Thoracic venous injuries: an imaging and management overview

Area of Science:

• Radiology
• Trauma Surgery
• Vascular Surgery

Background:

• Thoracic venous injuries stem from trauma (penetrating, blunt) and iatrogenic causes (e.g., central venous catheter complications).
• These injuries present diagnostic challenges due to similar symptoms to arterial injuries and their rarity, potentially underestimating incidence.
• The lethal nature of some thoracic venous injuries limits available literature for review.

Purpose of the Study:

• To discuss and illustrate the various causes of injury to thoracic veins.
• To present the supporting computed tomography (CT) findings for these injuries.
• To briefly discuss the management of thoracic venous injuries.

Main Methods:

• Review of available literature on penetrating, blunt, and iatrogenic injuries to major thoracic veins.
• Illustration of CT findings associated with injuries to the vena cava, innominate, subclavian, axillary, azygos, and pulmonary veins.
• Discussion of diagnostic challenges and management strategies.

Main Results:

• Multi-detector computed tomography (MDCT) has improved the detection of thoracic venous injuries in hemodynamically stable patients.
• CT findings are crucial for diagnosing injuries to specific thoracic veins.
• Management strategies vary depending on the specific vein injured and the nature of the trauma.

Conclusions:

• Thoracic venous injuries require careful diagnosis, with MDCT playing a key role in detection.
• Understanding the CT appearance of these injuries is vital for appropriate management.
• Further research may be needed to fully elucidate the incidence and optimal treatment of these rare but serious conditions.