David James Jackson Muckart1,2, Timothy Craig Hardcastle3,4, David Lee Skinner1,5. 1. Department of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, KZN, South Africa. 2. Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, KwaZulu-Natal, 4058, South Africa. 3. Department of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, KZN, South Africa. hardcastle@ukzn.ac.za. 4. Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, KwaZulu-Natal, 4058, South Africa. hardcastle@ukzn.ac.za. 5. Adult Intensive Care Service, Division of Anaesthesiology and Critical Care, King Edward VIII Hospital, Umbilo Rd, KwaZulu-Natal, South Africa.
Abstract
PURPOSE: Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. AIM: review of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning. METHODS: Admissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed. RESULTS: Three hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury. CONCLUSION: The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.
PURPOSE: Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. AIM: review of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning. METHODS: Admissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed. RESULTS: Three hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury. CONCLUSION: The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.
Entities:
Keywords:
Blunt; Chest trauma; Outcome; Pneumomediastinum; Pneumopericardium; Severe
Authors: Christian A Kuhne; Gernot M Kaiser; Sascha Flohe; Martin Beiderlinden; Hilmar Kuehl; Gregor A Stavrou; Christian Waydhas; Sven Lendemanns; Thomas Paffrath; Dieter Nast-Kolb Journal: Surg Today Date: 2005 Impact factor: 2.549