Intensive Care Med (2015) 41:134–135 DOI 10.1007/s00134-014-3495-1
Jean-Michel Maury Loraine Deslandes Sophie Oheix Jean-Stephane David
IMAGING IN INTENSIVE CARE MEDICINE
Acute traumatic right pulmonary artery rupture in blunt trauma
Received: 2 September 2014 Accepted: 10 September 2014 Published online: 18 September 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 J.-M. Maury ()) L. Deslandes Department of Lung, Heart Lung Transplantation and Thoracic Surgery, Service de Chirurgie Thoracique, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron Cedex, France e-mail: [email protected] Tel.: 33.472357590 S. Oheix J.-S. David Department of Anesthesia and Critical Care, Trauma and Emergency Surgery Unit, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Benite Cedex, France
A 51-year-old man was admitted to our trauma center immediately after suffering a high velocity motor vehicle accident without a seat belt. His medical history reported chronic tobacco use with COPD II and emphysema as well as chronic alcohol intoxication without cirrhosis. Clinical examination showed a hemodynamically stable patient with left thoracic chest wall pain. A body CT scan revealed multiple left rib fractures associated with an extremely rare rupture of the origin of the right pulmonary artery without right main bronchus lesions. 3D reconstruction showed an image of a false aneurysm (Fig. 1). The patient was immediately transferred to the operating room for surgical repair with a normothermic heart-beating cardiopulmonary bypass. Perioperative observation confirmed the initial diagnosis
Fig. 1 3D CT scan (a) of the chest showing a pseudoaneurysm of the right pulmonary artery (white arrow). Native image (b) with a pseudoaneurysm (black arrow)
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After a very short stay in ICU, a control CT scan revealed a complete repair of the vascular injury without stenosis and the patient was discharged from hospital to a rehabilitation center on day 15. Conflicts of interest None. Ethical standard According to ethical practices, consent was obtained for use of information and images, and the patient’s identity has been kept confidential. Patient consent
Fig. 2 Circumferential right pulmonary artery rupture (black arrow) during surgery
but with a more severe injury than shown by CT scan. An isolated complete transection of the origin of the right pulmonary artery was observed (Fig. 2) and repaired by means of end-to-end anastomosis.
Obtained.
Jean-Michel Maury Loraine Deslandes Sophie Oheix Jean-Stephane David
IMAGING IN INTENSIVE CARE MEDICINE
Acute traumatic right pulmonary artery rupture in blunt trauma
Received: 2 September 2014 Accepted: 10 September 2014 Published online: 18 September 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 J.-M. Maury ()) L. Deslandes Department of Lung, Heart Lung Transplantation and Thoracic Surgery, Service de Chirurgie Thoracique, Louis Pradel Hospital, Hospices Civils de Lyon, 69500 Bron Cedex, France e-mail: [email protected] Tel.: 33.472357590 S. Oheix J.-S. David Department of Anesthesia and Critical Care, Trauma and Emergency Surgery Unit, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Benite Cedex, France
A 51-year-old man was admitted to our trauma center immediately after suffering a high velocity motor vehicle accident without a seat belt. His medical history reported chronic tobacco use with COPD II and emphysema as well as chronic alcohol intoxication without cirrhosis. Clinical examination showed a hemodynamically stable patient with left thoracic chest wall pain. A body CT scan revealed multiple left rib fractures associated with an extremely rare rupture of the origin of the right pulmonary artery without right main bronchus lesions. 3D reconstruction showed an image of a false aneurysm (Fig. 1). The patient was immediately transferred to the operating room for surgical repair with a normothermic heart-beating cardiopulmonary bypass. Perioperative observation confirmed the initial diagnosis
Fig. 1 3D CT scan (a) of the chest showing a pseudoaneurysm of the right pulmonary artery (white arrow). Native image (b) with a pseudoaneurysm (black arrow)
135
After a very short stay in ICU, a control CT scan revealed a complete repair of the vascular injury without stenosis and the patient was discharged from hospital to a rehabilitation center on day 15. Conflicts of interest None. Ethical standard According to ethical practices, consent was obtained for use of information and images, and the patient’s identity has been kept confidential. Patient consent
Fig. 2 Circumferential right pulmonary artery rupture (black arrow) during surgery
but with a more severe injury than shown by CT scan. An isolated complete transection of the origin of the right pulmonary artery was observed (Fig. 2) and repaired by means of end-to-end anastomosis.
Obtained.
