Mediastinal impalement with survival: a case report

Mediastinal impalement injuries are rare and often fatal. Very few instances of survival after mediastinal impalement have been reported. We present the unusual case of an 18-year-old man who was involved in a motor vehicle crash in which a wooden fencepost intruded through the windshield and impaled him through the superior mediastinum. The patient remained hemodynamically stable and had no other significant injuries except a left pneumothorax. Arteriogram revealed a bovine aortic arch with the wooden piece passing over the aortic arch between the two brachiocephalic arteries at the precise point that a normal left common carotid artery would have been located. No other injuries were seen on arteriogram, venogram, or esophagram. The foreign body was extracted via thoracotomy along with resection of the apex of the left lung and ligation of the thoracic duct. The patient was discharged on hospital day eight and was doing quite well at one-year follow-up with no residual effects of his accident.