Case 309 Medical history Male patient, 68yo, taken by SAMU to the Emergency Department, after being hit by a car. He was admitted with cervical collar, complaining of pain in the left hemithorax. There was no loss of consciousness or vomiting. At examination: patent airways, hemodynamic stability, without neurological changes. FAST (Focused Assessment with Sonography for Trauma) showed no evidence of viscera lesion and no free fluid in the abdominal cavity. Chest X-ray was requested and, later, computed tomography (CT) of the chest. Image 1: Simple chest radiography, posteroanterior incidence, orthostatic position. Image 2: Chest CT, axial cut, supracarinal level, mediastinal window, without intravenous injection of iodinated contrast medium. Image 3: Chest CT, axial cut, infracarinal level, lung window, without intravenous injection of iodinated contrast medium. Question:Based on clinical history and imaging tests, in addition to costal arch fractures, one can diagnose: a) Pulmonary laceration b) Pneumomediastinum c) Subcutaneous emphysema d) Hemothorax Test question Question:(UFF-2014) Regarding post-traumatic hemothorax, it is correct to state that: a) 15 to 20% of the patients can be treated with only drainage in water seal. b) Persistence of bleeding, after drainage in water seal, at a rate of 50 ml/hour for three to four consecutive hours is a formal indication of thoracotomy. c) Most of bleeding in the thorax is a result of lesions in the low pressure pulmonary circulation. d) Massive hemothorax is, by definition, the one in which at least 500 ml of blood is drawn after thoracic drainage. e) At physical examination, the majority of the patients usually present a decrease of the vesicular murmur and hypertimpanism to percussion of the injured lobe. Time is Up! Time's up
