• Journal of Trauma and Injury
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• v.34 no.2
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• pp.136-140
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• 2021

We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial postoperative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.66-69
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• 2021

When treating firearms injuries, knowledge of the proper management is important because these injuries have high morbidity and mortality. However, due to strict gun safety regulations, surgeons in Asia often have limited experiences with gunshot wound management. Recently, the authors had the experience of removing a bullet that did not cause hemopneumothorax, but remained in the lung parenchyma. Due to the risk of complications that could occur if the bullet was not removed, surgical treatment was eventually performed to remove the bullet. A literature review was needed to determine whether this treatment was appropriate. We concluded that removing the bullet could prevent incidental complications. In this regard, the authors report a case along with a review of the relevant literature to suggest appropriate treatment directions for surgeons who do not have experience with gunshot wounds.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.713-718
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• 1997

Fracture of the sternum has been considered as a serious injury and also associated with major complications such as myocardial, major thoracic vascular, and spinal injury. Retrospective datas from blunt trauma victims admitted to our hospital were analyzed to determine significance of sternal fractures and possible associated injures. 101 sternal fractures by blunt trauma were admitted from january, 1986 to december, 1995. Frequency was about 3.51 olo of the nonpenetrating chest trauma. The ratio of male to female was 1.82 versus 1. Most common cause in the stemal fracture was high decelerating injury(73 cases). Most common fracture site was sternal body(75 cases). Average days of adm ssion were 26 days. Abnormal ECG findings were sinus bradycardia(Teases), complete or incomplete RBBB(6 cases), sinus tachycardia(4 cases), specific S-T change(3 cases), 1st degree A-V block(2 cases), LVH(1 case), PVC(1 case), and Low voltage(1 case). CPK-MB was increased about 32.Lolo of sternal fractures. Except of expired 2 patients, patients were treated with conservative treatment(94 cases) and open reductions & steel wire fixations(5 cases). Complication after operation was wound infection(1 case). Causes of death were 1 hypovolemia and 1 acute respiratory distress syndrome. In conclusion, although sternal fracture is less frequent, and mostly treats with conservative treatment, it shoed be carefully observed because of critical associated injuries.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.170-174
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• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.395-398
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• 2017

A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.195-198
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• 1987

We experienced a case of esophageal leiomyoma recently in department of Thoracic and Cardiovascular Surg., Pusan Baik Hospital, Inje Medical College. Patient had suffered from dysphagia and chest discomfort for 2 years. The esophagogram showed an ovoid smooth filling defect in lower portion of the esophagus, mucosal fold of esophagus was not destroyed. A benign intramural tumor of the esophagus such as leiomyoma was suspected with X-ray finding and clinical features. Open thoracotomy was performed through the left 8th intercostal space. A firm egg sized mass in the well of lower esophagus was enucleated by blunt dissection with caution to avoid injury of the mucosa of the esophagus. The diagnosis of leiomyoma was confirmed with histopathological finding. Postoperative course was uneventful.

• Journal of Chest Surgery
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• v.25 no.9
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• pp.936-942
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• 1992

There are three types of papillary muscle of the left ventricle[finger, tethered and mixed type] according to the morphology of the attachment to the ventricular wall. Especially finger type of the papillary muscle is more vulnerable to the injury than tethered or mixed type, because their blood supply is dependent upon the central artery whose diameter is less than 1mm and the papillary muscle itself is the end organ of the heart anatomically. There are several causes of papillary muscle rupture but few cases have been reported. Recently we have experienced 3 cases of papillary muscle rupture of the left ventricle with successful mitral valve replacement and the causes are postmyocardial infarction, percutaneous mitral valvulotomy and non-penetrating chest trauma. The common finding is the morphology of papillary muscle, that is the finger type and their rupture type is the complete type.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.765-767
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• 1999

Tracheobronchial rupture following tracheal intubation is a rare complication. We experienced a case of tracheal rupture following double-lumen endotracheal tube intubation. A 76 year old female was admitted due to coughing and chest discomfort. The operation was performed with the diagnosis of congenital broncho esophageal fistula. During the operation, accidently the main trachea was ruptured longitudinally. There was no history of surgical trauma. The ruptured trachea was repaired with prolene and monofilament absorbable sutures. The cause of tracheal rupture was suspected overinflation of the cuff. The patient was discharged from the hospital without any significant complications.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.335-340
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• 1992

Truamatic aortic rupture is usually fatal if left untreated. Prompt diagnosis is the cornerstone of suscessful management. But the usual screening tests are non specific and the accuracy of computerized tomography is low, Aortography which is a time consuming procedure may result in false-positive interpretations and significant morbidity. Recently transesophageal echocardiography provides a rapid, effective and relatively safe means of evaluating the distal aortic arch and also affords the opportunity to evaluate the heart during the same study, which may be of benefit in cases of suspected cardiac injury. The experience with the traumatic aortic ruptured patient and a critical review of the literature suggests that transesophageal echocardiography is a useful technique for the diagnosis of ruptured aorta following blunt chest trauma.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.916-921
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• 1990

Clinical observations were performed on 17 cases of the traumatic sternal fracture, those were admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 6 years 5months period from January 1983 to May 1989. Obtained results were as follows: 1. The frequency was about 4.8% of the nonpenetrating chest trauma. 2. The ratio of male to female was 16: 1 in male predominance and age distribution was from 24 to 62 years old. 3. The common cause were high decelerating injury [impact of the steering column] and falling down[more than 3 m in high]. 4. The most common fracture site was sternal body and next was sternomanubrial junction. 5. Associated intrathoracic organ injuries were cardiac contusion [6 cases], hemopneumothorax[1 Case], mediastinal bleeding[1 case], and thoracic cage and extrathoracic organ injuries were rib fracture, head injuries, thoracic spinal fracture, and long bone fracture. 6. Abnormal EGG findings were sinus bradycardia[1 case], bundle branch block [2 cases], and sinus tachycardia[3 cases]. 7. The operative reduction and fixation was necessary in only one case and the others were treated with conservative treatment.