GSW TO RIGHT CHEST. CT angiographic images

[SJASMD at aol.com]

Here is the composite of the vessels from neck to arch
 
sal
 
In a message dated 8/31/2007 9:53:21 P.M. W. Europe Daylight Time,  
mgreeds at reeds.uk.com writes:

Having  now read others comments on this case (and Sal's further info and rpt
CXR),  my further observations are:-



1.    Obvious surgical  emphysema on left side of rpt CXR (I cannot see
this on the previous CXR -  may be due to the poor quality of images on my
mobile) I presume this to be  evolving/rapidly developing. Is this a correct
assumption?;
2.   Bullet on left side - makes me  question
tracheal/bronchial/oesophageal/cardiac/pulmonary/aortic injury.  Assuming
patient is haemodynamically stable, I would first evaluate for  an
oesophagheal and tracheal injury and proceed from there;
3.   Surgical emphysema would lead me to question a  broncho-pleural
fistula - did the patient show any sign of  this?;
4.    Regarding the persistent haemothorax - is the right  ICD still
draining? If so, what is the content/output? Is it draining  adequately or
does it need replacing/resiting? What are the patient's  current
observations? I would like to know this before I would decide what  to do
next.



For now I shall wait and observe. I would not  wish to proceed to
thoracotomy/sternotomy at this point (based solely on  the current
information.) I would maintain that to perform either procedure  merely to
retrieve the bullet is inappropriate and not in the patient's  best interests
(unless there are good CLINICAL reasons for doing  so.)



As a side issue, what are the list's views on sternotomy  -v- thoracotomy and
the indications for each? If surgery is required, which  would people perform
and why?



I shall read with interest  further comments from the list.







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