• Journal of Trauma and Injury
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• v.28 no.2
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• pp.79-82
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• 2015

Simple rib fracture is one of most common injury after blunt thoracic trauma found in approximately 7% to 40% of cases. Delayed traumatic diaphragmatic injury with massive hemothorax after rib fracture is rare but a potentially life-threatening condition. We present a rare case of a 79-year-old male with delayed diaphragmatic injury with massive hemothorax due to fracture of the lower ribs. Under thoracoscopy, hemothorax was evacuated, diaphragmatic rupture was identified and repaired, and the lower ribs were fixed with metal plate (s). Although simple lower rib fractures may be the only clinical finding, close observation and monitoring are required because of the possibility of diaphragmatic and/or intraabdominal organ injury.

• Journal of Chest Surgery
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• v.57 no.6
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• pp.529-530
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• 2024

• Journal of Chest Surgery
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• v.57 no.6
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• pp.519-528
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• 2024

Background: Delayed hemothorax (dHTX) can occur unexpectedly, even in patients who initially present without signs of hemothorax (HTX), potentially leading to death. We aimed to develop a predictive model for dHTX requiring intervention, specifically targeting those with no or occult HTX. Methods: This retrospective study was conducted at a level 1 trauma center. The primary outcome was the occurrence of dHTX requiring intervention in patients who had no HTX or occult HTX and did not undergo closed thoracostomy post-injury. To minimize overfitting, we employed the least absolute shrinkage and selection operator (LASSO) logistic regression model for feature selection. Thereafter, we developed a multivariable logistic regression (MLR) model and a nomogram. Results: In total, 688 patients were included in the study, with 64 cases of dHTX (9.3%). The LASSO and MLR analyses revealed that the depth of HTX (adjusted odds ratio [aOR], 3.79; 95% confidence interval [CI], 2.10-6.85; p<0.001) and the number of totally displaced rib fractures (RFX) (aOR, 1.90; 95% CI, 1.56-2.32; p<0.001) were significant predictors. Based on these parameters, we developed a nomogram to predict dHTX, with a sensitivity of 78.1%, a specificity of 76.0%, a positive predictive value of 25.0%, and a negative predictive value of 97.1% at the optimal cut-off value. The area under the receiver operating characteristic curve was 0.832. Conclusion: The depth of HTX on initial chest computed tomography and the number of totally displaced RFX emerged as significant risk factors for dHTX. We propose a novel nomogram that is easily applicable in clinical settings.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.521-523
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• 2021

The increasing number of studies published on coronavirus disease 2019 (COVID-19) pneumonia has improved our knowledge of the disease itself and its complications. Despite a considerable number of publications on COVID-19 pneumonia-associated pneumothorax, no article on spontaneous hemopneumothorax has been found in the English-language literature. According to published case reports, pneumothorax generally occurs in hospitalized patients during treatment, whereas cases that arise in the late period after discharge are exceptional. Herein, we present a case of spontaneous hemopneumothorax occurring as a late complication of COVID-19 pneumonia on day 17 after discharge.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.406-408
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• 2014

A 66-year-old male patient arrived at the emergency room with a crush injury to his chest. Multiple rib fractures, hemothorax on both sides, left scapular fracture, liver laceration, and retroperitoneal hematoma were found upon the radiologic examination. After closed thoracostomy, the patient had been initially admitted to the intensive care unit, but he was transferred to the general ward on the next day. On the 4th post-trauma day, the patient complained of severe pain and there was bloody drainage through the chest tube. This case is an exploration with the consideration of the possibility of major bleeding and the subsequent repair of the descending thoracic aorta. This case is regarded as a case in which the aorta wall was damaged as the sharp margin of the fractured ribs caused continuous irritation.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.676-682
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• 1990

From August, 1978, to August, 1989, 22 patients underwent pericardiectomy for chronic constrictive pericarditis on the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. There were 14 male and 6 female patients ranging from 11 years to 70 years old[mean age, 44. 1 years]. All patients underwent radical pericardiectomy through a median sternotomy. There was 1 postoperative death[4.s%]. This patient died of low cardiac output 7 days after pericardiectomy. Postoperative complications were hemothorax[2 patients], low cardiac output[2 patients], generalized seizure[1 patient], wound infection[1 patient] and pneumonia[1 patient]. Clinical and pathological findings showed tuberculous origin in 12 patients[54.6%], unknown etiology in 8 patients[36.4%] pyogenic pericarditis in 2 patients[9.1%]. Three hemodynamic responses to pericardiectomy were observed: [1] rapid response, where central venous pressure[CUP] fell below 10 cmH2O by 24 hours in 6 patients; [2] delayed response. Where CVP fell below 10 cmH2O by 48 hours in 12 patients; and [3] no response of CVP in 4 patients. Follow-up ranged from 6 to 62 months with an average of 35.3 months. Postoperative Functional Class was obtained for 21 surviving patients and showed 18 patients[81.8%] to be New York Heart Association functional class I or II.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.923-935
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• 2021

Purpose We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. Materials and Methods Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. Results Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. Conclusion TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency surgery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.154-161
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• 1997

Purpose: Traumatic rupture of the diaphragm is not easy to diagnose and often delayed. Delayed diagnosis of diaphragmatic rupture accompanied by higher chances of strangulation of herniated viscera which may result in higher morbility and mortality. The purpose of this study was to evaluate diagnostic accuracy of spiral CT, MRI and US for the diagnosis of diaphragmatic rupture in an animal model. Materials and Methods: Small, medium, and large sized transabdominal diaphragmatic ruptures were surgically made in experimental rabbits and then followed up with spiral CT, MR!, and US at 1 day, 3 day, and 1 week after operation. Results: US was superior to MR! or spiral CT in diagnosis of diaphragmatic rupture(P(0.05). The sensitivity and specificity were 94.4% and 92.9% for US, 54.0% and 85.7% for MRI, and 46.0% and 78.6% for spiral CT, respectively. The size of laceration was not related to diagnostic sensitivity in US. Sensitivity of MRI and spiral CT increased as the size of laceration were larger, but no statistical significance was present(P>0.05). All experimental animals developed pleural effusion or hemothorax one day after operation. In acute phase, US and MRI were more sensitive than spiral CT in detecting diaphragmatic rupture. Spiral CT was more sensitive than US and MRI in delayed phase but without statistical significance(P>0.05). In the experimental rabbits with accompanying visceral hernia through the diaphragmatic defect, diagnostic accuracy was found equally high among three image modalities(P>0.05). Conclusion: This study indicates that US is the most accurate diagnostic method in detecting injury to the diaphragm in a rabbit model. The findings obtained in this experimental study can be applied to the diaphragmatic rupture of human being.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.418-423
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• 1979

Chest injuries due to blunt trauma often result in severe derangements that lead to death. And we have to diagnose and treat the patients who have blunt chest trauma immediately and appropriately. A clinical analysis was made on 324 cases of chest injury due to blunt trauma experienced at department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University during 8-year period from 1972 to 1979. Of 324 patients of blunt chest injuries, there were 189 cases of rib fracture, 121 of hemothorax or/and pneumothorax, 108 of soft tissue injury of the chest wall only, 41 of lung contusion, 24 of flail chest, 13 of scapular fracture, 7 of diaphragmatic rupture and others. The majority of blunt chest injury patients were traffic accident victims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 3rd decade and 4th decade [60%] and 238 patients were male comparing to 86 of female [Male: Female = 3:1 ]. In the patients who have the more number of fractured ribs, the more incidence of intrathoracic injury and intraabdominal organ damage were found. The principal associated injuries were head injury on 58 cases, long bone fractures on 37, skull fractures on 12, pelvic fractures on 10, renal injuries on 6 and intraabdominal organ injuries on 5 patients. The principle of early treatment of chest injury due to blunt trauma were rapid reexpansion of the lung by closed thoracotomy which was indicated on 96 cases, but open thoractomy was necessary on 14 cases because massive bleeding, intrapleural hematoma and/or fibrothorax, or diaphragmatic laceration-On 15 cases who were young and have multiple rib fracture with severe dislocation delayed elective open reduction of the fractured ribs with wire was done on the purpose of preserving normal active life. The over all mortality was 2.8% [9 of 324 cases] due to head injury on 3 cases, massive bleeding on 2,wet lung syndrome, acute renal failure on 1 and septicemia on 1 patient.