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Ann Thorac Surg 2004;77:755
© 2004 The Society of Thoracic Surgeons

Correspondence

Blunt chest trauma and tube thoracostomy: Reply

Jacques T. Janson, FCS (SA), David G. Harris, FCS (SA), Johann Pretorius, MMed (Thor), Gawie J. Rossouw, FCS (SA)

Department of Cardiothoracic Surgery, Tygerberg Hospital, University of Stellenbosch, Faculty of Medicine, PO Box 19173 Tygerberg 7505, South Africa

e-mail: jjanson{at}absamail.co.za

To the Editor:

We thank Dr Tekeli and Akgun for their comments regarding our article [1]. In general, our policy for tube thoracostomy in blunt chest trauma follows the guidelines of the Committee on Trauma of the American College of Surgeons [2].

The right intercostal drain was placed because of multiple rib fractures and a lung contusion. The patient also had subcutaneous emphysema on the right chest wall that was felt clinically and could be seen on the chest roentgenogram [1]. Positive-pressure ventilation was required, and the right chest drain would prevent a possible tension pneumothorax.

We agree that the left chest drain was unnecessary. The patient was referred to our department after the bilateral chest drains had been placed and the heart had herniated into the right hemithorax from the pericardial rupture. The doctor on duty in the trauma unit, who placed the chest drains, was concerned about the surgical emphysema and a possible large airway injury. The pneumopericardium next to the left heart border was initially misinterpreted as a left medial pneumothorax. The right chest drain bubbled with ventilation, but the left chest drain only swung and drained very little. The latter drain was removed after 48 hours without complications.

References

  1. Janson J.T., Harris D.G., Pretorius J., Rossouw G.J. Pericardial rupture and cardiac herniation after blunt chest trauma. Ann Thorac Surg 2003;75:581-582.[Abstract/Free Full Text]
  2. Alexander RH, Proctor HJ, eds. Thoracic trauma. In: Advanced trauma life support course for physicians. Chicago: American College of Surgeons, 1993:123–5




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