Saved by the Clot in Superior Vena Cava Injury

Abstract

Penetrating neck injuries (PNIs) can cause injuries to great vessels. Superior vena cava (SVC) injury from a stab to the neck is rare and when it occurs, poses a significant risk of exsanguinating hemorrhage. We report a case of a 17-year female who survived a delayed presentation of five hours after sustaining stab injury to zone 1 of the neck. Her external wound was just above the medial 1/3 rd of the clavicle which resulted in SVC laceration. Mechanism and site of injury along with clinical presentation with right hemothorax was highly suspicious for a vascular injury. Exsanguinating hemorrhage was halted by a soft clot in this hypotensive patient. Furthermore, permissive hypotension with judicious resuscitation stabilised the patient enough to undergo a contrast venogram to identify the level of SVC injury. The patient underwent successful surgical repair of SVC. This case illustrates the point that control of bleeding by soft clots does not rule out major vascular injury. Additionally, it demonstrates how permissive hypotension can be helpful as a damage control stepping stone in the management of these critical patients.

Role of coronary arteries in patients with Acute Coronary Syndrome

“…85.7% patients with SCA in our study had left anterior descending artery disease, a previous study reported this prevalence to be 79.5%. 11 Sudden cardiac arrest is commonly caused by acute coronary syndrome (ACS). Diagnosing ACS is another challenge.…”