• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.809-823
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• 2023

Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to nonaortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1257-1262
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• 1996

From January 1989 to February 1996, 50 patients with a traumatic diaphragmatic rupture were treated at the Yonsei University Wonju College of Medicine. There were 40 male and 10 female patients. The ages ranged from 2 to 80 years, with peak incidence in third decades. Thirty-nine cases had blunt trauma (traffic accident 29, falls down 7, others 3), and 11 cases had penetrating injuries (stab injury 9, gun shot 1, broken glass 1). The most common symptoms were dyspnea (76%), chest pain (58%), and abdominal pain (52%). In blunt trauma, the rupture was located in the left in 30 cases, right in 9 cases and in penetrating trauma, the rupture was located in the left in 8 cases and in the right in 3 cases. Eighteen cases underwent thoracotomy alone, 29 cases underwent laparotomy only and 3 cases had combined thoracotomy and laparotomy. The postoperative mortality occurred in 6% (3 cases), and the cause of death were septic shock (1), intracranial hemorrhage (1), and respiratory failure (1).

• Journal of Chest Surgery
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• v.53 no.5
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• pp.291-296
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• 2020

Background: We report our 10-year experience with traumatic peripheral arterial injury repair at an urban level I trauma center. Methods: Between January 2007 and December 2016, 28 adult trauma patients presented with traumatic peripheral arterial injuries. Data were retrospectively collected on demographic characteristics, the mechanism of injury, the type of vascular injury, and physiological status on initial assessment. The analysis also included the Mangled Extremity Severity Score (MESS), Injury Severity Score, surgical procedures, and outcome variables including limb salvage, hospital stay, intensive care unit stay, and postoperative vascular complications. Results: Four (14.3%) patients required amputation due to failed revascularization. MESS significantly differed between patients with blunt and penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005). The amputation rate was not significantly different between patients with blunt and penetrating trauma (20% vs. 0%, respectively; p=0.295). The overall mortality rate was 3.6% (1 patient). Conclusion: Blunt trauma was associated with higher MESS than penetrating trauma, and amputation was more frequent. In particular, patients with blunt trauma had significantly higher MESS than patients with penetrating trauma (8.2±2.2 vs. 5.8±1.3, respectively; p=0.005), and amputation was performed when revascularization failed in cases of blunt trauma of the lower extremity. Therefore, particular care is needed in making treatment decisions for patients with peripheral arterial injuries caused by blunt trauma.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.403-406
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• 2017

Tracheobronchial rupture due to blunt chest trauma is a rare but life-threatening injury in the pediatric population. Computed tomography (CT) is not always reliable in the management of these patients. An additional concern is that ventilation may be disrupted during surgical repair of these injuries. This report presents the case of a 4 -year-old boy with an injury to the lower trachea and carina due to blunt force trauma that was missed on the initial CT scan. During surgery, he was administered venoarterial extracorporeal membrane oxygenation (ECMO). Although ECMO is not generally used in children, this case demonstrated that the short-term use of ECMO during pediatric surgery is safe and can prevent intraoperative desaturation.

• Journal of Yeungnam Medical Science
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• v.38 no.4
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• pp.356-360
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• 2021

Treating cardiac injuries following blunt trauma to the chest requires thorough examination, accurate diagnosis, and therapeutic plan. We present two cases; pulmonary vein rupture and left atrial appendage laceration, both as a result of blunt chest trauma. Through these cases, our team learned the importance of maintaining hemodynamic stability during the examination of injured cardiac structures. And based on the comprehensive cardiac examination, a decision to surgically intervene with median sternotomy via cardiopulmonary bypass was made, saving lives of the patient. This report introduces how such decision was made based on what supporting evidence and the diagnostic process leading to the initiation of surgical intervention. This report may help with decision-making process when confronted by blunt cardiac injury patients who need cardiac exploration.

• Journal of the Korean Society of Radiology
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• v.85 no.4
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• pp.769-779
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• 2024

Purpose To determine the pros and cons of an artificial intelligence (AI) model developed to diagnose acute rib fractures in chest CT images of patients with chest trauma. Materials and Methods A total of 1209 chest CT images (acute rib fracture [n = 1159], normal [n = 50]) were selected among patients with chest trauma. Among 1159 acute rib fracture CT images, 9 were randomly selected for AI model training. 150 acute rib fracture CT images and 50 normal ones were tested, and the remaining 1000 acute rib fracture CT images was internally verified. We investigated the diagnostic accuracy and errors of AI model for the presence and location of acute rib fractures. Results Sensitivity, specificity, positive and negative predictive values, and accuracy for diagnosing acute rib fractures in chest CT images were 93.3%, 94%, 97.9%, 82.5%, and 95.6% respectively. However, the accuracy of the location of acute rib fractures was low at 76% (760/1000). The cause of error in the diagnosis of acute rib fracture seemed to be a result of considering the scapula or clavicle that were in the same position (66%) or some ribs that were not recognized (34%). Conclusion The AI model for diagnosing acute rib fractures showed high accuracy in detecting the presence of acute rib fractures, but diagnosis of the exact location of rib fractures was limited.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.308-312
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• 1995

A 5-year retrospective study of 14 patients with diaphragmatic injuries revealed 9 blunt and 5 penetrating injuries. In the blunt trauma group, 7 were left and 2 were right side. The penetrating diaphragmatic wound consist of 3 left and 2 right sided. Sex ratio was 11: 3, with male predominanace. Preoperative diagnosis was possible in 9 cases and delayed diagnosis [greater than 24 hours occured in 5 cases.Simple chest X-ray was diagnostic or highly suggestive in 7 cases. 7 cases were diagnosed diaphragmatic injuries by computed tomography, fiuroscopy or by explorative operation. All of the cases had association injury. 11 cases of diaphragmatic ruptures were corrected through thoracotomy and 3 cases needed exploratory laparotomy. One death occured after operation due to associated injuries and respiratory failure. Blunt and penetrating diaphragmatic injuries remain a diagnostic challenge and associated injuries, delayed diagnosis determine the outcome.

• Journal of Trauma and Injury
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• v.29 no.3
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• pp.89-92
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• 2016

Non-surgical traumatic chylothorax following blunt chest trauma is rare, with only a few cases having been reported. In general, conservative treatment measures are recommended as initial management of traumatic chylothorax; these include closed thoracostomy, dietary restriction, and parenteral nutrition. There are few reports of surgery for traumatic chylothorax. We report our experience with thoracic duct ligation using video-assisted thoracoscopic surgery in a patient with chylothorax following blunt chest injury with associated fractures of the thoracic spine.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.264-269
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• 2001

흉부 둔상에 의한 기도와 식도의 동시적 파열상은 매우 드물게 발생되고 있다. 그러나 최그들어 고속 교통사고의 증가와 환자에 대한 응급체계의 발전으로 점차 치험 보고례가 증가되고 있다. 저자들은 흉부의 둔상에 의하여 기도와 식도에 종적으로 긴 파열상을 입은 환자 2례의 치험을 보고한다. 1례는 이전 병원에서 시행한 기관식도 재건술이 실패한 상태에서 전원되어와 2차적으로 식도절제 및 기관재건술을 실시하였으나 사망하였고. 다른 1례는 식도절제 및 기도재건술로 합병증이 없이 생존하였다.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.722-725
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• 1986

Rupture of the main bronchus following closed injury to the chest is a comparatively rare accident. The late recognition of this injury is attended by difficulties in management which may endanger life or expose the patient to distressing months and years of arduous therapy. This case was a 17 year old female who was a high school student. The patient had sustained a crushing injury to her right hemithorax and had been taken to an emergency hospital where right closed thoracostomy had been performed for a tension pneumothorax. She improved following this procedure but massive atelectasis of the right lung developed on the 13th day after trauma and transferred to our hospital. Bronchoscopy disclosed granulation tissue in the right main stem bronchus and end to end anastomosis of the bronchus was performed. Postoperative course was uneventful.