Thoracic Trauma, Nonaortic Injuries

Abstract

Trauma is one of the leading causes of death worldwide. Approximately two-thirds of trauma patients have thoracic injuries. Nonvascular injury to the chest is most common; however, while vascular injuries to the chest make up a small minority of injuries in thoracic trauma, these injuries are most likely to require intervention by interventional radiology (IR). IR plays a vital role, with much to offer, in the evaluation and management of patients with both vascular and nonvascular thoracic trauma; in many cases, IR treatments obviate the need for these patients to go to the operating room. This article reviews the role of IR in the treatment of vascular an nonvascular traumatic thoracic injuries.

Keywords: hemorrhage; interventional radiology; pneumothorax; thoracic; trauma.

Fig. 1

A 66-year-old man with intercostal hemorrhage following bedside chest tube placement by pulmonary medicine. Hemothorax developed requiring large bore (28 Fr) chest tube placement by cardiothoracic surgery. ( a ) Angiography demonstrates active extravasation of contrast from the right T intercostal artery (arrow). ( b ) Resolution of active extravasation of contrast following embolization with 700–900 micron Embosphere particles (Merit Medical Systems, South Jordan, UT). ( c ) Cessation of flow in the distal intercostal artery following coil embolization with Ruby micro coils (black arrow) (Penumbra Medical, Alameda, CA). A pigtail chest tube is also noted (white arrow).

Fig. 2

A 55-year-old restrained driver in motor vehicle collision. ( a ) Contrast-enhanced CT demonstrates active hemorrhage in the right breast (arrow) with surrounding hematoma (arrowheads). ( b ) Angiography of a branch of the right internal mammary artery with a vessel cutoff, indicating arterial injury (arrow). ( c ) Angiography after embolization with NBCA glue demonstrates no flow in this successfully treated arterial branch. ( Images courtesy of Patrick Sutphin, MD, PHD—Massachusetts General Hospital .)

Fig. 3

A 43-year-old man with self-inflicted stab wound to the chest in the setting of intentional rivaroxaban overdose. ( a ) CT images demonstrate hemothorax (arrow). ( b ) Selective left internal mammary artery (LIMA) angiography with active extravasation of contrast (arrow). ( c ) Post-coil embolization angiography with successful occlusion of the LIMA (arrow—coil pack). ( Images courtesy of Guy Johnson, MD—University of Washington Medicine .)

Fig. 4

A 37-year-old man involved in head-on motor vehicle collision that developed ST elevations also had grade V liver laceration. ( a ) Cardiac MIP (white arrows) shows abrupt cutoff of the right coronary artery. ( b ) Cardiac curved planar reformat and ( c ) cardiac volume render images—white arrowheads show segment of dissected vessel. Treated by cardiology with two drug-eluting stents. ( Images courtesy of Patrick Sutphin, MD, PhD—Massachusetts General Hospital .)

Fig. 5

A 57-year-old man with chest pain after fall from a ladder. ( a ) CT chest shows rib fractures (open arrow) and a small right hemopneumothorax (solid arrow). ( b ) The pneumothorax resolved after placement of a 10-Fr pleural drain. ( Images courtesy of Guy Johnson, MD—University of Washington Medicine .)

Fig. 6

A 78-year-old man with lymphatic leak following right upper lobectomy for squamous cell carcinoma of the lung resulting in high output chylous pleural effusion. ( a ) Contrast injection in the thoracic duct demonstrates leakage of contrast from an accessory duct into the right pleural space (arrow). ( b ) Post embolization contrast injection demonstrates a coil pack and NBCA glue cast in the thoracic duct (arrows) and no extravasation of contrast.