Penetrating Wounds of Great Vessels

Symbas, Panagiotis N.; Kourias, E; Tyras, Denis H.; Hatcher, Charles R.; Whitehead, Joseph B.

doi:10.1097/00000658-197405000-00031

Cited by 15 publications

(5 citation statements)

References 14 publications

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“…Second is paradoxical embolisation, defined as the passage of a foreign body from the venous to the arterial system by communication through a right to left shunt. Causes include arteriovenous fistula, atrioventricular perforation, ventricular septal defect or patent foramen ovale [ 2 , 4 , 10 ]. Diagnosis of foreign body emboli is through x-ray, computerised tomography and echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Gunshot bullet embolus with pellet migration from the left brachiocephalic vein to the right ventricle: a case report

Greaves

2010

Scand J Trauma Resusc Emerg Med

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We report the case of a 16 year old male who was the victim of a drive by shooting sustaining the rare but recognised complication of cardiovascular bullet embolism. He was seen as a trauma call in the emergency department and CT scanning revealed 70 shotgun pellets scattered throughout left sided sub-cutaneous tissues of the head and neck, and more significantly a single pellet within the right atrium. It is believed to have got there via injury to the left brachiocephalic vein which was demonstrated by extravasation of contrast on the CT scan. He remained stable throughout admission and the injury was managed conservatively. Serial scanning showed the pellet had subsequently migrated into the right ventricle where it has remained since, presumably having become epithelialised. This case report highlights the importance of repeated scanning for the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury.

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Section: Discussionmentioning

confidence: 99%

Gunshot bullet embolus with pellet migration from the left brachiocephalic vein to the right ventricle: a case report

Greaves

2010

Scand J Trauma Resusc Emerg Med

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“…They are rarer following blunt chest trauma such as crushing and deceleration injuries [1]. The true incidence of penetrating wounds of the SVC as well as other great vessels is not known since many of these patients succumb shortly after injury and autopsy examination is not done in all patients dying after trauma [3]. Little has been written about cervicomediastinal venous injury [4].…”

Section: Incidencementioning

confidence: 99%

“…A massive haemothorax mandates a right thoracotomy [5] as in our case. However, there is no incision which will satisfy all needs in emergency exploration of SVC injuries [3]. The trap door incision (antero-lateral thoracotomy, upper mid-sternotomy and lower neck incision) has the advantage that it can be extended to gain access to almost all great vessel wounds but is associated with greater morbidity to the patient and is more time-consuming for the surgeon [3].…”

Section: Surgical Approachmentioning

confidence: 99%

“…However, there is no incision which will satisfy all needs in emergency exploration of SVC injuries [3]. The trap door incision (antero-lateral thoracotomy, upper mid-sternotomy and lower neck incision) has the advantage that it can be extended to gain access to almost all great vessel wounds but is associated with greater morbidity to the patient and is more time-consuming for the surgeon [3]. Wide prepping and draping of the thorax and neck so that thoracotomy incision can be extended if needed, good exposure, adequate assistance, effective suction, sufficient blood for transfusion (or the use of intra-operative auto-transfusion) is essential for successful repair of great vessel injury [3].…”

Section: Surgical Approachmentioning

confidence: 99%

“…Auto-transfusion greatly contributed to successful outcome in patients with massive intra-thoracic bleeding by promptly procuring sufficient quantities of blood [3]. This procedure has been proved to be safe and frequently life-saving for such patients [3].…”

Section: Special Measuresmentioning

confidence: 99%

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Shrapnel superior vena cava injury: Case report

Taha¹

2014

CRCM

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Shrapnel injuries of the superior vena cava (SVC) are extremely rare and highly lethal. The true incidence is not known since many patients succumb shortly after injury. The high fatality is due to difficulty in diagnosis, technical problems with repair and consequences of SVC clamping. Literature review revealed no shrapnel SVC injury reported before. This is a report of 30-year-old man from Kirkuk, Iraq, a victim of terroristic attack who was admitted to Sulaimania Teaching Hospital (STH) on June 2007 with shock, massive right-side haemothorax and a wound at base of neck following a shrapnel injury. Emergency right thoracotomy revealed clotted haemothorax and big shrapnel partly sealing a tear in SVC just above the entrance of the azygos vein. Severe bleeding ensued after extraction of the shrapnel. Attempts to control the hemorrhage and repair of the injury failed and unfortunately, the patient expired in the theatre. Though there is no pathognomonic sign of SVC injury, it should be suspected in patients presenting with shock and haemothorax. Successful repair is achievable with early diagnosis, aggressive resuscitation, early exploration, optimum operating conditions and special measures such as auto-transfusion and cardiopulmonary bypass.

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Thoracic Trauma

Symbas¹

1986

International Practice in Cardiothoracic Surgery

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Penetrating Wounds of Great Vessels

Cited by 15 publications

References 14 publications

Gunshot bullet embolus with pellet migration from the left brachiocephalic vein to the right ventricle: a case report

Gunshot bullet embolus with pellet migration from the left brachiocephalic vein to the right ventricle: a case report

Shrapnel superior vena cava injury: Case report

Thoracic Trauma

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