• Journal of Chest Surgery
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• 제38권1호
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• pp.84-87
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• 2005

자연성 혈흉의 원인은 다양하지만 늑골연골종으로 인한 혈흉은 드물다. 늑골연골종으로 인해 횡격막, 폐, 심막, 심장, 흉막등에 손상을 입혀 혈흥을 보이는 경우가 드물게 보고되고 있다. 저자들은 늑골연골종으로 인한 횡격막 열상환자를 치험하였기에 보고하는 바이다.

• Journal of Trauma and Injury
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• 제29권2호
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• pp.43-46
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• 2016

Traumatic diaphragmatic injury (TDI) occurs in 1% of patients of blunt abdominal trauma. Most TDIs involve the left diaphragm, however the authors experienced TDI accompanied by a liver laceration of the right diaphragm. When detected early, TDI can be easily treated, however serious complications can occur if not. When diaphragmatic injury is suspected due to clinical manifestation, comprehensive analysis of the patient data including radiologic findings is important.

• Journal of Trauma and Injury
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• 제32권2호
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• pp.122-125
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• 2019

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.49-52
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• 2010

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.154-161
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• 1997

목적: 횡격막 파열은 그 진단이 어렵고 지연되는 경우가 많으며, 진단이 늦어지면 유병율과 사망율이 높아지므로 조기진다는 매우 중요하다. 저자들은 최근 많이 이용되는 영상진단법인 나선형 CT와 자기공명영상, 그리고 초음파건사중 어떤 방법이 가장 예민하고 정확한 진단방법인지 동물실험 모델을 통하여 평가하고자 하였다. 대상 및 방법: 토끼에서 인위적으로 횡격막파열을 대, 중, 소로 만든 후 1일, 3일, 7일째 나선형 CT와 자기공명영상, 그리고 초음파검사를 동시에 시행하였다. 결과: 횡격막파열의 진단 민감도와 특이도는 초음파검사가 94.4%와 92.9%, 자기 공명영상이 54.0%와 85.75, 나선형 CT가 46.0%와 78.6%이었다. 횡격막 파열의 진단은 초음파검사, 자기공명영상, 나선형 CT순으로 정확하였으며 초음파 검사가 자기공명영상이나 나선형 CT보다 유의하게 우월하였고(P<0.05), 자기공명영상과 나선형 CT는 유의한 차이가 없었다. 초음파검사는 파열의 크기와 상관없이 횡격막파열의 구별이 용이하였고 자기공명영상과 나선형 CT는 파열의 크기가 클수록 횡격막파열의 구별이 용이하였으나 통계적으로 유의한 차이는 없었다(P>0.05). 수술후 1일에는 전예에서 늑막삼출액이나 혈흉을 동반하였다. 이때에는 초음파나 자기공명영상이 나선형 CT에 비해 우월하였다. 시간경과에 따랄 초음파검사와 자기공명영상은 진단율이 상대적으로 저하되었으나 통게적으로 유의한 차이는 없었다(P>0.05) 탈장을 동반한 경우에는 진단의 민감도가 자기공명영상, 나선형 CT, 초음파검사순으로 높았으며 초음파검사가 상대적으로 낮았다. 그러나 통계적으로 유의한 차이는 없었다(P>0.05). 결론: 초음파검사가 횡격막파열의 진단에 가장 유용한 것으로 밝혀졌으며, 이러한 결과는 앞으로 임상에 적용하여 검증되어야 할 필요가 있다고 생각된다.

• Journal of Chest Surgery
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• 제28권9호
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• pp.842-846
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• 1995

Recently, the trauma patients have been markedly increasing due to the vast increase of traffic accident, industrial disaster, incidental accident and violence. The authors have analysed of 22 patients of thoracic injuries combined with abdominal injuries and summarized as follows. The ratio of male to female was 3.4:1 and their age distribution was from 5 years to 68 years and mean age was 34.4 years. The etiologies of injury were traffic accident, stab wound, fall down and violence. Associated injuries were fractures, bowel perforation, kidney rupture, head injury, liver laceration, spleen rupture and so forth. The modes of treatment were closed thoracostomy, repair of diaphragm, ruptured bowel repair, explo-thoracotomy, splenectomy, hepatic lobectomy in this order of frequency. The postoperative complications were atelectasis, wound infection, pneumonia, empyema, acute renal failure, respiratory failure and bleeding. The mortality rate was 13.6% [3/22 and the causes of death were respiratory failure 1 case, acute renal failure 1 case and hypovolemic shock 1 case.

• Journal of Trauma and Injury
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• 제28권2호
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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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• 제23권5호
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• pp.905-915
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• 1990

A clinical evaluation was performed on 545 cases of the chest trauma those had been admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 11 years 5 months period from January 1978 to may 1989. Obtained results were as follows: 1. The ratio of male to female was 3.9: 1 in male predominance, and the majority[66.6%] was distributed from 3rd to 5th decade. 2. Nonpenetrating chest trauma was more common than penetrating about 4.6 times, and the most common cause of the nonpenetrating injuries was traffic accident[241/448, 53.8%] and of the penetrating injuries was stab wound[88/97, 90.7%]. 3. Only 79 cases[14.5%] were arrived to our emergency room within one hour after trauma. 4. The most common lesion due to trauma among these admitted patients was rib fracture[390/545, 71.6%], and the others were lung contusion[217/545, 39.8%], hemothorax[35%], hemopneumothorax[19.6%], and pneumothorax[11.8%] et al in decreasing order. 5. The associated injuries those required special treatment of other departments were 223 cases and its distributions were bone fractures[178/545, 32.7%], head injury[5.3%], and abdominal injury[6.6%]. 6. The others, but interesting chest injuries were follows: sternum fracture[3.1%], diaphragm rupture[2.6%], myocardial laceration and rupture[2 cases], bronchial rupture and laceration[2 cases], and traumatic thymoma rupture[1 case]. 7. The incidence of flail chest was 5.8%a[26/448] in the nonpenetrating injury, and the causes were multiple rib fracture which was in rows more than 4 rib fracture[20 cases], and sternum fracture[6 cases]. 8. We could managed the most of the patient with conservative treatment[43.1%] or closed tube thoracostomy[52.7%], but required emergency open thoracotomy in 64 cases

• Journal of Chest Surgery
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• 제31권8호
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• pp.804-810
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• 1998

배경: 다발성 외상환자는 교통사고, 산업재해, 우발적사고, 폭력 등의 증가로 최근 증가 추세에 있다. 다발성 외상은 심장, 폐, 대혈관 등의 흉부외상을 포함하는 경우가 많으며 이때는 환자의 생명을 위협할 수 있으므로 적절한 진단과 치료가 필요하다. 대부분의 흉부외상은 보존적 치료와 흉관 삽관술과 같은 간단한 외과적 시술 만으로 만족할 만한 치료효과를 보이지만 적절한 시기에 개흉술을 시행함으로써 환자의 생명을 구할 수 있는 경우가 있어 그 적응증 이나 시기의 판단에 있어서 경험있는 흉부외과 의사의 역할이 필요하다. 대상 및 방법: 저자는 다발성 외상 후 흉부개흉술이 필요했던 70례에 대하여 분석하였다. 환자들의 평균 나이는 35.6세 남녀비는 3.4:1이었다. 손상의 기전은 주로 교통사고, 추락사고, 자상이었다. 결과: 흉부손상의 가장 일반적인 유형은 혈흉이며, 두 번째는 횡격막 파열이었다. 환자의 60%에서 골절을 동반 하고 42.9%에서 복부손상을 37.1%에서 두부손상을 동반하고 있었다. 개흉술을 시행한 이유로는 출혈교정 혹은 지혈이 48.6%, 횡격막손상의 복구가 35.7%였으며, 폐 열상 봉합이 25.7% 였으며, 흉부 손상으로 인한 수술외에도 비장적출술(14.3%), 간엽절제술(8.6%) 간 열상 복구(5.7%)를 시행하였다. 수술후 합병증으로는 무기폐(8.6%), 창상감염(8.6%), 폐렴(4.3%)이었다. 수술후 6명의 환자가 사망하였고 수술사망율은 8.6%였다. 사망의 원인으로는 호흡부전증(2례), 급성 신기능부전증(2례), 패혈증(1례), 저혈량성 쇽(1례)이었다.