• Journal of Trauma and Injury
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• v.33 no.3
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• pp.186-190
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• 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as a resuscitative adjunct for trauma patients with life-threatening non-compressible torso hemorrhage. By blocking the aorta temporarily with an inflated balloon, REBOA preserves cerebral and coronary perfusion while diminishing exsanguination below the balloon, thereby providing time for resuscitation and definitive bleeding control. When determining the occlusion zone during the REBOA procedure, factors such tortuosity of the aorta, co-occurring minor chest injuries, and the severity of shock must be considered, as well as the main injury site. This paper describes a case of high Zone I REBOA in an elderly patient with a tortuous aorta who had concomitant injuries of the chest and pelvis.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.113-124
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• 1972

Clinical observations were performed on 150 cases of chest trauma, those were admitted and treated at the Department of Surgery, Korea University Woosok Hospital, during the past 8 years period from August 1965 to August 1972. 1. The ratio of male to female patient of chest trauma was 3.4:1 in male predominence and age from 20 to 50 occupied 62% of the total cases. 2. The most common cause of chest trauma was traffic accident in this series. Eighty-one cases[54%] were injured by traffic accident and total cases due to blunt trauma [non-penetrating injury] were 113 cases[75.4%]including the cases with traffic accident, and remaining 37 cases[24.6%] were due to penetrating injury including 25[16.6%] cases of stab wounds. 3. Hemopneumothorax were observed in 645/[96 cases] of the total cases, and etiologic distribution revealed 78.1% due to non-penetrating trauma and 20.8% due to penetrating injury. 4. Rib fracture was found in 50% of cases. Common injuries associated with rib fracture were lung, brain and liver. 5. Most common symptom was chest pain and respiratory difficulty, and common sign associated with chest injury was decreased respiratory sound and subcutaneous emphysema. 6. Conservative non-operative treatment was performed in 94 cases[62.6%] and 56 cases [37.4%] were treated with operative treatment including 31 cases[20.6%] with open thoracotomy. 7. Overall mortality was 9.3%[14 cases] and most common causes of death were due to brain edema,asphyxia and shock.

• Journal of Trauma and Injury
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• v.18 no.1
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• pp.17-25
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• 2005

Background: Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.24-28
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• 2018

Ascending aortic injury after blunt chest trauma is an emergency condition that requires urgent diagnosis and treatment. The authors report the case of a patient with traumatic ascending aortic injury who received ascending aorta replacement under cardiopulmonary bypass after failure of primary repair.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.427-431
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• 1987

A case is presented of a steering wheel Injury to the chest which developed right atrial free wall rupture and cardiac tamponade without rib fractures or hemo-pneumothorax. A 30 year old man who sustained, blunt chest trauma by steering wheel injury to his chest developed right atrial rupture and cardiac tamponade. Pericardiocentesis was performed and cardiac tamponade was confirmed. After a median sternotomy, large right atrial free wall laceration [about 8cm] was noted. He was placed on cardiopulmonary bypass. The laceration wound of right atrium was closed with a 2 rows of continuous suture. Recovery was uneventful. The patient has returned to his previous level of activity.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.105-110
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• 2011

Purpose: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). Methods: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. Results: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. Conclusion: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.760-765
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• 1989

Cardiac injury remains one of the most spectacular injuries which the present day cardiac surgeon is called upon to treat. Eight consecutive patients with penetrating or blunt injury to the heart underwent operation at the Department of Thoracic and Cardiovascular Surgery, Masan Koryo General Hospital from April 22 88 to April 6 89. l. Among the 8 cases of cardiac injured patients, 7 cases were penetrating injury [stab injury] and one case was blunt injury [traffic accident]. 2. The site of cardiac injury was LV mainly and the next RV, SVC-RA junction in order. 3. The all patients were admitted to our hospital via ER and most of cases, CVP was elevated above 15 cmH2O and 7 of 8 cases were shock state. 4. In 6 of 8 cases revealed cardiomegaly in simple chest X * ray. 5. 7 cases were operated through the median sternotomy, 1 case the right anterolateral thoracotomy. 6. Associated injuries in penetrating cardiac injury were hemothorax, pneumothorax, sternal fracture, lung laceration, LAD transaction in blunt injury, hemoperitoneum.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.296-299
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• 2012

The aorta is the most common major thoracic artery injured by blunt chest trauma. Injuries to major aortic arch branch arteries can also occur but are much less common than aortic injuries in the setting of blunt trauma. Although internal mammary artery (IMA) injury is uncommon and rarely diagnosed in cases of blunt chest trauma, it is one of the important sources of bleeding in chest trauma. IMA bleeding can cause ongoing blood loss and may lead to serious conditions such as extensive hemothorax, anterior mediastinal hematoma or its catastrophic complication, cardiac tamponade. However such arotic and branch artery injuries are not easily detected by plain radiograph, and are detected indirectly because of associated mediastinal hematoma. Herein, we report a case of IMA injury caused by blunt chest trauma secondary to pedestrian traffic accident. The injured patient was successfully treated by transcatheter arterial embolization (TAE).

• Journal of Chest Surgery
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• v.21 no.2
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• pp.307-315
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• 1988

A clinical analysis was performed on 97 cases of chest injuries experienced at Department of Thoracic and cardiovascular Surgery, Armed Forces Capital Hospital during 2 years period from 1986 to 1988. Of 97 patients of chest trauma, 39 cases were result from penetrating injuries whereas 58 cases were from non-penetrating injuries, and there were 77 cases of hemothorax and / or pneumothorax, 47 of rib fracture, 8 of foreign body, 6 scapular and clavicle fracture, 5 of diaphragmatic injuries, 4 of paraplegia. The majority of chest injuries were encounted in the age group between 21 and 30 years-old, mean age was 25.9 years-old and all cases were male except one. Gun-shot wound was the most common cause in the penetrating injuries and the majority of non-penetrating chest injury patients were traffic accident and fist or kick accounted for next. The principles of therapy for chest trauma were rapid expansion of the lung by closed thoracostomy[45 cases] and thoracentesis only[3 cases] but thoracotomy done at 27 cases because of massive bleeding or intrapleural hematoma, foreign body, cardiac injury, diaphragmatic injury and bronchial rupture. The over-all mortality was 2.07 percent[2 cases among all], a case was from penetrating injuries and another was from non-penetrating injuries.

• Journal of Trauma and Injury
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• v.37 no.2
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• pp.114-123
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• 2024

Purpose: Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients. Methods: Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma. Results: In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5-15] vs. 15 [14-15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively) Conclusions: Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.