Thoracic: Chest Wall
Commentary: Expeditious treatment of pericardial herniation after blunt traumaIn their report, LeBlanc and Tan1 describe a unique case of a young man with a pleuropericardial rupture with subsequent herniation of the heart into the right chest following a motor vehicle collision. Through the heroic efforts of the team at the initial stabilizing emergency department and the trauma center physicians who ultimately received and saved the patient, the physiologic reserve of a young person, and a little good fortune, a patient with injuries that typically are fatal at the scene survived to discharge.
Commentary: A prompt diagnosis and timely surgical intervention can improve survival after traumatic cardiac herniationA case of pleuropericardial rupture with right-sided cardiac herniation after high-impact blunt chest trauma is presented by LeBlanc and colleagues.1 As mentioned by the authors and previously reported in the literature, pericardial rupture and associated right-sided cardiac herniation after blunt chest trauma is uncommon2,3; however, it must be in the differential diagnosis of any patient who experienced blunt chest trauma and it should be recognized promptly to improve survival. Given the high prehospital mortality of this type of injury, with most of the cases identified postmortem, a clear diagnostic approach has been difficult to establish.
Pericardial rupture with cardiac herniation following blunt thoracic traumaA previously healthy 24-year-old male patient presented to a rural hospital with hemodynamic and respiratory instability following a high-speed motor vehicle collision involving multiple fatalities. He was managed with aggressive intravenous fluid resuscitation, blood transfusions, bilateral chest tubes, and intubation. Chest radiography revealed dextrocardia, and a focused assessment with sonography for trauma examination was limited secondary to massive subcutaneous emphysema and the heart's abnormal anatomical location.
Commentary: Scapulocostal syndrome after trauma: A snap caused by a breakScapulocostal syndrome, also known as “snapping scapula,” is an under-recognized problem involving overhead or throwing motion of the upper extremities.1 It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Pain can be elicited with movements that include shoulder abduction. The syndrome is more common in active young adults. Scapulocostal syndrome is often caused by bursitis but can also be caused by bony and soft-tissue abnormalities.
Commentary: The complete cardiothoracic surgeon: Give me a rib plateIn the current issue of the Journal, Nakamoto and colleagues1 describe the presentation and management of a patient who developed shoulder pain and discomfort with abduction 6 years after blunt trauma with multiple rib fractures, which were treated conservatively. Based on presentation, physical findings, and radiographic findings, snapping scapula syndrome was diagnosed. Surgical intervention and rib plating were performed, with resolution of symptoms.1
Snapping scapula due to traumatic costal fractures: A case reportCostal fractures with flail chest, severe rib dislocation, or chest pain may require emergent fixation in the operating room.1 Snapping scapula is a syndrome involving disturbed scapular motion and persistent pain, usually associated with audible or palpable clicks during overhead or throwing motions.2 Common causes include bursitis, muscle abnormalities, and bone or soft-tissue abnormalities. Snapping scapula syndrome caused by 6th rib fractures is generally unrecognized in cases of chest trauma.