Asymptomatic Stab Wounds of the Chest

Imaging of Penetrating Chest Trauma

“…The appropriate in-hospital observation time to detect potential delayed complications is controversial. Ordog and colleagues [8] reported the initial chest radiograph was 92.5% sensitive and had a negative predictive value of only 87% in detecting injuries. The negative predictive value of chest radiographs for thoracic injury increased to 99.9% at 6 hours after injury and allowed subsequent outpatient management.…”

“…Most penetrating injuries to the chest are caused by knives or handgun bullets [7,8]. Unlike injury to the chest wall, pleura, and lung, transmediastinal knife and gunshot wounds that enter within the tight confines of the mediastinum are associated with injuries to vital structures, including the heart, great vessels, esophagus, and trachea [6,9,10].…”

“…Prehospital mortality from transmediastinal penetrating injury may be as high as 86% for cardiac injuries, 92% for thoracic vascular injuries, and 11% for pulmonary injuries [6,7]. Most patients (60%) who have transmediastinal gunshot wounds, who do not require immediate surgery will need imaging studies to diagnose injuries and plan treatment [6][7][8][9][10]34,35]. Occult injuries to mediastinal structures are not uncommon, and any possible transmediastinal trajectory must be assumed to have created life-threatening injuries [Figs.…”

Cardiac and Pulmonary Injury

“…In a prospective study of 4,106 stab wound patients, Ordag et al reported that the initial CXR was 92.5% sensitive and had a negative predictive value (NPV) of 87% in detecting penetrating chest injuries. The NPV in this study increased to 99.9% at 6 h after injury, and was sufficient enough to permit outpatient management [39]. CXR has many limitations, especially in diagnosing small pneumothorax, evolving pulmonary contusions and pulmonary lacerations.…”

Role of thoracoscopy in acute management of chest injury

“…The remaining 20% of patients with cardiac injuries will present relatively asymptomatically. Decompensation, however, can occur rapidly and without warning [21]. Diagnosing occult cardiac trauma is therefore a priority in any patient with a transmediastinal or precordial injury.…”