Picture quiz: Chest trauma
BMJ 2007; 335 doi: https://doi.org/10.1136/sbmj.0709322 (Published 01 September 2007) Cite this as: BMJ 2007;335:0709322
- Chetan S Modi, clinical fellow in trauma1,
- A Alani, senior house officer in trauma2,
- Gwyn S Williams, cardiothoracic senior house officer2,
- Patrick Yiu, consultant cardiothoracic surgeon2
- 1Leicester Royal Infirmary
- 2New Cross Hospital, Wolverhampton
A 35 year old man presented at the emergency department with a penetrating chest injury. He was involved in an alleged assault that resulted in a screwdriver being thrust into his sternum. He had no other associated injuries. Initial assessment showed that he was haemodynamically stable with no signs of respiratory distress. The screwdriver was left in place. Chest radiographs taken in the emergency department confirmed the penetrating chest injury (fig 1).
Chest radiograph taken in the emergency department
(1) What can you see on this chest radiograph (fig1)? Is this an adequate view?
(2) What are the potential worries with this patient?
(3) Should the screwdriver be removed straight away?
Answers
(1) This anteroposterior chest radiograph shows a foreign body within the thoracic cavity. There is a normal cardiac shadow but no signs of pneumothorax or pleural effusion. Although this rules out various important sequelae of chest injury, it does not identify the anatomical path of the foreign body. A lateral chest radiograph taken at the same time is shown in fig 2.
The radiograph shows the foreign body has penetrated the body of the sternum and is butting against the cardiac shadow. The pericardium and, of more concern, the right ventricle are potentially injured.
(2) Several potential complications may arise as a result of this injury:
Pleural injury–Pneumothorax (simple or tension), haemothorax, haemopneumothorax, and pulmonary contusion.
Cardiac injury–Cardiac arrhythmias, cardiac tamponade, and intracardiac injury.
Other Injuries–Diaphragmatic injury and injury to the great vessels.
(3) Removing the screwdriver at this stage could prove fatal, …
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