c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Penetrating Thoracic Trauma: 13

A D V E R T I S E M E N T

   
 

Injuries to the pulmonary hilum (see pulmonary hilum) can be difficult to control. The left pulmonary hilum is shown. Division of the inferior pulmonary ligament is necessary to gain circumferential control. The inferior pulmonary ligament must be divided with care at its cephalad end where it splits around the inferior pulmonary vein. In the face of major hemorrhage, the pulmonary hilum may be temporarily occluded en masse with a large vascular clamp. Twisting the entire hilum 180 degrees can also achieve temporary control. Intrapericardial control of the pulmonary artery can then be accomplished. With massive injury, rapid pneumonectomy may be indicated. Left exposure also provides the best exposure of the descending aorta and distal esophagus.   

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Penetrating Thoracic Trauma: 14

A D V E R T I S E M E N T

   
 

The right pulmonary hilum is shown. Optimal exposure of both pulmonary hila is obtained with posterolateral thoracotomies, but such incisions are not adequate exploratory incisions in an unstable patient, and should only be used if specific injuries are suspected in a stable patient. If ligation of a pulmonary lobar vein is necessary, the lobe should be resected.      

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Penetrating Thoracic Trauma: 15

A D V E R T I S E M E N T

   
 

Exposure of the right pulmonary hilum and azygous vein. Injury to the azygous vein can be potentially lethal, and the injured vein should be suture ligated. Azygous injury should raise the suspicion of associated mid-esophageal injury (see Ivor-Lewis esophagectomy).  

References:

1. Townsend: Sabiston Textbook of Surgery, 16th ed., 327-330.

2. Hoyt, RV et al, Anatomic exposures for vascular injuries, Surgical Clinics of North America, 81:6 , December 2001, W. B. Saunders Company. 

3. Wall Jr, MJ, et al, Thoracic aortic and thoracic vascular injuries, Surgical Clinics of North America, 81:6 December 2001, W. B. Saunders Company. 

4. Taghavi S. Initial experience with two sequential anterolateral thoracotomies for bilateral lung transplantation. Ann Thorac Surg. 01-May-1999; 67(5): 1440-3.   

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This page was last modified on 3/22/2002.