抄録
A 56-year-old man caught between a farm tractor and a tree was brought by ambulance 20 minutes after thoracic trauma. In the emergency room, his blood pressure was 117/70mmHg, heart rate 140 beats/minute, respiratory rate 36 breaths/minute, and GCS score 11. He showed jugular vein dilation, absence of the right breath sound, and abnormal respiratory movements associated with right chest wall instability. He had flail chest and tension pneumothorax. Emergency thoracostomy was conducted and 350ml of blood drained initially and 500ml each consecutive 40 minutes. Immediate thoracotomy done in the operating room showed complete transection of the azygos vein in front of the dislocated 5th thoracic vertebra. Both distal and proximal ends of the azygos were ligated. We found only 23 cases, including ours, of azygos vein injury due to blunt trauma, most due to motor vehicle accidents. Sudden deceleration plays an important role in etiology. Our patient drove a tractor, and did not appear to sustain abrupt force. We assume that the azygos vein was torn by direct shear force from vertebra, a possibility to be kept in mind in diagnosing such trauma.
