Rubber bullets and pellet guns are considered non-lethal low-velocity weapons. They are used to disperse a mob during street protests. The present study was undertaken to analyze the pattern, presentation and management of vascular injuries caused by these weapons.
Patients and Methods:
This was a prospective study of patients with features of vascular injuries due to pellets and rubber bullets from June 2010 to November 2010. All patients with features of vascular injuries due to these non-lethal weapons were included in the study. Vascular injuries caused by other causes were excluded from the study.
A total of 35 patients who presented with features of vascular injury during this period were studied. All of them were males. The mean age was 22 years. Fifteen patients were revascularized primarily, 19 patients needed reverse saphenous vein graft and, in one, patient lateral repair was done. There were two mortalities in our series. Wound infection was the most common complication. The amputation rate was around 6%.
Pellet and rubber bullets can cause serious life-threatening injuries. Vascular injury caused by these weapons need no different approach than other vascular injuries. Early revascularization and prompt resuscitation prevents the loss of limb or life.
Pellet; rubber bullet; vascular injury
The aim of this study is to investigate the characteristics of patients experience cardiopulmonary arrest (CPA) in the acute phase following aortic dissection and aneurysm (AD).
Materials and Methods:
Patients who were transported to this department from January 2005 to December 2010 and subsequently diagnosed with AD were included in this study. Patients with asymptomatic AD or those with AD that did not develop CPA were excluded. The AD was classified into four categories: Stanford A (SA), Stanford B (SB), thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). The frequency of witnessed collapse, gender, average age, past history including hypertension, vascular complications and diabetes mellitus, the initial complaint at the timed of dissection, initial electrocardiogram at scene, classification of CPA and survival ratio were compared among the patient groups.
There were 24 cases of SA, 1 case of the SB, 8 cases of ruptured TAA and 9 cases of ruptured AAA. The frequency of males among all subjects was 69%, the average age was 72.3 years old and the frequency of hypertension was 47.6%. There was no ventricular fibrillation (VF) when the patients with AD collapsed. A loss of consciousness was the most common complaint. The outcome of the subjects was poor; however, three patients with SA achieved social rehabilitation. Two out of the three had cardiac tamponade and underwent open heart massage.
The current study revealed that mortality of cardiac arrest caused by the AD remains very high, even when return of spontaneous circulation was obtained. VF was rare when the patients with AD collapsed. While some cases with CPA of SA may achieve a favorable outcome following immediate appropriate treatment.
Aneurysm; aortic dissection; cardiopulmonary arrest
The three pillars of a good trauma system are the prehospital care, definitive care, and rehabilitative services. The prehospital care is a critical component of the efforts to lower trauma mortality.
To study the prehospital profile of patients who died due to trauma, compute the time taken to reach our facility, find the cause of delay, and make feasible recommendations.
Materials and Methods:
A hospital-based study was performed at a trauma center in Puducherry from June 2009 to August 2010. Puducherry is a union territory of India in the geographical terrain of the state of Tamil Nadu. A total of 241deaths due to trauma were included. Apart from the demographic and injury characteristics, a detailed prehospital log was constructed regarding the time of incident, the referral patterns, care given in the prehospital phase, the distance travelled, and the total time taken to reach our center.
The majority (59%) of patients were referred, with stopovers at two consecutive referral centers (30%), needing at least two vehicles to transport to definitive care (70%), clocking unnecessary distances (67%), and delayed due to non therapeutic intervention (87%). The majority of deaths (66%) were due to head injury. Only 2.96% of referred cases reached us within the first hour. Few of the patients coming directly to us had vehicle change due to local availability and lack of knowledge of predestined definitive care facility. Overall, 94.6% of direct cases arrived within 4 h whereas 93.3% of referred cases required up to 7 h to arrive at definitive care.
Seriously injured patients lose valuable prehospital time because there is no direction regarding destination and interfacility transfer, a lack of seamless transport, and no concept of initial trauma care. The lack of direction is compounded in geographical areas that are situated at the border of political jurisdictions.
Prehospital care; prehospital time; referrals; trauma death
Tissue injury increases blood levels of extracellular histones and nucleic acids, and these may influence hemostasis, promote inflammation and damage the endothelium. Trauma-induced coagulopathy (TIC) may result from an endogenous response to the injury that involves the neurohumoral, inflammatory and hemostatic systems.
To study the contribution of extracellular nucleic constituents to TIC, inflammation and endothelial damage.
Setting and Design:
Prospective observational study.
Materials and Methods:
We investigated histone-complexed DNA fragments (hcDNA) along with biomarkers of coagulopathy, inflammation and endothelial damage in plasma from 80 trauma patients admitted directly to the Trauma Centre from the scene of the accident. Blood was sampled a median of 68 min (IQR 48-88) post injury. Trauma patients with hcDNA levels >median or ≤median were compared.
Trauma patients with high plasma hcDNA had higher Injury Severity Score (ISS) and level of sympathoadrenal activation (higher adrenaline and noradrenaline) and a higher proportion of prolonged activated partial thromboplastin time (APTT) and higher D-dimer, tissue-type plasminogen activator (tPA), Annexin V and soluble CD40 ligand (sCD40L) concurrent with lower plasminogen activator inhibitor (PAI)-1) and prothrombin fragment (PF) 1 + 2 (all P < 0.05), all indicative of impaired thrombin generation, hyperfibrinolysis and platelet activation. Furthermore, patients with high hcDNA had enhanced inflammation and endothelial damage evidenced by higher plasma levels of terminal complement complex (sC5b-9), IL-6, syndecan-1, thrombomodulin and tissue factor pathway inhibitor (all P < 0.05).
Excessive release of extracellular histones and nucleic acids seems to contribute to the hypocoagulability, inflammation and endothelial damage observed early after trauma.
Coagulopathy; deoxyribonucleic acid; histones; nucleic acids; tissue injury; trauma
An increase in abdominal pressure can lead to so-called intra–abdominal compartment syndrome (ACS). Multiple factors such as an increase in retroperitoneal volume due to pancreatitis, bleeding and edema as a result of pelvic fracture can lead to compartment syndrome. Prevention is better than cure in compartment syndrome. By measuring the intra-abdominal pressure (IAP) through the bladder, a quick and accurate assessment of abdominal pressure is achieved. Therefore, this study aimed to evaluate the relationship between pelvic fracture and ACS in traumatic patients.
Materials and Methods:
This research was a descriptive–analytical study conducted on 100 patients referring to the Shiraz Nemazee Hospital in 2010. IAP was monitored every 4 h in patients suspected to be at high risk for ACS, e.g., those undergoing severe abdominal trauma and pelvic fracture. The IAP was measured via the urinary bladder using the procedure described by Kron et al. Data collected were analyzed using SPSS software.
The findings showed that ACS occurred in 28 of 100 patients. With regard to the associated injuries with abdominal trauma, 19% of all patients and 46/42% of the patients with ACS had pelvic fracture. Chi-square test revealed a significant relationship between pelvic fracture and incidence rate of ACS (P < 0.001).
According to the collected data, pelvic fracture due to a trauma can be one of the important causes of an increase in IAP and ACS. In this lethal condition, prevention is better than cure. Therefore, serial measurement of IAP through the bladder in high-risk patients (those with pelvic fracture by trauma) is recommended to the nurses to diagnose this condition and to decrease the incidence of mortality.
Abdominal compartment syndrome; pelvic fracture; trauma
Coagulopathy frequently occurs following traumatic brain injury (TBI) and usually occurs 6-72 hour post-trauma. The incidence and the probable risk factors for development of coagulopathy and poor outcome following TBI are largely unknown and vary considerably.
To assess the incidence and probable risk factors for development of coagulopathy and to identify the risk factors for poor outcome in terms of median survival time following TBI.
Materials and Methods:
In this prospective study over two years, patients of isolated moderate and severe traumatic brain injury (GCS≤12) admitted to trauma center had coagulation profile (PT, APTT, thrombin time, fibrinogen and D-dimer), arterial lactate and ABG analysis done on day of admission and on day three. Coagulopathy was defined as prothrombin time (PT) or/and activated partial thromboplastin time (APTT) more than 1.5 times the normal control. Incidence of in-hospital mortality was assessed in all cases.
A stepwise logistic regression analysis was performed to identify risk factors for coagulopathy and mortality in these patients.
A total of 208 patients were enrolled in the study. The mean age was 32 ± 12 years and mean GCS was 7.1 ± 2.8. Coagulopathy was present in 46% (n = 96) of patients. Risk factors for development of coagulopathy were found out to be severity of head injury (OR: 2.81), elevated D-dimer (OR: 3.43), low hemoglobin (OR: 3.13), and effaced cisterns in the CT scan (OR: 2.72). Presence of coagulopathy (OR: 2.97) and severity of head injury (OR: 5.70) strongly predicted poor outcome, and were associated with a decreased median survival time.
There is a high incidence of coagulopathy following TBI. The presence of coagulopathy as well as of severity of TBI are strong predictors of in-hospital mortality in these patients.
Coagulopathy; head trauma; outcome; prognosis; severity of head injury; traumatic brain injury
Missed or inappropriately-treated splenic injury is a significant cause of preventable trauma-related death. Physical examination and abdominal ultrasonography are essential tools for early diagnosis of splenic injury. However, some injuries may not be accurately diagnosed by ultrasonography at initial evaluation.
The aim of this study was to audit indications for splenectomy at the University College Hospital, Ibadan and to compare the intra-operative findings in trauma-related cases with the sonographic findings.
Materials and Methods:
We retrospectively reviewed all adult (12 years and older) patients’ records who had splenectomy between July 2003 and June 2010. The data extracted included patient demographics and indications for splenectomy. In trauma cases, the mode of injury and vital signs at presentation, sonographic findings, and operation findings were recorded. The intervals between injury and sonography and duration to surgery were also noted respectively.
Eighty-four patients were reviewed in the 7-year review period. The male to female ratio was approximately 2:1. The ages ranged from 14 to 76 years with a peak incidence in the third decade. Elective indications for splenectomy were 14 (16.6%), while 70 (83.3%) were emergency cases. Forty-four of the trauma-related patients had pre-operative abdominal ultrasound, of which 31 (70%) was reported as sonographically normal prior to surgery, while the rest of the trauma-related cases were considered too ill for ultrasonography.
Potentially significant injuries may be missed with screening sonography. For this reason, a physician must maintain a high index of suspicion and consider the patient's clinical status or an alternative imaging modality in excluding a diagnosis of splenic injury.
Sonography; spleen; trauma
Animal and molecular studies have shown that cocaine exerts a neuroprotective effect against cerebral ischemia.
To determine if the presence of cocaine metabolites on admission following traumatic brain injury (TBI) is associated with better outcomes.
Settings and Design:
Level-1 trauma center, retrospective cohort.
Materials and Methods:
After obtaining Institutional Review Board (IRB) approval, the trauma registry was searched from 2006 to 2009 for all patients aged 15-55 years with blunt head trauma and non-head AIS <3. Exclusion criteria were pre-existing brain pathology and death within 30 min of admission. The primary outcome was in-hospital mortality; secondary outcomes were hospital length of stay (LOS), and Glasgow Outcome Score (GOS).
Logistic regression was used to determine the independent effect of cocaine on mortality. Hospital LOS was compared with multiple linear regression.
A total of 741 patients met criteria and had drug screens. The screened versus unscreened groups were similar. Cocaine positive patients were predominantly African-American (46% vs. 21%, P < 0.0001), older (40 years vs. 30 years, P < 0.0001), and had ethanol present more often (50.7% vs. 37.8%, P = 0.01). There were no differences in mortality (cocaine-positive 1.4% vs. cocaine-negative 2.7%, P = 0.6) on both univariate and multivariate analysis.
Positive cocaine screening was not associated with mortality in TBI. An effect may not have been detected because of the low mortality rate. LOS is affected by many factors unrelated to the injury and may not be a good surrogate for recovery. Similarly, GOS may be too coarse a measure to identify a benefit.
Amphetamine; cocaine; traumatic brain injury
Our objective was to study the accuracy of emergency physician (EP) performed bedside ultrasonography (BUS) in patients with suspected anterior talofibular ligament (ATFL) injury.
Materials and Methods:
After a 6-h training program, from January to December 2011, an EP used BUS to prospectively evaluate patients presenting to the emergency department (ED) with suspected ATFL injury. Then, patients underwent ankle X-ray and Magnetic Resonance (MR) imaging. Outcome was determined by official radiology reports of the MR imaging. BUS and MR imaging results were compared using Chi-square testing.
Of the 65 enrolled patients, 30 patients were BUS positive. Of these, MR imaging results agreed with the BUS findings in 30 patients. In 35 cases, BUS was negative, and 33 of these were corroborated by MR imaging. The sensitivity, specificity, positive predictive value, negative predictive value, and negative likelihood ratio for BUS were 93.8%, 100%, 100%, 94.3%, and 0.06%, respectively. The diagnostic accuracy of BUS was not statistically different from MR imaging (K = 0.938, P = 0.001).
BUS for the diagnosis of ATFL injury is another application of BUS in the ED. EPs can diagnose ATFL injury using BUS with a high degree of accuracy.
Ankle; bedside ultrasonography; emergency; injury
Snake bite is a common medical emergency faced mainly by the rural populations in tropical and subtropical countries with heavy rainfall and humid climate. Although India is a single largest contributor of snake bite cases, reporting is very poor. There is hardly any publication of the same from Gujarat state that is developing at a good pace. Hence, we aimed to study the snake bite cases with particular attention to demography, epidemiology, and clinical profile.
Settings and Design:
The present descriptive, observational study was carried out at the Emergency Medicine Department of a tertiary care center in Ahmedabad, Gujarat. This department is one if the firsts to get recognized by the Medical Council of India.
Materials and Methods:
This is a cross-sectional single-center study. Cases were entered into the prescribed form, and detailed information regarding demographic, epidemiologic, and clinical parameters was entered.
Data were analyzed using Epi2000. Means and frequencies for each variable were calculated.
Majority (67.4%) of the snake bite victims were in the age group between 15 and 45 years. Majority were male victims (74.2%). 71% victims of snake bite lived in rural areas. Farmers and laborers were the main victims. 61.2% incidents took place at night time or early morning (before 6 a.m.). 64% patients had bite mark on the lower limb. 40% victims had seen the snake. Eight patients had snake bite, but were asymptomatic. 52% had neuroparalytic manifestation, 34% were asymptomatic, and 9.6% had hemorrhagic manifestation. 14% cases received treatment within 1 h of the bite and 64.84% within 1-6 h after the bite. First aid given was in the form of application of tourniquet (16.2%), local application of lime, chillies, herbal medicine, etc., (1%). 2.20% cases were sensitive to anti-snake venom. Only three patients died.
In this region (Gujarat), neuroparalytic manifestation of snake bite is more prevalent. Cobra and krait are the commonest types of poisonous snakes. The time of seeking treatment has reduced because of awareness about snake bite treatment and better transport and ambulance facility. Mortality is very less in well-equipped hospitals due to early initiation of treatment with anti-snake venom.
Anti-snake venom; first aid treatment; Gujarat; poisoning; snake bite
Allopurinol acts protectively in the ischemia reperfusion injury of the small intestine. The aim of this experimental study is to define the ideal time of administration of allopurinol, in experimental models of ischemia/reperfusion.
Materials and Methods:
We used 46 rabbits that were divided into four groups. Group A was the control. In Group B allopurinol was administered 10 min before ischemia and in Group C 2 min before reperfusion. In Group D, allopurinol was administered before ischemia and before reperfusion in half doses. Blood samples were collected at three different moments: (t1) prior to ischemia, (t2) prior to reperfusion, and (t3) after the end of the reperfusion, in order to determine superoxide dismutase (SOD) and neopterin values. Specimens of the intestine were obtained for histological analysis and determination of malondialdehyde (MDA).
In Group A, mucosal lesions were more extensive compared to those of the other three groups. Similarly, MDA, SOD and neopterin values were significantly higher. On the contrary, Group D showed the mildest mucosal lesions, as well as the lowest MDA, SOD and neopterin values. Finally, the lesions and the above mentioned values were bigger in Group C than in Group D.
The administration of allopurinol attenuates the production and damage effect of free oxygen radicals during ischemia reperfusion of the small intestine, thus protecting the intestinal mucosa. Its maximum beneficial action is achieved when administered both before ischemia and before reperfusion of the small intestine.
Allopurinol; allopurinol's timing; ischemia reperfusion injury; small intestine ischemia
Reduction in admissions is an important aim of emergency department working policy to overcome the problems of a shortage of inpatient beds, rising costs and exhausted resources. A new policy was instituted in the pediatric emergency department (PED) of a hospital in Kuwait with the following components: (1) assigning senior doctor staff (2) implementation of new disease management guidelines; and (3) maximizing the use of the pediatric emergency department observation unit.
to evaluate the effect of change in our policy on the admission rate.
Materials and Methods:
The effects of this policy on reduction of admission rates for total pediatric admissions and for some selected common pediatric conditions were prospectively studied over a period of 3 years from institution of the policy and compared with the 3-year period before the policy was instituted.
There was a significant reduction in admission rates after institution of the new policy. The proportion of hospital admissions to PED observation unit cases was significantly reduced as a whole from 64.9% ± 5.1% to 33.2 ± 0.6% and also for the common pediatric problems studied.
A multidisciplinary pediatric emergency department policy, using as much available evidence as possible, was successful in significantly reducing pediatric hospital admissions.
Change in emergency policy; pediatric admission; pediatric emergency
Transanal rectal injuries caused by foreign body insertion, sexual abuse, or iatrogenic procedures represent a very uncommon surgical emergency. Morbidity may be further increased by patient's embarrassment and delayed presentation. Since management decisions largely depend on anatomic and severity assessment, multidetector Computed tomography with rectally administered water-soluble iodinated contrast medium is highly valuable to accurately depict traumatic rectal injuries, and to distinguish between intraperitoneal vs extraperitoneal injuries that require different surgical approaches.
Computed tomography; contrast medium enema; foreign body; penetrating rectal trauma; rectal perforation; transanal rectal injury
The proposal for an integrated national emergency number for India is garnering a lot of enthusiasm and stimulating debate. This ambitious project has a two-part paradigm shift to set in; the first being the integration into a single number and the infrastructure required for setting up and operating this number such that a call can be received and identified. The second is the submerged part of the iceberg: That of the ability to respond to a call and deliver the appropriate emergency service. The first part is more technical and has potential precedents like the 911 phone hotline, for example, to emulate. The main premise of this paper is that the second part is a rather subjective exercise largely determined by the realities of existing public infrastructure in a specific geographical area with respect to emergency services management, especially medical care. Consequently, we highlight the key areas of both precall preparedness and postcall execution that need to be reviewed prior to going live with an integrated number on a national scale.
Integrated emergency communication reponse service; integrated national emergency number for India; national emergency number
The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.
Bowel entrapment; external fixator; pelvic injury
A 51-year-old woman was brought into the Emergency Department (ED) following an intentional overdose of alcohol and her medication. Along with two bottles of wine it was estimated that she had taken 5800 mg of Quetiapine and 240 mg of Citalopram along with the wine. The ambient temperature in her flat was thought to be 10°C. On arrival to the ED her GCS was 8. She had agonal respirations with a pulse of 56/min, hypotensive 55/35 mmHg and a temperature 24°C. The patient was intubated and was given sodium bicarbonate, magnesium sulphate, calcium gluconate and an adrenaline infusion. She received active and passive rewarming measures. She had significant ECG findings related to her hypothermia and polypharmacy overdose which seemed to have been cumulative. The patient recovered and the only neurological deficit was numbness in her left leg which was thought to be related to prolonged immobility. Hypothermia may have contributed to her good outcome as hypothermia has been shown to improve both cardiac and neurological outcome.
Electrocardiogram; hypothermia; toxicology
Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries.
Materials and Methods:
The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome.
Twenty-three patients met inclusion criteria: 3 (13%) following blunt injury and 20 (87%) after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days.
Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.
Thoracic trauma; video-assisted thoracoscopic surgery; retained hemothorax
The penalty points system (PPS) was introduced in 2002 in an attempt to reduce the increasing rate of road traffic accident (RTA) related fatalities and serious injuries. Points are awarded based on the severity of the offence and are cumulative. A total of 12 points results in the disqualification from driving.
A few studies have looked at the immediate or short term impact of PPS on trauma services or specific injuries such as spine trauma in Ireland. Little data is available on the long term effect of the PPS. The aim of this study is to see if the PPS system has had an influence on the number of pelvic injuries referred to our unit for surgical intervention and if this influence is sustained in the longer term.
Materials and Methods:
A retrospective review of all pelvic and acetabular injuries admitted to our unit from 1999 to 2008 was undertaken. The mechanism of injury, the site and patient demographics were noted.
A total of 467 patients were identified over the ten year period. 454 patients were included in the study. There was a significant male preponderance of 76%. Mean age was 36.5 years (range 16 to 83). RTA's were the cause in 74% (n = 335) of the cases. The annual work load remained similar over the years. There has been a reduction in the number of RTA related pelvic injuries. There have been notable drops in the number of these cases corresponding to the introduction of the PPS and its subsequent expansion. The number of pelvic injuries due to falls continues to rise.
The introduction of the PPS and its subsequent expansion has had a positive influence on the number of RTA related pelvic trauma. Continued surveillance and enforcement of the PPS is important for a sustained benefit from it in the long term.
Pelvic trauma; penalty points; road safety
Sternal fractures are predominantly associated with deceleration injuries and blunt anterior chest trauma. Sternal trauma must be carefully evaluated by monitoring of vital parameters and it is of paramount importance that concomitant injuries are excluded. Nevertheless, routine admission of patients with isolated sternal fractures for observation is still common in today's practice, which is often unnecessary. This article aims to describe the prognosis, the recommended assessment and management of patients with sternal fractures, to help clinicians make an evidence-based judgment regarding the need for hospitalization.
Fracture; management; sternum; trauma
Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries.
Esophageal injury; neck trauma; tracheal injury
Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim's chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers’ wrists of less than 10% of those seen during the performance of chest compressions significantly strain the scapholunate ligament. Biomechanical research should be performed to further evaluate this possible correlation. Compensation for worker injury maybe involved.
Cardiopulmonary resuscitation; Emergency Medical Services; resuscitation
A 42-year-old woman, presented to our emergency room with chief complaints of acute onset of dyspnea, left-sided chest pain, and respiratory distress. On arrival, she had blood pressure of 90/50 mm Hg, respiratory rate of 40/min, and oxygen saturation of 95% breathing on 10 L oxygen. She was in significant respiratory distress. On examination, she was found to have diminished breath sounds on the left side of chest. Her chest radiograph showed left massive pleural effusion causing contralateral shift of mediastinum. Diagnostic pleural aspiration was done; results were consistent with hemothorax. Her multidetector computed tomography chest showed features of left-sided hemothorax (high attenuation) along with a 2 cm-enhancing lobulated opacity in the left lingular lobe, suggestive of pulmonary arteriovenous malformation (PAVM). She was successfully treated with surgical resection of PAVM.
Lobectomy; malformation; multidetector computed tomography; pulmonary arteriovenous; spontaneous hemothorax