Gunshot Wound of the Heart (original) (raw)
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INTRAPERICARDIAL VENA CAVA INJURY BY FIREARM PROJECTILE (Atena Editora)
INTRAPERICARDIAL VENA CAVA INJURY BY FIREARM PROJECTILE (Atena Editora), 2023
INTRODUCTION: Firearm projectile injuries (PAF) are the cause of thousands of deaths in Brazil every year, being responsible for 75% of homicides that occurred in 2012 in underdeveloped countries in the Americas¹, in Brazil, 30825 homicides were committed by PAF, 1878 in Minas Gerais. Despite observing a drop of approximately 25%. Vascular injuries are the main causes of death in FAP trauma, with a mortality rate of up to 90%2, making timely management in trauma reference centers a challenge. CASE REPORT: Male patient, 17 years old, admitted to ``Hospital João XXIII`` in Belo Horizonte from Rio Piracicaba by helicopter after 12 hours of trauma. In the emergency room, an initial assessment was carried out and the patient was found to be hemodynamically stable. On examination, PAF perforations were observed in the anterior chest wall, in the second parasternal intercostal space on the right and a hole in the seventh right intercostal space in the midclavicular line, a tangential hole in the left hypochondrium, holes in the left arm, right forearm and right leg with open fractures. of the left humerus, right tibia and right ulna. Distal pulses were present and without motor deficits. The chest X-ray showed hypotransparency in the right hemithorax with the presence of two projections in this topography. In FAST, the presence of free fluid (LL) was detected in the four quadrants and a small amount of LL in the pericardial sac. Referred to the surgical center (SC), chest drainage was performed on the right, draining 1.5 L of blood. Xyphopubic midline laparotomy revealed grade III liver injury in segment VIII with active bleeding, tamponade with compresses, pericardial window positive for blood, followed by sternotomy and opening of the pericardial sac, with profuse bleeding from a lesion in the superior vena cava (SVC). Partial clamping of the SVC was performed with Satinsky forceps and the wound was raffiated with 4.0 polypropylene. Then, the mediastinal pleura on the right was opened, revealing a diaphragmatic injury and transfixing injury of the lower lung lobe, without active bleeding, hepatorrhaphy and abdominal drainage after synthesis of the cavities, cleaning and temporary fixation of the bone fractures and sent to the ICU. On the 6th day he developed pericarditis, responding well to clinical treatment, returning to the CC on the 17th day for definitive treatment of the fractures. DISCUSSION: For Naidoo and Hardcastle (2021), injuries in the region of confluence between the right atrium and the SVC are potentially fatal. According to Westphal (2009), the involvement of large vessels is one of the main factors for the lethal outcome after thoracic trauma. The patient remained hemodynamically stable for 12 hours due to the presence of a clot that formed plugging the SVC lesion. Cardiac tamponade did not occur due to communication between the pericardial sac and the pleural space on the right. Hemothorax is justified by both intrapericardial injury and liver injury.
A case of gunshot wound presenting with atypical cardiorespiratory findings
Journal of Pediatric Neurosciences, 2011
It is well known that a significant increase has occurred in the incidence of thoracic gunshot wounds in children over the last 15 years. Gunshot wounds have been defined as an a€A“epidemica€, a€A“a diseasea€, and a€A“a preventable public health problema€ all over the world. Gunshot wounds in children lead to more lethal or morbid outcomes due to the relatively small area in which their vital organs exist. Gunshot wounds are an increasingly more important problem in present communities with both their morbidities leading to significant impairment in quality of life and significant mortality. In this article, a case with various clinical outcomes following a gunshot wound is presented.
Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability
Case Reports in Surgery, 2014
Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situ...
Innocuous cardiac gunshot that proved fatal: A bitter lesson learned
Chinese journal of traumatology, 2017
The management of hemodynamically normal patients with retained intra-pericardial foreign body remains a matter of conjecture. The available literature supports non-operative management of such innocuous foreign bodies. We report our experience of a hemodynamically normal patient with a retained intra-pericardial pellet from a firearm injury. He initially received successful non-operative management but developed fatal hemopericardium 21 days after injury. In this paper, we discussed the pitfalls in the management of such injuries in light of the available literature and summarized the clinical experience.
Journal of Oral and Maxillofacial Surgery, 2010
Gunshot wounds to the face can have devastating effects on local and distant tissues. The amount of local damage is directly proportional to the kinetic energy transmitted by the missile. Distant injuries, not in the path of the bullet, can be incurred by a pressure wave created by the temporary cavity, a secondary projectile, aspiration of the missile or bony fragments, and embolization of the bullet, which is a rare phenomenon. Embolization, aspiration, and ingestion of the missile should be suspected when there is an entry wound but no exit wound and no missile is found on x-ray in the expected area after a gunshot wound to the head and neck. Bullet embolism to the heart after gunshot wound of the mandible has been reported in the literature. There are several case reports of bullet embolization to the pulmonary artery after sustaining gunshot wounds to the chest, abdomen, and/or extremities. The purpose of this article is to present a case of bullet embolization to the pulmonary artery after a gunshot wound to the face, fracturing the mandible along its course, to review the literature, and to offer a strategy for managing such injuries.