DOCSLIB.ORG

Management of Post-Traumatic Retained Hemothorax: a Prospective, Observational, Multicenter AAST Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Post-Traumatic Retained Hemothorax: a Prospective, Observational, Multicenter AAST Study EAST MULTICENTER STUDY PROPOSAL (Proposal forms must be completed in its entirety, incomplete forms will not be considered) GENERAL INFORMATION Study Title: Hemothorax Management and Outcomes in Blunt and Penetrating Trauma Primary investigator / Senior researcher: Jeremy Cannon, MD, SM, FACS Co-primary investigator: Mark Seamon, MD, FACS BACKGROUND AND SIGNIFICANCE Use this area to briefly (1-2 paragraphs only) outline the burden of the problem to be examined: The true incidence and outcomes of traumatic hemothorax remains unknown. The landmark study by the AAST Retained Hemothorax Study Group described the management course in these patients once a retained hemothorax has been identified. However, management during the index presentation with a hemothorax remains poorly quantified. In addition, interventions which might mitigate the progression of a hemothorax to either a retained hemothorax or empyema have not been fully characterized. Presently, the management options for primary traumatic hemothorax include observation, open tube thoracostomy, percutaneous/small-bore tube thoracostomy, or surgical drainage. To fully characterize the ideal management strategy for hemothorax following blunt or penetrating trauma, the natural history of this disease needs to be captured from initial presentation through to post-discharge follow-up. The specific aims of this multicenter study are: Primary aim: Primary aim should be succinctly stated here – single sentence ideal: We aim to fully characterize the incidence and outcomes of hemothorax management in blunt and penetrating trauma. Secondary aims: Any secondary aims should be stated here: 1 EXPERIMENTAL DESIGN/METHODS Inclusion Criteria: Any age, blunt or penetrating trauma resulting in a hemothorax of any size on initial Chest CT on the day of admission for trauma. Exclusion Criteria: None Therapeutic Interventions: Prospective observational study managed at the surgeon’s discretion with observation through the 1st follow-up visit post-discharge. Outcomes Measures: Primary Outcome: (List here) Retained hemothorax ≥ 300 mL on Chest CT obtained at any time after initial Chest CT Secondary Outcomes: (List here) Death Hospital Length of Stay Ventilator-free days in 1st 30 days of admission Glasgow Outcomes Scale-Extended SF-36 Fibrothorax Empyema Number of interventions including tube thoracostomy, VATS, thoracotomy or other procedures Variables: List the specific variables to be collected and analyzed here. For organization, it is useful to divide these into categories for consideration. Examples of categories might include: Demographics, Admission physiology, Management variables, Surgical variables, Outcomes 2 DEMOGRAPHICS Age Gender COPD/Home O2 Antiplatelets/Anticoagulants Obesity (BMI) ADMISSION PHYSIOLOGY HR Blood Pressure HCT Cr INR Base Excess Lactate INJURY CHARACTERISTICS Mechanism of injury (blunt, penetrating, both, other) Hemothorax Side Hemothorax Size (mL--measured on CT) Diaphragmatic injury Rib fractures (number, location) Flail chest ISS AIS head AIS chest AIS abdomen Pulmonary contusion MANAGEMENT Initial Management-Injury Day 1 Observation Open tube thoracostomy Percutaneous tube thoracostomy (“pigtail”) VATS Open Evacuation Estimated Hemothorax Evacuated (mL) Antibiotics used YATS used Follow-up CT Imaging Indication (abnormality on CXR, respiratory symptoms, other) Day of follow-up imaging Size of retained hemothorax or effusion, if present (mL) Other findings (PE, consolidation, pneumatocele) Management—Injury Day 2 to Discharge Successful initial management Subsequent tube (injury day) Subsequent thrombolytics (injury day) Subsequent VATS (injury day) Subsequent Thoracotomy (injury day) OUTCOMES Retained hemothorax (describe management) Death 3 Discharge (LTAC, SNF, Rehab, or Home) Hospital LOS Ventilator-free days in the first 30 Post-discharge visit x1 Post-injury day at follow-up CXR findings on post-discharge visit (if obtained) CT findings on post-discharge visit (if obtained) Empyema (describe management and cultures) Fibrothorax Glasgow Outcomes Scale-Extended (at discharge, at 1st follow-up and at 6 months) SF-36 (at 1st follow-up and at 6 months) Need for additional interventions after initial discharge Data Collection and Statistical Analysis: Outline the data collection plan and statistical analysis plan succinctly here The above data will be collected on each patient starting within 24 hours of admission and continuing through their hospital course. Follow-up data will be collected within 24 hours of their post-discharge visit. Data will be entered into a de-identified online data repository. Target enrollment is 500 patients over 2 years. Risk factors for retained hemothorax or empyema development will be assessed using univariate and multivariate analysis. Continuous variables will be compared using Student’s t-test and the Mann Whitney U test. The Chi-squared tests or Fisher’s exact test will be used to compare categorical variables. All variables with a p value <0.2 on univariate analysis will be entered into a multivariable logistic regression analysis to identify independent risk factors for retained hemothorax or empyema development. Data will be reported as adjusted odds ratios with 95 % confidence intervals. Statistical significance will be set at a p<0.05. Consent Procedures: Outline consent procedures here, if applicable. As an example for a prospective study where waiver of consent will be sought, verbiage might include: “This is a prospective observational study, designed to prospectively record data on patients who are managed according to institutional patient management protocols. Thus, waiver of informed consent is requested. Data will be recorded on a data sheet and transferred to a secured database that is devoid of patient identifiers.” This is a prospective observational stud intended to record data on patients who are managed according to institutional patient management protocols. Waiver of informed consent will be requested; however, we appreciate that some institutional IRBs may request formal consent from the patient or a legally authorized representative. Data will be recorded on a data sheet and transferred to a secured database that is devoid of patient identifiers. 4 Risk/ Benefit Analysis: Succinctly outline a risk / benefit analysis. An example of this might include: “The incidence and natural history DISEASE PROCCESS TO BE STUDIED is unknown. If the optimal timing for and type of intervention can be identified to optimize outcomes in these patients, then significant benefit will result.” The incidence and natural history of traumatic hemothorax is unknown. If the optimal timing for and type of intervention can be identified to optimize outcomes in these patients, then significant benefit will be realized by future patients. Instructions for submitting data collection tools: All data submissions should be entered through the EAST Multicenter Trial Taskforce website portal. Instructions can be found on the EAST website. The data collection sheet located under the Multicenter Trial Taskforce heading for this study can be utilized to record the data, and then the information transferred to the portal entry system. For any questions regarding this study, please contact the PI. 5 References: Include a brief listing of key references here: 1. Stiles PJ, Drake RM, Helmer SD, Bjordahl PM, Haan JM. Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax. Am J Surg. 2014 Jun;207(6):960-3. PubMed PMID: 24495319. 2. Kulvatunyou N, Erickson L, Vijayasekaran A, Gries L, Joseph B, Friese RF, O'Keeffe T, Tang AL, Wynne JL, Rhee P. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014 Jan;101(2):17-22. PMID: 24375295. 3. Kulvatunyou N, Joseph B, Friese RS, Green D, Gries L, O'Keeffe T, Tang AL, Wynne JL, Rhee P. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? J Trauma Acute Care Surg. 2012 Dec;73(6):1423-7. PubMed PMID: 23188235. 4. Moore FO, Duane TM, Hu CK, Fox AD, McQuay N Jr, Lieber ML, Como JJ, Haut ER, Kerwin AJ, Guillamondegui OD, Burns JB; Eastern Association for the Surgery of Trauma. Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S341-4. PubMed PMID: 23114491. 5. DuBose J, Inaba K, Okoye O, Demetriades D, Scalea T, O'Connor J, Menaker J, Morales C, Shiflett T, Brown C, Copwood B; AAST Retained Hemothorax Study Group. Development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study. J Trauma Acute Care Surg. 2012 Sep;73(3):752-7. PubMed PMID: 22929504. 6. Inaba K, Lustenberger T, Recinos G, Georgiou C, Velmahos GC, Brown C, Salim A, Demetriades D, Rhee P. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma Acute Care Surg. 2012 Feb;72(2):422-7. PubMed PMID: 22327984. 7. DuBose J, Inaba K, Demetriades D, Scalea TM, O'Connor J, Menaker J, Morales C, Konstantinidis A, Shiflett A, Copwood B; AAST Retained Hemothorax Study Group. Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. J Trauma Acute Care Surg. 2012 Jan;72(1):11-22; discussion 22-4; quiz 316. PubMed PMID: 22310111. 8. Smith JW, Franklin GA, Harbrecht BG,
Load more

Recommended publications
  • Trauma-Associated Pulmonary Laceration in Dogs—A Cross Sectional Study of 364 Dogs
    veterinary sciences Article Trauma-Associated Pulmonary Laceration in Dogs—A Cross Sectional Study of 364 Dogs Giovanna Bertolini 1,* , Chiara Briola 1, Luca Angeloni 1, Arianna Costa 1, Paola Rocchi 2 and Marco Caldin 3 1 Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] (C.B.); [email protected] (L.A.); [email protected] (A.C.) 2 Intensive Care Unit, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] 3 Clinical Pathology Division, San Marco Veterinary Clinic and Laboratory, via dell’Industria 3, 35030 Veggiano, Padova, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-0498561098 Received: 5 March 2020; Accepted: 8 April 2020; Published: 12 April 2020 Abstract: In this study, we describe the computed tomography (CT) features of pulmonary laceration in a study population, which included 364 client-owned dogs that underwent CT examination for thoracic trauma, and compared the characteristics and outcomes of dogs with and without CT evidence of pulmonary laceration. Lung laceration occurred in 46/364 dogs with thoracic trauma (prevalence 12.6%). Dogs with lung laceration were significantly younger than dogs in the control group (median 42 months (interquartile range (IQR) 52.3) and 62 months (IQR 86.1), respectively; p = 0.02). Dogs with lung laceration were significantly heavier than dogs without laceration (median 20.8 kg (IQR 23.3) and median 8.7 kg (IQR 12.4 kg), respectively p < 0.0001). When comparing groups of dogs with thoracic trauma with and without lung laceration, the frequency of high-energy motor vehicle accident trauma was more elevated in dogs with lung laceration than in the control group.
    [Show full text]
  • Large Traumatic Pneumatocele in a 2-Year-Old Child
    Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2013, Article ID 940189, 3 pages http://dx.doi.org/10.1155/2013/940189 Case Report Large Traumatic Pneumatocele in a 2-Year-Old Child N. K. Cheung,1 A. James,2 and R. Kumar3 1 Department of Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia 2 Department of Cardiothoracic Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia 3 Department of Paediatric Surgery, John Hunter Children’s Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia Correspondence should be addressed to R. Kumar; [email protected] Received 3 August 2013; Accepted 22 August 2013 Academic Editors: Y. Z. Bai, S. Burjonrappa, S. G. Golombek, and Z. Jiang Copyright © 2013 N. K. Cheung et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Traumatic pneumatoceles are a rare complication of blunt chest trauma in children. Although they characteristically present as small, regular shaped lesions which can be safely treated nonoperatively, larger traumatic pneumatoceles pose diagnostic and management difficulties for clinicians. This case study reports one of the largest traumatic pneumatoceles reported to datein the paediatric population, which resulted in aggressive surgical intervention for both diagnostic and treatment reasons. This case adds further evidence to the current literature that significantly large traumatic pneumatoceles with failure of initial conservative management warrant surgical exploration and management to optimise recovery and prevent complications. 1. Introduction 2. Case Presentation Traumatic pneumatocele (TP) is a rare condition occurring A 2-year-old boy presented to the emergency department after blunt chest trauma in children and young adults, after being knocked over and his left shoulder and chest accounting for 3.9% of paediatric blunt chest traumas.
    [Show full text]
  • A Case of Congenital Bronchial Defect Resulting in Massive Posterior Pneumomediastinum : First Case Report
    대 한 주 산 회 지 제26권 제3호, 2015 � Case Report � Korean J Perinatol Vol.26, No.3, Sep., 2015 http://dx.doi.org/10.14734/kjp.2015.26.3.255 A Case of Congenital Bronchial Defect Resulting in Massive Posterior Pneumomediastinum : First Case Report Ji Eun Jeong, M.D.1, Chi Hoon Bae, M.D.2, and Woo Taek Kim, M.D.1 Department of pediatrics1, Department of Thoracic and Cardiovascular Surgery2, Catholic university of Daegu School of Medicine, Daegu, Korea Bronchial defects in neonates are known to occur very rarely as a complication of mechanical ventilation or intubation. This causes persistent air leakage that may form massive pneumomediastinum or pneumothorax, leading to cardiac tamponade or cardiorespiratory deterioration. Early diagnosis and treatment of bronchial defects are essential, as they can be accompanied by underlying severe lung parenchymal diseases, especially in preterm infants. We encountered an extremely low birth weight infant with an air cyst cavity in the posterior mediastinum that displaced the heart anteriorly, thereby causing cardiopulmonary deterioration. During exploratory-thoracotomy, after division of the air cyst wall (mediastinal pleura), we found a small bronchial defect in the posterior side of the right main bronchus. The patient had shown respiratory distress syndrome at birth, and she was managed by constant low positive pressure ventilation using a T-piece resuscitator after gentle intubation. As the peak inspiratory pressure was maintained low throughout and because intubation was successful at the first attempt without any difficulty, we think that the cause of the defect was not barotrauma or airway injury during intubation.
    [Show full text]
  • Imaging of Thoracic Injuries 2.6
    Chapter Imaging of Thoracic Injuries 2.6 G. Gavelli, G. Napoli, P.Bertaccini, G. Battista, R. Fattori Contents Since the chest X ray is essential in providing informa- tion regarding life-threatening conditions, such as tension 2.6.1 Introduction . 155 pneumothorax, hemothorax, flail chest, and mediastinal 2.6.2 Clinical and Imaging Findings . 156 abnormalities, the radiologist must have deep knowledge 2.6.2.1 Chest Wall Injuries . 156 of the possibilities and limits of this modality, which may 2.6.2.2 Parenchymal Lung Injuries . 159 not point out, or may underestimate, all these conditions. 2.6.2.3 Extra-alveolar Air . 162 2.6.2.4 Pleural Effusion and Hemothorax . 163 Poor-quality radiographs are, therefore, not acceptable 2.6.2.5 Tracheobronchial Injury . 164 especially when it becomes difficult or impossible to ex- 2.6.2.6 Thoracic Esophageal Disruption . 165 clude life-threatening conditions and an alternative imag- 2.6.2.7 Diaphragmatic Injury . 166 ing study should be performed. 2.6.2.8 Blunt Cardiac and Pericardial Injury . 169 2.6.2.9 Traumatic Aortic Injury . 169 In selected cases, it could be very useful to perform an additional lateral radiograph with horizontal incidence of 2.6.3 Conclusion . 175 the ray because the evaluation of pleural effusion, pneu- mothorax, and the identification of sternal fractures may References . 176 be easier. As mentioned previously, a CT study must be per- formed in all chest trauma patients in whom there is even the smallest diagnostic doubt on plain film. 2.6.1 Introduction Computed tomography has come to assume an increas- ingly important role in the evaluation of patients with Traumatic injuries are the fourth cause of death in the known or suspected chest injuries.
    [Show full text]
  • Download Poster Abstracts
    Poster # 1 Failure to Rescue and the Weekend Effect: A Study of a Statewide Trauma System Catherine E. Sharoky MD, Morgan M. Sellers MD, Elinore J. Kaufman MD, MSHP, Yanlan Huang MS, Wei Yang Ph.D., Rachel R. Kelz MD, MSCE, Patrick M. Reilly* MD, Daniel N. Holena* MD, MSCE University of Pennsylvania Introduction: Differential patient outcomes based on weekday or weekend patient presentation (i.e. the “weekend effect”) have been reported for several disease states. Failure to rescue (FTR, the probability of death after a complication) has been used to evaluate trauma care. We sought to determine whether the weekend effect impacts FTR across a mature statewide trauma system. Methods: We examined all 30 Level I and II trauma centers using the Pennsylvania Trauma Outcomes Study (PTOS) from 2007-2015. Patients age >16y with a minimum Abbreviated Injury Score 2 were included; burn patients and transfers were excluded. Our primary exposure was first major complication timing (weekday vs weekend), FTR was the primary outcome. We used multivariable logistic regression to examine the association between weekend complication occurrence and mortality. Results: Of 178,602 patients, 15,304 had a major complication [median age 58 (IQR 37-77) years, 68% male, 89% blunt injury mechanism, median injury severity score (ISS) 19 (IQR 10-29)]. Patient characteristics by complication timing were clinically similar (Table). Major complications were more likely on weekdays than weekends (9.3% vs 7.1%, p<0.001). Pulmonary and cardiac complications were most common in both groups (Table). Death occurred in 2,495 of 15,304 patients with complications, for an overall FTR rate of 16.3%.
    [Show full text]
  • “Bubbles in the Chest” the Pediatric Spectrum of Air Containing Pulmonary Lesions
    “BUBBLES IN THE CHEST” THE PEDIATRIC SPECTRUM OF AIR CONTAINING PULMONARY LESIONS Maria d' Almeida, MD • Katie Lopez, MD • Julieta Oneto, MD • Ricardo Restrepo, MD Miami Children’s Hospital, Miami, Florida EXHIBIT OUTLINE • Anatomy of the tracheobronchial tree Bronchopulmonary Dysplasia and secondary pulmonary lobule Pulmonary Interstitial Emphysema Meconium Aspiration • Definition Congenital Diaphragmatic Hernia Bronchiectasis Bleb • Pathologies seen in older children and Bulla adolescents involving the Cyst Tracheobronchial tree Pneumatocele Lung parenchyma Cavity • Take Home Points • Pathologies seen in the newborn Congenital Lobar Emphysema • References Bronchogenic Cyst Congenital Cystic Adenomatoid Malformation Sequestration ANATOMY OF THE TRACHEOBRONCHIAL TREE Distal trachea ap ap/p post LUL RUL ant ant LINGULA sup lat inf RML med lb ab RLL mb LLL lb pb pb am Bronchus – Cartilage is seen in the wall Bronchiole – Absence of cartilage in the wall Respiratory bronchiole – Alveoli are seen in the wall Lobular bronchiole – Supplies secondary pulmonary lobule ANATOMY OF THE SECONDARY PULMONARY LOBULE Secondary pulmonary lobule – Functional pulmonary unit appearing as an irregular polyhedron separated from each other by thin fibrous interlobular septa. Acinus – Functionally most important subunit of lung consisting of all parenchymal tissue distal to one terminal bronchiole. Acinus Lobular bronchiole Lobular artery Terminal bronchiole Pulmonary vein Interlobular septa DEFINITION Bulla – Sharply demarcated dilated air space within lung parenchyma > 1 cm in diameter with epithelialized wall (<1 mm) BULLA due to destruction of alveoli. Typically at lung apex. Pneumatocele –Cystic air collection within lung parenchyma with thin wall PNEUMATOCELE (<1mm) due to obstructive overinflation. Does not indicate destruction of lung parenchyma. Frequently multiple. Cavity – Gas containing space THIN WALLED in the lung having a wall > 1 mm CAVITY thick.
    [Show full text]
  • Pneumatocele in a 33-Year-Old Ghanaian Woman: a Case Report
    J Radiol Clin Imaging 2020; 3 (3): 080-084 DOI: 10.26502/jrci.2809032 Case Report Pneumatocele in a 33-Year-Old Ghanaian Woman: A Case Report Emmanuel Kobina Mesi Edzie1*, Klenam Dzefi-Tettey2, Philip Narteh Gorleku1, Henry Kusodzi1, Abdul Raman Asemah1 1Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana 2Department of Radiology, Korle Bu Teaching Hospital. 1 Guggisberg Avenue, Accra, Ghana *Corresponding Author: Dr. Emmanuel Kobina Mesi Edzie, Department of Medical Imaging. School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, PMB, Cape Coast, Ghana, Tel: +233244687946; E-mail: [email protected] Received: 06 July 2020; Accepted: 17 July 2020; Published: 29 July 2020 Citation: Emmanuel Kobina Mesi Edzie, Klenam Dzefi-Tettey, Philip Narteh Gorleku, Henry Kusodzi, Abdul Raman Asemah. Pneumatocele in a 33-year-old Ghanaian Woman: A Case Report. Journal of Radiology and Clinical Imaging 3 (2020): 080-084. Abstract towards the left. Her condition was stable and A 33-year-old female baker presented to our facility subsequently improved after passage of chest tubes. with a chronic cough of 7-month duration, difficulty The ability to differentiate pneumatoceles from other in breathing, and tachypnea and had been on anti- conditions like pneumothorax, giant bullae, and tuberculous treatment for the past six months prior to cavities is crucial since an error in diagnosis may her referral. A chest radiograph revealed huge thin- affect the management ultimately. walled rounded hyper luscencies with smooth inner margins and without vascular markings and fluid in Keywords: Pneumatocele; Lung; Chest radiograph; both upper zones subsequently diagnosed as bilateral Adult pneumatoceles with mild compressive effects Journal of Radiology and Clinical Imaging 80 J Radiol Clin Imaging 2020; 3 (3): 080-084 DOI: 10.26502/jrci.2809032 1.
    [Show full text]
  • Chapter 9 - Thoracic Injuries Test Questions
    Chapter 9 - Thoracic Injuries Test Questions 1. Which injuries are considered life-threatening requiring immediate intervention? a. Tension pneumothorax and pericardial tamponade b. Cardiac contusion and rib fractures c. Clavicle fracture and pulmonary contusion d. Pneumomediastinum and subcutaneous emphysema 2. What is an early sign of tension pneumothorax? a. Tracheal deviation b. Respiratory distress c. Increased cardiac output d. Epistaxis 3. What is the immediate management of tension pneumothorax a. Chest tube placement in 7th intercostal space b. Place a three-sided dressing over chest tube site c. Needle thoracentesis in 2nd intercostal space d. ED thoracotomy 4. Flail chest is defined as: a. Multiple rib fractures with subsequent subcutaneous emphesema b. Chyle in the pleural space c. Excess fluid in pericardium d. Two or more ribs fractured at two points 5. Which patient would benefit most from an emergent thoracotomy? a. 48 year old patient with gunshot wound to the back who lost vital signs upon arrival to the ED b. 12 year old patient with traumatic asphyxsia with CPR in progress for past 15 minutes upon arrival to the ED c. 16 year old patient with traumatic amputation of arm with CPR in progress for 5 minutes d. 19 year old patient with stab wound to chest who arrived with fixed and dilated pupils. 6. A nasogastric tube was inserted in a trauma patient. A follow-up chest radiograph shows abdominal contents in the chest cavity. The nurse should be suspicious of a. Diaphragmatic rupture b. Chylothorax c. Pleural effusion d. Tension pneumothorax STN 2012 Electronic Library: Chapter 9 – Thoracic Trauma Test Questions 2 7.
    [Show full text]
  • Juerg Hodler Rahel A. Kubik-Huch Gustav K. Von Schulthess Editors Diagnostic and Interventional Imaging
    IDKD Springer Series Series Editors: Juerg Hodler · Rahel A. Kubik-Huch · Gustav K. von Schulthess Juerg Hodler Rahel A. Kubik-Huch Gustav K. von Schulthess Editors Diseases of the Chest, Breast, Heart and Vessels 2019–2022 Diagnostic and Interventional Imaging IDKD Springer Series Series Editors Juerg Hodler Department of Radiology University Hospital of Zürich Zürich, Switzerland Rahel A. Kubik-Huch Department of Radiology Kantonsspital Baden Zürich, Switzerland Gustav K. von Schulthess Deptartment of Nuclear Medicine University Hospital of Zürich Zürich, Switzerland The world-renowned International Diagnostic Course in Davos (IDKD) represents a unique learning experience for imaging specialists in training as well as for experienced radiologists and clinicians. IDKD reinforces his role of educator offering to the scientific community tools of both basic knowledge and clinical practice. Aim of this Series, based on the faculty of the Davos Course and now launched as open access publication, is to provide a periodically renewed update on the current state of the art and the latest developments in the field of organ- based imaging (chest, neuro, MSK, and abdominal). More information about this series at http://www.springer.com/series/15856 Juerg Hodler • Rahel A. Kubik-Huch Gustav K. von Schulthess Editors Diseases of the Chest, Breast, Heart and Vessels 2019–2022 Diagnostic and Interventional Imaging Editors Juerg Hodler Rahel A. Kubik-Huch Department of Radiology Department of Radiology University Hospital of Zürich Kantonsspital Baden
    [Show full text]
  • Acute Chest— ICU, ER, Trauma
    Afshin Karimi, MD, JD, PhD Department of Radiology University of California, San Diego Understand the importance of detailed inspection and accurate interpretation of the daily ICU chest radiograph Recognize the typical radiologic manifestation of thoracic trauma including injuries to the aorta, lungs, airways, esophagus, and diaphragm ICU Chest: . Lines and Tubes—Malpositioning and Complications . Abnormal Collections of Gas . Lobar Atelectasis . Acute Respiratory Distress Syndrome (ARDS) ER/Trauma Chest: . Traumatic aortic injury (TAI) . Lung injury ▪ Contusion, Laceration, Hemo/Pneumothorax . Tracheobronchial injury . Esophageal injury . Diaphragmatic injury Endotracheal tubes (ETT) Pulmonary artery/Swan-Ganz catheters Central venous catheters (CVC) Enteric tubes (nasogastric and feeding tubes) Intra-aortic balloon pump (IABP) Ideal position: . 5-7 cm above the carina (neutral position) . Flexion may displace ETT 2-4 cm caudally . Extension may displace ETT 2-4 cm cranially If ETT too distal (mainstem or lobar bronchus)→ lobar and/or total lung collapse Ideal position: . Large central pulmonary artery If Swan-Ganz catheter is too distal: . Thrombosis and pulmonary infarction . Pulmonary artery rupture and pseudoaneurysm formation (hemoptysis) Pulmonary Infarction Ideal position: . SVC . Tip should be central to valves (beyond the medial aspect of the 1st rib) . Tip should be above the cavo-atrial junction Complications: Malposition: . PTX/hemothorax . Azygos vein . Mediastinal hematoma . Superior intercostal vein . Mediastinal or pleural . Carotid artery infusion . Subclavian artery . Venous thrombosis . Pleural space . Vessel/right atrial perforation . Catheter embolization . Arrhythmia Feeding tube: . Tip should be post-pyloric Nasogastric tube: . Tip should be at least 10 cm distal to the GE junction to ensure side-hole is beyond the GE junction Ideal position: .
    [Show full text]
  • Imaging Guided Thoracic Interventions
    Black plate 507,1) Copyright #ERS Journals Ltd 2001 Eur Respir J 2001; 17: 507±528 European Respiratory Journal Printed in UK ± all rights reserved ISSN 0903-1936 SERIES "THORACIC IMAGING" Edited by P.A. Gevenois and A. Bankier Number 1 in this Series Imaging guided thoracic interventions B. Ghaye, R.F. Dondelinger Imaging guided thoracic interventions. B. Ghaye, R.F. Dondelinger. #ERS Journals Dept of Medical Imaging, University Ltd 2001. Hospital Sart Tilman, LieÁge, Belgium. ABSTRACT: Interventional Radiology is a technique based medical specialty, using all available imaging modalities ¯uoroscopy, ultrasound, computed tomography, magnetic Correspondence:B. Ghaye, Dept of Medical Imaging, University Hospital resonance, angiography)for guidance of interventional techniques for diagnostic or Sart Tilman B 35, B-4000 LieÁge, therapeutic purposes. Belgium. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides Fax:32 43667772 ®ne needle aspiration. Any pleural, pulmonary or mediastinal ¯uid or gas collection is amenable to percutaneous pulmonary catheter drainage. Keywords:Arteries Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, interventional radiology transcatheter embolization of pulmonary arteriovenous malformations and pseudoa- stents neurysms, angioplasty and stenting of the superior vena caval system and percutaneous therapeutic blockade thorax foreign body retrieval are well established routine procedures, precluding unnecessary transthoracic biopsy surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being Received:October 10 2000 considered for endobronchial stenting. Many procedures can be performed on an Accepted after revision December 27 outpatient basis, thus increasing the cost-effectiveness of radiologically guided 2000 interventions in the thorax.
    [Show full text]
  • East Multicenter Study Proposal
    EAST MULTICENTER STUDY PROPOSAL GENERAL INFORMATION Study Title: Hemothorax Management and Outcomes in Blunt and Penetrating Trauma Primary investigator / Senior researcher: Jeremy Cannon, MD, SM, FACS Co-primary investigator: Mark Seamon, MD, FACS BACKGROUND AND SIGNIFICANCE Use this area to briefly (1-2 paragraphs only) outline the burden of the problem to be examined: The true incidence and outcomes of traumatic hemothorax remains unknown. The landmark study by the AAST Retained Hemothorax Study Group described the management course in these patients once a retained hemothorax has been identified. However, management during the index presentation with a hemothorax remains poorly quantified. In addition, interventions which might mitigate the progression of a hemothorax to either a retained hemothorax or empyema have not been fully characterized. Presently, the non-perative management options for primary traumatic hemothorax include observation, open tube thoracostomy, percutaneous/small-bore tube thoracostomy, or Yankauer-assisted evacuation (i.e. “YATS”). To fully characterize the ideal management strategy for hemothorax following blunt or penetrating trauma, the natural history of this disease needs to be captured from initial presentation through to post-discharge follow-up. The specific aims of this multicenter study are: Primary aim: We aim to fully characterize the incidence and outcomes of hemothorax management in blunt and penetrating trauma. Hypothesis: YATS results in fewer moderate to large retained hemothorax as compared to all other non-operative techniques Secondary aims: Any secondary aims should be stated here: 1 EXPERIMENTAL DESIGN/METHODS Inclusion Criteria: Any age, blunt or penetrating trauma resulting in a hemothorax of any size on initial Chest CT on the day of admission for trauma.
    [Show full text]