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Tension Hemothorax in Aortic Rupture: A Case Report.
Jana Pometlová1,2, Roman Madeja1,2, Jiří Demel1,2
1Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic.
Medicina (Kaunas, Lithuania)
|August 27, 2021
Summary
Chest drain insertion for hemothorax can be fatal if thoracic aortic rupture is the cause. Prioritize CT angiography for diagnosis and bleeding control before drainage in suspected aortic injuries.
Area of Science:
- Trauma surgery
- Thoracic surgery
- Emergency medicine
Background:
- The Advanced Trauma Life Support (ATLS) protocol recommends chest drain insertion for hemothorax before further diagnostics.
- This approach can be life-threatening if thoracic aortic rupture is the underlying cause of hemothorax.
Observation:
- A 21-year-old polytrauma patient presented with chest trauma and decreased breath sounds.
- Urgent CT angiography revealed Grade III thoracic aortic transection and massive left-sided hemothorax with mediastinal shift.
- The patient experienced circulatory instability following stent-graft repair and subsequent hemothorax drainage.
Findings:
- Prompt diagnosis via CT angiography is crucial for identifying thoracic aortic injury.
- Controlling aortic bleeding before chest drainage is vital to prevent hemorrhagic shock.
- Successful management of traumatic hemorrhagic shock was achieved in the ICU.
Implications:
- Rethinking the standard ATLS protocol for hemothorax management in trauma patients is necessary.
- Suspected aortic injuries require immediate diagnostic imaging and hemorrhage control before chest decompression.
- This case highlights the critical importance of accurate diagnosis in managing complex thoracic trauma.
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