A case of lobectomy after an emergency thoracotomy for tension hemothorax by penetrating thoracic injury

Abstract

A 79-year-old man was stabbed in the left back with a sharp knife and was transported to our hospital by ambulance. On admission, he went into shock, but soon recovered after extensive infusion. We diagnosed a left hemothorax by chest X-ray. About 2000 ml of hemorrhagic pleural effusion was released when we inserted a thoracic drainage tube into the left thoracic cavity. Chest enhanced computed tomography showed pleural effusion in the left thoracic cavity and leakage of contrast medium from the left lower lobe to the thoracic cavity. We diagnosed a hemothorax caused by left lung damage. He immediately went into shock again. We decided to perform an emergency operation. He underwent cardiac arrest when he reached the operating room. Because of a blockage in the drainage tube, we suspected a tension hemothorax. So, we urgently performed a thoracotomy in the supine position and removed the massive hematoma. The heartbeat was restarted and he recovered from shock. We performed a left lower lobectomy for hemostasis at the right lateral decubitus. He was discharged without complications. We report this case including consideration of other cases of chest injures that we have managed at our hospital.