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Mediastinal impalement with survival: a case report
M K Tsuei1, R D Riley, T E Oaks
1Department of Trauma, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.
The American Surgeon
|June 21, 2001
Summary
Survival after a rare mediastinal impalement injury is possible. This case highlights successful management of a severe traumatic injury involving a wooden fencepost impaling the superior mediastinum.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Mediastinal impalement injuries are infrequent and carry a high mortality rate.
- Survival is exceptionally rare, making reported cases crucial for understanding management.
Observation:
- An 18-year-old male sustained a mediastinal impalement from a wooden fencepost during a motor vehicle crash.
- The patient was hemodynamically stable with a left pneumothorax, and the impalement involved the superior mediastinum, passing over the aortic arch.
Findings:
- Imaging revealed a bovine aortic arch with the foreign body positioned between brachiocephalic arteries.
- The wooden object was successfully removed via thoracotomy, with resection of the left lung apex and thoracic duct ligation.
- The patient experienced a favorable recovery and was discharged on hospital day eight.
Implications:
- This case demonstrates the feasibility of survival and successful surgical intervention in severe mediastinal impalement injuries.
- It underscores the importance of prompt and precise surgical management in high-risk trauma cases.
- Long-term follow-up confirmed no residual effects, supporting the efficacy of the treatment strategy.