Although it is very rare, hemopneumothorax can occur during breast augmentation. This potentially fatal surgical complication can be experienced by any plastic surgeon who performs breast augmentation surgery. In this article, we present a case from our institution and review the related literature in order to explore the etiological mechanism of hemopneumothorax, as well as preventive measures and treatments. In addition, we have tried to emphasize the importance of a thorough knowledge of anatomical variations and proper surgical techniques as ways to minimize the likelihood of this complication.
Breast* ; Hemopneumothorax* ; Hemorrhage ; Hemothorax ; Plastics ; Pneumothorax ; Wounds and Injuries

Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.
Angiography ; Brain ; Carotid Artery, Common* ; Contusions ; Deception ; Diagnosis ; Drinking ; Enoxaparin ; Flail Chest ; Hematoma ; Hemopneumothorax ; Humans ; Infarction, Middle Cerebral Artery ; Lung ; Middle Aged ; Paresis ; Rib Fractures ; Rupture ; Surgeons ; Thoracotomy ; Tomography, X-Ray Computed ; Urinary Bladder

A traumatic aortic injury due to blunt chest trauma is well recognized. However, a delayed death due to an aortic laceration after blunt chest trauma is very rare. A 49-year-old man arrived at the emergency room after falling from a height of approximately 4 m. Upon radiological examination, multiple fractures to his left ribs with a hemopneumothorax on his left side were found. After undergoing a closed thoracostomy, he was admitted to the general ward due to his vital signs being stable. After 13 hours from his admission, he complained of chest discomfort with the sudden development of massive blood drainage through his chest tube. A cardiopulmonary resuscitation was performed, where the patient then died and an autopsy was performed 36 hours after his death. On internal examination, a small laceration of the descending aorta with irritation of the tunica adventitia was revealed. Given the findings of an additional histological examination and the aforementioned findings, the author thought that the fractured fragments of the posterior ribs had irritated the tunica adventitia of the adjacent descending aorta for some time after the chest trauma and that a perforation had finally occurred. The author here reports a case of a delayed death due to an aortic laceration after a blunt chest trauma with the patient's clinical information and full autopsy findings.
Accidental Falls ; Adventitia ; Aorta ; Aorta, Thoracic ; Autopsy* ; Cardiopulmonary Resuscitation ; Chest Tubes ; Delayed Diagnosis ; Drainage ; Emergency Service, Hospital ; Fractures, Multiple ; Hemopneumothorax ; Humans ; Lacerations* ; Middle Aged ; Patients' Rooms ; Ribs ; Thoracic Injuries ; Thoracostomy ; Thorax* ; Vital Signs

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. METHODS: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. RESULTS: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). CONCLUSION: Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.
Abbreviated Injury Scale ; Contusions ; Diaphragm ; Flail Chest ; Hemopneumothorax ; Hemothorax ; Humans ; Injury Severity Score ; Intensive Care Units ; Logistic Models ; Lung ; Lung Injury ; Mortality ; Pneumonia* ; Pneumonia, Ventilator-Associated ; Pneumothorax ; Retrospective Studies ; Rib Fractures* ; Ribs* ; Risk Factors* ; Thoracic Injuries ; Wounds and Injuries

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.
Adult ; Bronchi ; Bronchoscopy ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemopneumothorax ; Humans ; Lung Injury ; Rupture* ; Tears ; Thorax ; Ventilation ; Wounds, Nonpenetrating

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.
Adult ; Bronchi ; Bronchoscopy ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Hemopneumothorax ; Humans ; Lung Injury ; Rupture ; Tears ; Thorax ; Ventilation ; Wounds, Nonpenetrating

Bilateral pneumothorax is very rare in primary spontaneous pneumothorax patients. This condition can cause chest pain, dyspnea, and even lead to tension pneumothorax. Spontaneous hemopneumothorax can be lethal due to massive bleeding and hypovolemic shock. This condition requires precise decision making and emergency management. We report on a case of simultaneous bilateral spontaneous pneumothorax combined with hemopneumothorax in a healthy 21-year-old male patient with chest discomfort. In the emergency department, closed thoracostomy was performed for decompression of hemopneumothorax, with drainage of 850 mL of blood. Then bilateral video-assisted thoracoscopic surgery was performed successfully.
Chest Pain ; Decision Making ; Decompression ; Drainage ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Hemopneumothorax* ; Hemorrhage ; Humans ; Male ; Pneumothorax* ; Shock ; Thoracic Surgery, Video-Assisted ; Thoracostomy ; Thorax ; Young Adult

OBJECTIVETo investigate the therapeutic effect of total en bloc spondylectomy (TES) for thoracolumbar tumors and the results of spinal stability reconstruction.

METHODSFrom January 2007 to June 2011 there were 18 patients with thoracolumbar tumors distributed in the thoracic vertebrae (n = 10) and lumbar vertebrae (n = 8). There were 7 haemangiomas, 5 giant cell tumors of bone, 1 malignant schwannoma, 1 solitary plasmocytoma, 1 neuroblastoma, 1 osteoblastoma, 1 metastatic malignant fibrous histiocytoma, and 1 metastasis of breast cancer. All the 18 patients were treated with improved TES under electrophysiological monitoring of spinal cord. Four patients were treated through one-stage combined anteroposterior approach and 14 patients through one-stage posterior approach. The anterior reconstructions included titanium mesh cages filled with bone or bone cement in 15 cases, titanium mesh cage with strengthened rings in 2 cases and artificial vertebral body replacement in 1 case. The posterior reconstruction included multiple segmental fixation with pedicle screw-rod system in 15 cases and short segmental fixation in 3 cases. Massive bone auto-graft was employed in 13 cases and fragmental bone graft in 5 cases.

RESULTSThe total en bloc spondylectomy was performed successfully in 15 patients and unsuccessful in 3 whose spinal tumors were resected by piecemeal technique. In 15 patients with successfully performed TES, the duration of surgery was from 340 to 610 min (average, 450.7 min), the blood loss was from 3000 to 10 200 ml (average, 4850 ml), and the intraoperative blood transfusion was from 2800 to 9600 ml (average, 4200 ml). The operation-related complications comprised hemopneumothorax, intercostal nerve pain, stress ulcer and bleeding, and so on. One year after operation, the patients with neurological dysfunction recovered from grade A to grade D in one patient, and to grade E in the other 14 cases. The average visual analog scale (VAS) scores was 0.5. One patient with plasmacytoma and another one with L5 metastatic tumor suffered progression of the disease and were living with the diseases. The patient with metastatic malignant fibrous histiocytoma died of local recurrence and lung metastasis 16 months postoperatively. One patient with L4 neuroblastoma died of other reason and all the rest were free from relapse. The Cobb angle of upper and lower vertebral body adjacent to the involved vertebrae in sagittal plane was from -26.7° to 12.0° (average, -2.57°) just postoperatively and from -17.5° to 57.2° (average, 11.5°) at the last follow-up or before reoperation. There were 2 patients with screw-rod breakdown and 2 patients with internal fixation loosening. The measurement of titanium mesh cage subsided into adjacent vertebral bodies was average 7.5 mm. The revision surgery was performed in 3 patients, through combined anteroposterior approach in 2 and only posterior approach in 1 patient.

CONCLUSIONSTES significantly increases the therapeutic effect of spinal tumors, although accompanied with high difficulty and massive bleeding. In spinal stability reconstruction after total spondylectomy, it should be emphasized that posterior long segment fixation with pedicle screw-rod system, massive bone bridging graft and the application of thoracolumbosacral orthosis can achieve short-term firm fixation and long-term fusion-stabilization.

Adult ; Blood Loss, Surgical ; Bone Transplantation ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; surgery ; Hemangioma ; surgery ; Hemopneumothorax ; etiology ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Orthopedic Procedures ; adverse effects ; methods ; Reconstructive Surgical Procedures ; adverse effects ; Retrospective Studies ; Spinal Neoplasms ; surgery ; Thoracic Vertebrae ; Treatment Outcome ; Young Adult

BACKGROUND: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. MATERIALS AND METHODS: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. RESULTS: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). CONCLUSION: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.
Accidents, Occupational ; Accidents, Traffic ; Aged ; Anti-Bacterial Agents ; Chest Tubes ; Contusions ; Flail Chest ; Hemopneumothorax ; Hemothorax ; Hospital Mortality ; Humans ; Injury Severity Score ; Intensive Care Units ; Lung ; Male ; Multiple Trauma ; Multivariate Analysis ; Pneumonia ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Ribs ; Risk Factors ; Thoracic Cavity ; Thorax

Boerhaave syndrome is a rare and life-threatening disease that often presents a diagnostic challenge. It is usually confused with critical but more prevalent diseases such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Boerhaave syndrome is caused by forceful vomiting resulting in a full-thickness tear of the middle or lower esophagus, typically an area of natural narrowing and at the esophagogastric junction and the left atrium. Because of these anatomic sites, hydropneumothorax, hemopneumothorax and pneumopericardium can occur. We report a case of a 48-year-old chronic alcoholic man presenting with abrupt onset of massive bilateral hydropneumothorax. In this case, it was hard to take a medical history from the patient due to sudden respiratory arrest when he arrived at the emergency room. Despite ongoing chest tube drainage, hydropneumothorax didn't improve. Pleural fluid amylase level was increased. Because of the possibility of esophageal rupture, esophagography was performed. As a result of the esophagography, he was diagnosed as Boerhaave syndrome with penumopericardium. If massive hydropneumothorax of unknown cause presents abruptly, boerhaave syndrome should be suspected as one of its causes. We recommend that pleural fluid amylase levels to be checked and if it is elevated, esophagography should be performed immediately.
Alcoholics ; Alcoholism ; Amylases ; Chest Tubes ; Drainage ; Emergencies ; Esophageal Perforation ; Esophagogastric Junction ; Esophagus ; Heart Atria ; Hemopneumothorax ; Humans ; Hydropneumothorax ; Mediastinal Diseases ; Middle Aged ; Myocardial Infarction ; Pancreatitis ; Peptic Ulcer ; Pneumopericardium ; Rupture ; Vomiting