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Review
. 2023 Jan-Dec:11:23247096231211063.
doi: 10.1177/23247096231211063.

Needle Decompression Causing Pericardial and Pulmonary Artery Injuries in Patients With Blunt Trauma: Two Case Reports and Literature Review

Husham Abdelrahman  1 , Sajid Atique  1 , Ahmad G Kloub  1 , Suhail Y Hakim  1 , James Laughton  2 , Yassir S Abdulrahman  1 , Ayman El-Menyar  1   3 , Hassan Al-Thani  1
Affiliations
Review

Needle Decompression Causing Pericardial and Pulmonary Artery Injuries in Patients With Blunt Trauma: Two Case Reports and Literature Review

Husham Abdelrahman et al. J Investig Med High Impact Case Rep. 2023 Jan-Dec.

Abstract

Tension pneumothorax (TPX) is a severe chest complication of blunt or penetrating trauma. Immediate decompression is the lifesaving action in patients with TPX. Needle decompression (ND) is frequently used for this purpose, particularly in limited resources setting such as the prehospital arena. Despite the safe profile, the blind nature of the procedure can result in a serious range of complications, including injury to the vital intrathoracic structures such as the lungs, great vessels, and heart. Here, we reported 2 cases of blunt chest trauma resulting in TPX demanding immediate ND; however, nonintentional pericardial and pulmonary artery injuries occurred. The first case was a 42-year-old man with a needle-related pulmonary artery injury that required surgery. The second case was a 19-year-old man in whom a needle-related pneumopericardium occurred and was treated conservatively. In both cases, trained personnel performed the ND. Although ND in the field is a lifesaving intervention, it may further complicate the patient condition. Therefore, it should be performed in adherence to the universal guidelines.

Keywords: needle decompression; pneumopericardium; tension pneumothorax; trauma.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Bilateral needle decompression at second intercostal space; notice blood emerging from laterally placed left catheter directed downward and medially, it is not perpendicular to the chest wall.
Figure 2.
Figure 2.
eFAST with evidence of pericardial fluid (Tamponade) on subxiphoid view (3 arrows).
Figure 3.
Figure 3.
Intraoperative view of the lung injury (through and through).
Figure 4.
Figure 4.
Repair of cardiac injury with Proline 4/0 “Figure of 8” technique.
Figure 5.
Figure 5.
Case II: the needle decompression(ND) directed medially toward the heart. It shows misplacement of the needle decompression (it should be midclavicular), and markers of repeated attempts are also misplaced.
Figure 6.
Figure 6.
Case II: chest x-ray shows the decompression catheter touching the heart.
Figure 7.
Figure 7.
Case II: computed tomography scan of the chest showing a pneumopericardium.
Figure 8.
Figure 8.
Case II: subcutaneous emphysema that extended to the root of the neck.
See this image and copyright information in PMC

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