging modalities, identifying retained foreign bodies within the lung remains arduous. Detecting small foreign bodies is crucial as they can serve as a focal point for subsequent infections. Initial assessments may mimic malignancy. Herein, we present a case of a retained foreign body masquerading as an endobronchial mass, accompanied by unilateral pleural effusion and persistent hypoxia. Subsequent bronchoscopy showed a pearly white endobronchial mass partially obstructing the segmental bronchus at the posterior basal segment of the right lower lobe of lung with accompanying right pleural effusion and atelectasis. Methods/Case Report This is a 58-year-old male with history of hypertension, deep vein thrombosis, transient ischemic attack, and a recent motor vehicle accident with blunt chest trauma. He had a thoracic spinal cord transection with grade III blunt thoracic aortic injury, developed anasarca, hypoxia, right pleural fluid requiring multiple thoracentesis, and right sided hemothorax requiring massive transfusion protocol. Subsequent evaluations, including bronchoscopic transbronchial forceps biopsies and bronchial wash and pleural fluid cytologic examinations showed no malignant cells. Repeat bronchoscopy was concerning for enlarging mass and obstruction. Bronchoscopy almost 2 months after MVA revealed an endobronchial foreign body (tooth) lodged in the left lower lobe of lung posterior segment. Results (if a Case Study enter NA) N/A Conclusion While aspiration of foreign bodies into the tracheobronchial tree is not uncommon especially in children, foreign bodies, particularly teeth, are rare in adults. Bronchial foreign body aspiration may occur in trauma, with diagnosis typically relying on history and physical examination. Detection remains challenging despite imaging advancements, with implications including infection nidus formation. In our case, delayed diagnosis highlights the importance of considering unusual etiologies in persistent pulmonary pathology. Retrospective imaging analysis and CT findings suggested a foreign body, emphasizing the utility of imaging in suspected cases. Prompt surgical intervention is crucial to prevent complications such as recurrent infections.

Air under pressure: a case report on tension pneumomediastinum arising from traumatic injury

Abstract Background Tension pneumomediastinum (TPM) is a rare but critical condition characterized by the accumulation of air in the mediastinum, leading to increased intrathoracic pressure and cardiovascular compromise. This case report is novel due to the rarity of TPM arising from blunt chest trauma and the necessity for emergent surgical intervention after initial conservative management failed. Case presentation A 63-year-old male presented with severe chest pain and dyspnea following a high-impact motor vehicle collision. Initial assessment revealed tachypnea, tachycardia, and hypotension, along with extensive subcutaneous emphysema over the chest and neck. Imaging confirmed pneumomediastinum and bilateral pneumothoraxes, consistent with TPM. Despite initial management with high-flow oxygen and bilateral chest tube insertion, the patient’s condition deteriorated, necessitating emergent mediastinal decompression via an anterior subxiphoid incision. This intervention resulted in immediate hemodynamic improvement. Conclusions This case underscores the importance of recognizing TPM in patients with chest trauma and highlights the need for prompt surgical intervention in cases of hemodynamic instability. Early and accurate diagnosis and timely surgical management are crucial for improving patient outcomes in TPM.

MYOCARDIAL DYSFUNCTION IN POLYTRAUMA

Trauma remains one of the leading causes of mortality worldwide, particularly among the young population. A significant number of people die within the first 48 hours due to acute cardiovascular pathology. Cardiac injury is a significant predictor of adverse outcomes following multiple trauma, associated with poor prognosis and prolonged hospitalization. Systemic elevation of cardiac troponin levels is linked to survival, the severity of trauma, and catecholamine consumption in patients after multiple trauma. Clinical signs of the so-called "commotio cordis" include arrhythmias, such as ventricular fibrillation and sudden cardiac arrest, as well as wall motion abnormalities. In trauma patients with inadequate hypotension and a lack of adequate response to fluid therapy, the possibility of cardiac injury should be considered. Therefore, a combination of electrocardiography, echocardiography, and the systemic determination of cardiomyocyte injury markers, such as troponin, appears to be an appropriate diagnostic method for identifying cardiac dysfunction after trauma. However, the mechanisms of post-traumatic cardiac dysfunction continue to be actively studied. The aim of this review is to discuss cardiac injury following trauma, focusing on the mechanisms of post-traumatic cardiac dysfunction related to inflammation and complement activation. The review illustrates the causal relationship between cardiac dysfunction and blunt chest trauma, multiple trauma, and hemorrhagic shock.

A STUDY ON THE DIFFERENT CLINICAL PRESENTATION PATTERNS OF BLUNT THORACIC TRAUMA AND ASSOCIATED MORBIDITY FOLLOWING ROAD TRAFFIC ACCIDENT IN A TERTIARY CARE CENTRE

Introduction:Chest trauma is a significant cause of morbidity and mortality following road traffic accidents (RTA). Given the significant potential for complications including respiratory failure and shock, blunt chest trauma following RTA remains a priority in trauma care and so this study aims to look into the clinical pattern of presentation of patients following chest trauma with/without associated injuries to other parts of body i.e. head/abdomen/extremities along with morbidity and mortality associated with it. Aims and objectives of the study : 1. To study the various clinical patterns of presentation of RTA patients with blunt chest trauma. 2. To study the disease burden and death rate of individuals with blunt chest trauma. Methodology: The study has been conducted in the Department of General Surgery, Silchar Medical College and Hospital from March 2024 to August 2024 after taking appropriate consent from 53 patients diagnosed with chest trauma following RTA with/without associated extra- thoracic injuries. Their data was analyzed and results published. Result and Analysis: Mean age in my study was 38.90 ± 6.57 years with male preponderance. Most patients had 3 rib fractures with pulmonary contusion being most common complication. Most common associated extra-thoracic trauma is abdominal injuries (24.5%) with mean ISS of 13.25 ± 7.73. most patients were managed conservatively with adequate pain control. Surgical intervention carried out were either tube thoracostomy (92.3%) or needle thoracostomy (7.2%). Most common secondary complication following blunt chest trauma is pneumonia (18.84%) while ARDS complication arose in 9.43% of the patients. Mortality rate was 5.6% and the most common cause that let to the demise was ARDS. Conclusion: To conclude, blunt thoracic injury is a major health problem as it carries significant mortality and morbidity more so, in case of RTA and association of other extra-thoracic injuries also play a pivotal role in the process of recovery of the patient. Presence of lung contusion, pneumothorax, hemothorax are to be dealt adequately with proper analgesia. Even though most cases of chest trauma can be dealt conservatively need for emergency surgical intervention needs to be assessed promptly. One must look for number of rib fractures as they may reflect the disease burden of the patient. Pneumonia and ARDS are a major mortality factor following chest trauma and its complications.

Damage Control Orthopaedics Induced Less Trauma-Induced Coagulopathy than Early Total Care in a Porcine Polytrauma Model

Introduction: Coagulopathic disorders (CDs) complicate treatment in polytraumatised patients. Against this background, operative strategies for fracture management are controversial in this cohort. This study therefore investigated the effects of two established operative concepts, early total care (ETC) and damage control orthopaedics (DCO), on CD in a large-animal polytrauma (PT) model. Methods: Twenty-two animals (Sus scrofa domesticus) sustained PT involving blunt-chest trauma, liver laceration, bilateral femur fracture, and pressure-controlled haemorrhagic shock. After resuscitation, animals were allocated to ETC (n = 8), DCO (n = 8), or served as a non-traumatised control group (CG, n = 6). Animals were ventilated and monitored under ICU standards for 72 h. Blood samples were collected at baseline and post-trauma after 1.5, 2.5, 24, 48, and 72 h. Plasminogen activator inhibitor-1 (PAI-1) and thrombin-antithrombin (TAT) complex concentrations were determined by ELISA. Results: Compared to the CG, ETC and DCO subjects had significantly increased plasma concentrations of PAI-1 after 2.5 h (CG vs. ETC: p = 0.0050, CG vs. DCO: p = 0.0016). Furthermore, the ETC group showed significantly increased plasma PAI-1 concentrations after 24 h compared to the CG and DCO groups (CG vs. ETC: p = 0.0002, DCO vs. ETC: p = 0.0004). During the later clinical course, concentrations of TAT were significantly increased in the ETC group compared to the CG and DCO group after 72 h (CG vs. ETC: p = 0.0290, DCO vs. ETC: p = 0.0322). Conclusion: PT is strongly associated with CD in the early post-traumatic course. In comparison to DCO, ETC appeared to be negatively associated with CD. Future studies must investigate this impact, especially in those patients admitted with trauma-induced coagulopathy, to improve outcomes.

Traumatic Atrial Septal Defect with Tricuspid Regurgitation Following Blunt Chest Trauma Presenting as Hypoxemia: A Case Report

Traumatic Atrial Septal Defect with Tricuspid Regurgitation Following Blunt Chest Trauma Presenting as Hypoxemia: A Case Report

Utilizing Un-enhanced Chest Computed Tomography Screening for Blunt Trauma Surgery Decisions.

Background Blunt chest trauma is a common and potentially life-threatening condition that requires prompt assessment for potential surgical intervention. Computed tomography (CT) of the chest has emerged as a valuable tool due to its heightened sensitivity and specificity in detecting thoracic injuries compared to conventional chest radiography. Objective This study aims to assess the impact of non-contrast CT chest findings on surgical decision-making and compare these findings with those from chest radiographs. Methods The study was conducted at the Accident and Emergency Department of Medical Teaching Institute, Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan. Patients of all ages and genders who presented with blunt chest trauma were included. Non-contrast CT chest scans were used as an initial screening tool and compared with traditional chest radiographs. Data collected included patient demographics, mechanism of injury, diagnostic findings, and treatment decisions. Imaging was performed using a GE Optima 16-slice scanner (Medsystems Sp. z o.o., Lublin, Poland). Results The study included 246 patients, of whom 210 (85.4%) were males. The most common age group was 50 years or older, comprising 71 (28.9%) of the sample. The predominant mechanism of trauma was road traffic accidents, reported by 188 (76.4%) patients. Hemopneumothorax was detected in 121 (49.2%) patients on CT scans compared to 34 (13.8%) patients on chest radiographs. On chest radiograph, the pneumothorax component was missed in 43 (17.5%) patients, and the hemothorax component was not detected in 21 (8.5%) patients. Patient management included conservative management in 30 (12.2%) cases and surgical intervention in the form of unilateral tube thoracostomy in 173 (70.3%) patients or bilateral tube thoracostomy in 43 (17.5%) patients. Conclusion Our study supports the use of non-contrast CT scans as a reliable diagnostic tool for blunt chest trauma, consistent with current literature. This approach facilitates prompt management decisions, particularly for initiating tube thoracostomy based on findings of pneumothorax and hemothorax. The rarity of mediastinal great vessel trauma further justifies minimizing routine contrast use, thereby enhancing the efficiency of trauma evaluations.

Silent severe aortic regurgitation due to blunt chest trauma: ignore it at your peril—a case report

Abstract Background Blunt chest trauma (BCT) presenting to the emergency department is common and may cause life-threatening cardiac complications. Whilst complications causing haemodynamic instability are generally detected promptly, others may present late with long-term consequences. We describe a rare, serious complication of BCT presenting five years after a road traffic accident (RTA). Case summary A 23-year-old man was incidentally found to have a murmur. Past history was notable only for BCT with rib fracture sustained in a RTA 5 years prior. Examination revealed a hyperdynamic pulse, loud decrescendo diastolic murmur, and Duroziez’s sign over the femoral arteries. Echocardiography showed severe valvular aortic regurgitation (AR) from a hole in the left coronary cusp and holodiastolic flow reversal in the descending aorta. The left ventricle (LV) showed marked dilatation in diastole, mild dilatation in systole, and preserved systolic function. The aorta was normal. Severe AR was attributed to his previous BCT, with AR causing subsequent LV dilatation. He underwent aortic valve replacement (AVR) with rapid recovery. He remains well, and his echo shows a well-functioning AVR with normalization of LV dimensions. Discussion Aortic regurgitation following BCT is rare but well-recognized, most often resulting from RTAs. Only a third of cases are diagnosed acutely. In others, lack of haemodynamic instability means that emergency echocardiography is not routinely performed, such that this may go unrecognized with long-term consequences. Clinicians should be aware of possible valve damage following BCT. Prompt echocardiography should be routinely performed for all BCT at initial presentation, even without haemodynamic instability.

The contemporary approach to chylothorax – Single-center experience with the proposal of a management algorithm

Objectives: Chylothorax is a relatively rare condition of lymphatic fluid accumulation in the thoracic cavity due to a leakage from the thoracic duct or its tributaries. Patients present with dyspnea, malnutrition, and immunosuppression. Treatment can be conservative or surgical, depending on etiology and clinical course. The optimal management algorithm for chylothorax is still controversial. Methods: This is a ten-year period retrospective study of all patients with chylothorax treated at our Department of Thoracic Surgery. Results: A total of 14 patients were identified for the study. Nine patients had chylothorax after lung or esophageal cancer surgery. Four patients had chylothorax in advanced lymphoma. One patient had chylothorax after blunt chest trauma. A conservative approach was initiated in most patients (92%), including pleural drainage, nil per mouth, total parenteral nutrition, and somatostatin 0.1 mg bid subcutaneously. Surgical treatment was indicated in patients with thoracic drain production >800 mL per day beyond the fifth day of treatment and those with blunt thoracic trauma. Two patients had thoracic duct ligation via right-sided thoracotomy, and five patients had video-assisted thoracoscopic thoracic duct ligation with the immediate arrest of chylous leakage. Conclusion: Chylothorax should be treated conservatively initially. Surgical treatment should not be delayed beyond the fifth day in case of failure. In our series of patients, a video-assisted thoracoscopic approach for thoracic duct ligation proved to be minimally invasive, highly efficient, and well tolerated. Therefore, it should be the preferable route of surgical treatment.

Wolf in sheep’s clothing: a case of primary lung adenosquamous carcinoma mimicking traumatic pulmonary pseudocyst

BackgroundTraumatic pulmonary pseudocyst is a rare “cystlike” lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst.Case presentationA 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled “cystlike” lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion’s cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence.ConclusionsThe potential of lung cancer associated with cystic airspaces should be considered for “cystlike” lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.

Lung ultrasonography underdiagnoses clinically significant pneumothorax

BackgroundUltrasonography for trauma is an integral part of the Advanced Trauma Life Support algorithm and supported extensively in the literature. The reliability of chest ultrasonography as a screening examination for pneumothorax during initial trauma evaluation is unclear. We performed a prospective study where we hypothesized that chest ultrasonography would have low sensitivity for detecting clinically significant pneumothorax. MethodsA prospective observational analysis of patients with blunt chest trauma at a level 1 trauma center was performed. Patients included had supine chest radiography and chest ultrasonography performed prior to intervention as well as confirmatory computed tomographic imaging. All chest ultrasonography was performed in the trauma bay by a registered sonographer. All imaging was evaluated by an attending trauma surgeon and radiologist in real time. ResultsOf 2,185 patients screened with a diagnosis of blunt thoracic trauma, 1,489 patients had chest radiography, chest ultrasonography, and confirmatory computed tomography and were included for analysis. Patients were 71% male, with median age of 42 years, and mean Injury Severity Score of 6. The sensitivity of chest ultrasonography to detect pneumothorax was low. Chest ultrasonography had a false negative rate of 72% (n = 58), with 22% (n = 13) undergoing tube thoracostomy. Patients with false negative examinations had lower initial O2 saturation and systolic blood pressure and were more likely to have rib fractures compared with true negative chest ultrasonography examinations. ConclusionChest ultrasonography performed on initial trauma evaluation has low sensitivity with a high rate of false negative examinations. Because many of these false negative results are clinically significant requiring thoracostomy, using chest ultrasonography alone to screen for pneumothorax should be done with caution.

Diagnostic value of serum Clara cell secretory protein level in an experimental blunt chest trauma model

Objective: Blunt chest trauma is a significant clinical problem leading to injury of the lungs that may be fatal. Experimental blunt chest trauma is well established in animal models. This study aimed to investigate whether Clara cell secretory protein (CC16) can be a biomarker in an experimentally created blunt chest trauma model. Material and Methods: A total of 30 rabbits were used in our study. A modified bilateral blunt thoracic trauma model was used to produce different levels of lung contusion. We divided the rabbits into four groups according to the energy level at which blunt thoracic trauma was applied. Blood samples were taken from the control and trauma groups to evaluate CC16 levels at 0, 12, and 24 hours. Results: The CC16 levels measured at the start of the experiment were significantly lower in the control and low-energy groups compared to the medium- and high-energy groups (p =.002). While there was a significant difference in CC16 levels measured at the 12th hour (p =.004), no significant difference was found among the groups at the 24th hour. Upon analyzing the change in CC16 levels over time within the groups, we observed that CC16 levels decreased from 0–12 hours and subsequently increased after the 12th hour. Histopathologically, we observed that the level of contusion increased in proportion to the severity of trauma across the different groups. Conclusion: With the designed platform, we created a reproducible experimental model of pulmonary contusion from blunt thoracic trauma in rabbits. Increased levels of CC16 following a lung contusion could serve as a foundation for clinical decision-making. Thus, CC16 has the potential to serve as a rapid and simple biochemical indicator for acute traumatic lung injury.

Outcomes of severe isolated blunt chest trauma in young and geriatric patients.

Our understanding of the growing geriatric population's risk factors for outcomes after traumatic injury remains incomplete. This study aims to compare outcomes of severe isolated blunt chest trauma between young and geriatric patients and assess predictors of mortality. The ACS-TQIP 2017-2020 database was used to identify patients with severe isolated blunt chest trauma. Patients having extra-thoracic injuries, no signs of life upon presentation to the emergency department (ED), prehospital cardiac arrest, or who were transferred to or from other hospitals were excluded. The primary outcome was in-hospital mortality. Univariate and multivariable regression analyses were performed to assess independent predictors of mortality. A total of 189,660 patients were included in the study, with a median age of 58 years; 37.5% were aged 65 or older, and 1.9% died by discharge. Patients aged 65 and older had significantly higher mortality (3.4% vs. 1.0%, p < 0.001) and overall complications (7.0% vs. 4.7%, p < 0.001) compared to younger patients. Age ≥ 65 was independently associated with mortality (OR: 5.45, 95%CI: 4.96-5.98, p < 0.001), prolonged hospitalization, and complications. In the geriatric group, age > 75 was an independent predictor of mortality compared to ages 65-75 (OR: 2.62, 95%CI: 2.37-2.89, p < 0.001). Geriatric patients with an MVC, presenting with a GCS ≤ 8, and having an SBP < 90 had the highest mortality of 56.9%. The geriatric trauma patient with isolated severe blunt chest injury has significantly higher mortality and morbidity compared to younger patients and warrants special consideration of multiple factors that affect outcomes. Individual predictors of mortality carry a greater impact on mortality in geriatric patients.

DELAYED PRESENTATION OF A TRAUMATIC ESOPHAGEALPERFORATION&amp; THE PHYSICAL AS WELL AS MENTAL BURDENASSOCIATED WITH IT

Esophageal perforations are an uncommon entity with an incidence of 3.1 per 1,000,000 per year in the USA. (1).There are numerous causes of esophageal perforations, the commonest ones being iatrogenic (those that occur secondary to esophageal instrumentation - endoscopy or post surgical repairs)and spontaneous(Boerhaave Syndrome). Among all esophageal perforations, the reported incidence of traumatic esophageal rupture varies from 4% to 14%. (2), (3).Esophageal injury following blunt chest trauma is extremely rare (up to 0.1%). (4)Hence , we present a case of a middle aged male who presented to our emergency department withhistory of progressively worseningleft sided chest pain, shortness of breath and lethargy since last 5 days. Chest Xray revealed a large left sided suspected hemo/hydropneumothorax for which an Intercostal drain was placed but a large amount of frank purulent discharge was drainedinstead of the anticipated blood/fluid. On further probing , patientrevealed history of blunt trauma to chest12 days priordue to a road traffic accident. The finding of empyema warranted urgent further evaluation. Hence a contrast Computed Tomography scan of the chest was done which revealed an intrathoracic esophageal perforation communicating to the left pleural space. This is a rare and interesting case for a few reasons Anesophageal perforation secondary to blunt chest trauma is a rare entity, this patientpresented to us after almost 2 weeks of trauma and the presenting symptoms led us to makea differential diagnosis of a post traumatic hydro/hemothorax vs an infected hydropneumothorax / empyema (? Tubercular). Hence, thorough history takingenabled us to take a quick and calculated step to rule inesophageal perforation.

Posttraumatic aortic regurgitation and root pseudoaneurysm following blunt chest trauma: a case report

BackgroundThe simultaneous diagnosis of severe aortic regurgitation and aortic root pseudoaneurysm resulting from traffic injury is extremely rare. This report presents the case of a patient with Marfan syndrome who experienced aortic root pseudoaneurysm and subacute severe aortic regurgitation following a traffic accident.Case presentationA 64-year-old woman was diagnosed with Marfan syndrome 16 years ago and is undergoing ongoing follow-up at an outpatient clinic. Eight years previously, the patient underwent total arch replacement combined with J-graft open stent graft® (JGOS; Japan Lifeline Co., Tokyo, Japan) deployment for acute type A dissection. Five months before presentation, the patient suffered a left rib fracture in a traffic accident and received conservative management at a local hospital. The patient presented to the emergency room with worsening shortness of breath and orthopnea. Echocardiography revealed severe aortic regurgitation and moderate tricuspid regurgitation. Computed tomography revealed new-onset pseudoaneurysm at the aortic root. Surgical repair was successfully performed using a modified Bentall procedure with a bioprosthetic valve and tricuspid annuloplasty. Intraoperative findings revealed pseudoaneurysm with perforation of the right sinus of Valsalva. Although the left and right aortic valve leaflets were normal, the noncoronary leaflet exhibited a ruptured fibrous strand of a cusp fenestration, resulting in acute aortic regurgitation.ConclusionsThis case report highlights the rare occurrence of aortic root pseudoaneurysm and subacute aortic regurgitation following a traffic accident. In cases of blunt chest trauma, particularly in patients with Marfan syndrome, frequent examination is crucial to assess the possibility of posttraumatic aortic regurgitation and aortic injury.

Plain Chest Film Versus Computed Tomography of the Chest as the Initial Imaging Modality for Blunt Thoracic Injury.

While chest X-ray (CXR) is an efficient tool for expeditious detection of life-threatening injury, chest computed tomography (CCT) is more sensitive albeit with added time, cost, and radiation. Thus far, there is limited evidence and lack of consensus on the best imaging practices. We sought to determine the association between imaging modality and outcomes in isolated blunt thoracic trauma. The 2017-2020 TQIP database was queried for adult patients who sustained isolated blunt chest trauma and underwent chest imaging within 24 hours of admission. Patients who underwent CCT were 2:1 propensity-score-matched to those who underwent CXR. The primary outcome was mortality, and the secondary outcomes were hospital and ICU length of stay (LOS), ICU admission, need for and days requiring mechanical ventilation, complications, and discharge location. Propensity score matching yielded 17716 patients with CCT and 8861 with CXR. While bivariate analysis showed lower 24-hr (CCT .2% vs CXR .4%, P = .0015) and in-hospital mortality (CCT 1.2% vs CXR 1.5%, P = .0454) in the CCT group, there was no difference in survival probability between groups (P = .1045). A higher percentage of CCT patients were admitted to the ICU (CCT 26.9% vs CXR 21.9%, P < .0001) and discharged to rehab (CCT .8% vs CXR .5%, P = .0178). CT offers no survival benefit over CXR in isolated blunt thoracic trauma. While CCT should be considered if clinically unclear, CXR likely suffices as an initial screening tool. These findings facilitate optimal resource allocation in constrained environments.

Aortopathy - A surgical pathology experience.

Aortopathy is a non-inflammatory and non-atherosclerotic disease of aorta that results from significant 'degenerative' changes in the media. This often leads to thoracic aortic aneurysms and/or dissections in young individuals. This study aimed to analyze the clinical and pathological features of aortic resections performed for aortopathy. Over the span of 15 years (2008-2022), all surgically resected specimens of aorta showing aortopathy in all age groups were studied. Particular attention was paid to the changes in the media to assess the extent, grade and severity of aortopathy. During the 15-year study period, 73 surgically resected specimens of the ascending aorta showed features of aortopathy. There were 48 males and 25 females, who had chief complaints of dyspnea, chest pain and palpitation. The aortopathic manifestations observed were ascending aortic aneurysms (36 patients, 49.3%), aortic dissections (21 patients, 28.8%) and aneurysms with dissections (16 patients, 21.9%). Bicuspid aortic valve (24 cases), Marfan syndrome (13 cases) and hypertension (12 cases) were commonly identified. There was one case each of Loeys-Dietz syndrome, and aortopathy possibly related to blunt chest trauma. In a significant proportion of patients (22 cases), the cause remained elusive. Moderate to severe aortopathy was observed in 60 cases (82.2%). This study helps in standardizing the histological parameters of aortopathy. In patients where the cause is uncertain despite of detailed clinico-radiological assessment, there is a need for molecular and genetic studies.

High-flow nasal cannula oxygen therapy for mild-moderate acute respiratory failure in patients with blunt chest trauma: An exploratory descriptive study

ObjectiveThe use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT). MethodsThis retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa). ResultsA total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, −5.94–16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40–16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure. ConclusionIn BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.