2017 Volume 31 Issue 1 Pages 36-40
A woman in her forties was brought to our critical care center in shock after a 3-story fall. Blunt force trauma was observed on the anterior aspect of the thorax and a FAST exam revealed fluid collection only in the left thoracic cavity. Contrast-enhanced computed tomography demonstrated multiple facial fractures, a pneumomediastinum, left hemopneumothorax and pulmonary contusion, right hepatic injury and a left ischiopubic fracture. During transarterial embolization for post-traumatic extravasation from the bilateral hepatic and external carotid arteries, continuous evacuation of blood was observed from the left thoracostomy tube, and therefore, an emergency left lateral thoracotomy was performed, whereby an active hemorrhage from the pulmonary contusion was identified and partially resected. Further bleeding from the dorsal aspect of the heart was noted and subsequently diagnosed as a rupture of the left atrial roof complicated by pericardial injury. Hemostasis was achieved using a pericardial patch and surgical sealant to seal off the transverse pericardial sinus, which ultimately saved the patient's life. The post-operative course was uneventful and the patient was stabilized and transferred to another hospital 61 days postoperatively. The method described in this report is an effective treatment option in cases such as this where the use of heart-lung machines is considerably restricted.
