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Case Reports
. 2019 Apr 4:8:Doc07.
doi: 10.3205/iprs000133. eCollection 2019.

Thoracic compartment syndrome after penetrating heart and lung injury

Holger Rupprecht  1 , Harald Dormann  2 , Katharina Gaab  1
Affiliations
Case Reports

Thoracic compartment syndrome after penetrating heart and lung injury

Holger Rupprecht et al. GMS Interdiscip Plast Reconstr Surg DGPW. .

Abstract
in English, German

Thoracic injuries are the most lethal penetrating injuries. After attempting suicide, two patients with a penetrating thoracic wound were admitted to our emergency department. During CT scan they became hemodynamically unstable, which is why we had to perform an emergency thoracotomy. In both cases, a perforation in the left ventricle as well as multiple lesions of the lung parenchyma and vessel injuries were found. After the treatment of the different injuries, a massive edema of the heart and lung prevented a primary closure of the thorax. Due to massive diffuse bleeding, a "packing" of the pleural cavity became necessary. To prevent a thoracic compartment syndrome, the thoracic wall was left open and the skin was closed with a plastic sheet. Due to the "open chest" procedure combined with "packing" of the thoracic cavity, the majority of patients with an edema of the heart and lung after a penetrating chest injury can be saved. Pitfalls of preclinical and clinical treatment, aspects of diagnostics and surgery are discussed.

Thorakale Verletzungen sind die tödlichsten penetrierenden Verletzungen.Zwei Patienten wurden nach einem Suizidversuch mit einer penetrierenden Thoraxverletzung in unsere Notaufnahme eingeliefert. Während der CT-Untersuchung kam es zu einer Kreislaufdekompensation, so dass die notfallmäßige Thorakotomie erfolgen musste. In beiden Fällen fand sich eine Perforation im linken Ventrikel neben multiplen Lungenparenchym- und Gefäßverletzungen. Nach Versorgung der verschiedenen Läsionen verhinderte ein massives Ödem des Herzens und der Lunge einen Primärverschluss des Thorax, wobei wegen diffuser Blutung noch ein „Packing“ der Thoraxhöhle notwendig wurde. Zur Prävention eines Kompartmentsyndroms blieb der knöcherne Thorax offen und es wurde nur die Haut mit einer Plastikfolie verschlossen. Aufgrund der Kombination des offen belassenen Thorax und des Austamponierens der Thoraxhöhle kann die Mehrzahl der Patienten mit einem Herz-Lungen-Ödem nach penetrierender Verletzung gerettet werden.Fallstricke der präklinischen und klinischen Behandlung sowie Aspekte der Diagnostik und Operation werden diskutiert.

Keywords: bogota bag; compartment syndrome; myocardial and lung edema; packing; penetrating heart and lung injury.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Table 1
Table 1. Extracardiac injuries
Figure 1
Figure 1. Entry wound of 45-Magnum-revolver
Figure 2
Figure 2. Thoracic wound of the letter opener
Figure 3
Figure 3. Computer-assisted tomography: hematothorax
Figure 4
Figure 4. Computer-assisted tomography: pericardial tamponade
Figure 5
Figure 5. Left ventricle with non-absorbable sutures sheathed with teflon plates (Prolene 2-0)
Figure 6
Figure 6. Left ventricle sealed with fibrin fleeces (Tachosil®)
Figure 7
Figure 7. Pericardium with bovine patch (Tutomesh®)
Figure 8
Figure 8. Thoracic “Bogota bag”
See this image and copyright information in PMC

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