Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.

• Klíčová slova
• blunt thoracic injury, chest drainage, hemothorax, trauma-induced aortic rupture,
• MeSH
• hemotorax * diagnostické zobrazování   etiologie   chirurgie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• ruptura aorty * komplikace   diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.

• Klíčová slova
• VATS, complications, endovenous laser ablation, hemothorax, varicose veins of lower extremities,
• MeSH
• hemotorax * etiologie   MeSH
• katetrizační ablace * MeSH
• laserová terapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• migrace cizích těles * komplikace   MeSH
• pánev MeSH
• varixy * terapie   MeSH
• vena saphena MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Cardiac injury following blunt chest trauma is common in motor vehicle accidents due to a crush or blast injury. Severe cardiac trauma is associated with a very high mortality. If a cardiac injury develops several weeks after non-penetrating chest trauma, establishing a causal link between the traumatic event and the cardiac injury becomes complicated. This article reports a case of fatal delayed hemopericardium and hemothorax following a motor vehicle accident including blunt chest trauma 34 days prior to death. The cardiac injury was caused by displacement of a sharp irregular fragment of one of the decedents fractured ribs and the primary defect was sealed by blood clots. Subsequent bleeding occurred when the thrombus was displaced. Since the incidence of blunt high-energy chest injuries is relatively high, heart and large vessel injuries must be taken into account and a comprehensive examination needs to be done in order to prevent the delayed development of fatal complications.

• Klíčová slova
• Blunt trauma, Cardiac injury, Delayed hemopericardium, Delayed hemothorax, Stab wound,
• MeSH
• časové faktory MeSH
• chodci MeSH
• dopravní nehody MeSH
• fraktury žeber komplikace   patologie   MeSH
• hemoragický šok etiologie   MeSH
• hemotorax etiologie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• perikardiální efuze etiologie   patologie   MeSH
• poranění hrudníku komplikace   MeSH
• srdeční komory zranění   patologie   MeSH
• trombóza patologie   MeSH
• tupá poranění komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Spontaneous hemothorax is a well-known yet seldom-reported entity in forensic literature. While trauma-related hemothorax is frequently encountered in a medicolegal setting, non-traumatic and spontaneous hemothorax are relatively uncommon entities. The wide range of causes that can trigger fatal intrathoracic bleeding include thoracic aortic dissection, followed by vascular malformations, various oncological diseases, and connective tissue abnormalities. In rare instances, extramedullary hematopoiesis, ectopic pregnancy, congenital heart defects, amyloidosis, or parasitic diseases may constitute a source of bleeding. This etiological heterogeneity may, as a result, cause diagnostic difficulties during post-mortem elucidation of hemothorax. It should be borne in mind that hemothorax after low-energy trauma does not exclusively indicate traumatic hemorrhage, hence, the non-traumatic origin of bleeding must be taken into consideration. In this paper, we present a systematic review of the relevant literature enriched by the results of our observations to investigate the etiologies and recommendations for the post-mortem diagnosis of spontaneous hemothorax in an attempt to better delineate the possible medicolegal considerations. It is important that forensic pathologist as well as clinicians are aware of the diseases that could potentially give rise to fatal hemothorax.

• Klíčová slova
• Diagnostics, Etiology, Post-mortem evaluation, Spontaneous hemothorax, Sudden death,
• MeSH
• amyloidóza komplikace   MeSH
• cévní malformace komplikace   MeSH
• disekce aorty komplikace   MeSH
• echinokokóza plic komplikace   MeSH
• Ehlersův-Danlosův syndrom komplikace   MeSH
• endometrióza komplikace   MeSH
• exostózy komplikace   MeSH
• hemotorax etiologie   patologie   MeSH
• kardiopulmonální resuscitace škodlivé účinky   MeSH
• krevní nemoci komplikace   MeSH
• lidé MeSH
• nádory komplikace   MeSH
• nemoci hrudníku komplikace   MeSH
• pneumotorax komplikace   MeSH
• prasklé aneurysma komplikace   MeSH
• soudní patologie MeSH
• vrozené srdeční vady komplikace   MeSH
• žebra MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

Aortic arch blunt injury has highly lethal nature. Because the physical examination findings are subtle, immediate medical evaluation is very important. The case was a 72-year-old woman. Massive haemorrhage in the left haemotorax, contusion area in the left lung and a traumatic transection of the distal aortic arch was observed during autopsy. We described intersting autopsy case of aortic arch blunt injury.

• MeSH
• aorta thoracica zranění   MeSH
• dopravní nehody * MeSH
• fatální výsledek MeSH
• hemotorax diagnóza   etiologie   patologie   MeSH
• lidé MeSH
• pitva MeSH
• polytrauma diagnóza   etiologie   patologie   MeSH
• senioři MeSH
• tupá poranění diagnóza   etiologie   patologie   MeSH
• zhmoždění diagnóza   etiologie   patologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Cardiac ventricle perforation by a pacemaker (PM) lead is an uncommon complication of PM implantation. We report a patient with a delayed right ventricular perforation from a permanent PM lead which presented as a left hemothorax.

• MeSH
• biokompatibilní materiály MeSH
• cizí tělesa diagnóza   etiologie   chirurgie   MeSH
• defibrilátory implantabilní škodlivé účinky   MeSH
• dilatační kardiomyopatie terapie   MeSH
• hemotorax diagnóza   etiologie   chirurgie   MeSH
• implantované elektrody škodlivé účinky   MeSH
• kardiogenní šok diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• odstranění implantátu MeSH
• perikard zranění   MeSH
• pleura zranění   MeSH
• počítačová rentgenová tomografie MeSH
• polytetrafluoroethylen MeSH
• senioři MeSH
• šicí techniky MeSH
• srdeční komory zranění   MeSH
• srdeční selhání terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• biokompatibilní materiály MeSH
• polytetrafluoroethylen MeSH

Extensive traumatic haemothorax is a life-threatening condition that requires the surgeon's resolute approach. Massive bleeding may first lead to hypovoleamic shock, then to haemorrhagic shock. The most common sources are bleeding from the chest wall (intercostal artery), bleeding when the lung parenchyma or major intrathoracic vessels are injured. The case report describes a rare case of massive right-sided haemothorax in pericardial rupture with cardiac herniation in a patient with polytrauma when the source of bleeding was artery pericardium. The report draws attention to the treacherousness of the diagnosis in a polytraumatised patient; the report retrospectively evaluates the interpretation of imaging examinations that were carried out

• MeSH
• dopravní nehody MeSH
• hemotorax etiologie   MeSH
• lidé MeSH
• perikard zranění   MeSH
• poranění hrudníku komplikace   MeSH
• poranění srdce komplikace   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Haemothorax is frequent consequence of blunt and penetrating thoracic trauma and is usually associated with pneumothorax. The occurence of haemothorax in blunt thoracic trauma patients is estimated between 25-75%. The reason of bleeding is impairment of intercostal arteries or lung parenchyma after trauma of the ribs. Uncontrolled bleeding is the main cause of the death. The article is focused on the treatment of this injury. MATERIAL AND METHODS: There were enrolled 238 patients with thoracic trauma, who were admitted into our department, into the study. The average age of the patients was 42.5 years. The ISS > or = 16 were in 101 patients. Forty two patients were artefitially ventilated. Conservative treatment prevails, almost in 65%. Special care was indicated in patients with haemothorax (fluidotoraxem). RESULTS: Clinically and based on other screening methods the presence of the fluid in thoracic cavity was in 131 patients. Surgical treatment (punction, drainage, videothoracoscopy and thoracotomy) was necessary in 47 (35.0%). Thoracotomy for the bleeding was indicated in seven cases (5.3 %). CONCLUSION: In diagnostics and in treatment of the bleeding in thoracic trauma patients the most important factor is clinical status of the patient. Indication for thoracotomy must be unambigous. Massive haemotorax leads to restrictive ventilation disorder with decreased preload and can be activator of the haemocolaguation disorders. This fact decreases chance for the survival of the patient.

• MeSH
• dospělí MeSH
• hemotorax diagnóza   etiologie   chirurgie   MeSH
• lidé MeSH
• poranění hrudníku komplikace   chirurgie   MeSH
• tupá poranění komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION: Cannulation v. subclavia is connected with many complications. Haemothorax is occurs approximately in 2% of cases. Surgical revision is indicated immediately if a major blood loss or a circulation insufficiency occur. Surgical treatment of bleeding in cupola of pleural cavity is due to its bad accesability difficult and conventional surgical methods aren't sufficient. In these cases one can use local haemostyptic. CASE REPORT: The authors present a case review of a 36-years old patient with a developed massive haemothorax on the left side post a catheterization of v. subclavia. During surgical revision it was found out that a source of bleeding in superior thoracic aperture is present. It wasn't able to be stopped by classical surgical procedure. TachoSil and Arista preparations were used in this case with a good effect.

• MeSH
• dospělí MeSH
• hemotorax etiologie   chirurgie   MeSH
• katetrizace centrálních vén škodlivé účinky   MeSH
• lidé MeSH
• vena subclavia * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The authors present a case report of bleeding from the small dissection of descending aorta. Patient, 71 year old woman, with severe comorbidities (nephrotic syndrome based on membraneous glomerulonephritis, diabetes mellitus, lung emphysema, hepatopathy, polyneuropathy and others). One month after last stay in hospital chemotherapy et corticotherapy. In while on heparin during hospitalization at nephrologic department, patient developed right side haemothorax and haemomediastinum. An urgent transfer to surgical department with cardiopulmonary resuscitation was performed. The suspection of aneurysm on CT angioscan was non confirmed. The damage of oesophagus due to previous endoscopy (for chest pain) was non confirmed, too. During surgery masive sanquine effusion of mediastinum and right side haemothorax was found. The drainage and redrainage of the chest was performed. The cause of bleeding was not found. Critically ill patient had died and on autopsy a small dissection of thoracic aorta was found as a cause of bleeding. The problems of diagnosis and therapy are discussed. (Fig. 2, Ref. 7.)

• MeSH
• aneurysma hrudní aorty komplikace   diagnóza   MeSH
• disekce aorty komplikace   diagnóza   MeSH
• hemotorax etiologie   MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH