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The unexpected complications of thoracic trauma: Case report

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ABSTRACT

Introduction. Thoracic trauma patients usually have a severe outcome due to sequencing of events and complexity of associated lesions. The most important life-threatening lesions should be diagnosed at the pri- mary evaluation of the patient.

Case presentation. A 55 year-old man presented to the Emergency Department of Emergency County Hospital Constanta on 18.12.2016. The patient was victim of a car accident, right seated passenger with seatbelt on. He was admitted in the ER with low blood pressure (blood pressure 80/55 mmHg) and dyspnea. After the car accident, nausea appeared, along with chest pain (posterior, interscapular-vertebral) and diz- ziness. No other symptoms were mentioned by the patient and no traumatic marks were identified. The mechanism of injury was by frontal impact with anoth- er vehicle. The past medical history included chronic peripheral artery disease, amputation of inferior 1/3 of right thigh, recurrent paroxysmal atrial fibrillation. Contrast chest and abdominal CT scan in A&E pro- vided the etiology of shock: hepatic abscess in 2nd and 3rd liver’s segments, size 82 mm/75 mm/61 mm, extended to subphrenic space and transdiaphragmatic, to the anterior mediastinum, where it drained in the pericardium, causing acute pericardial effusion and cardiac tamponade.

Conclusion: This case is interesting due to major discrepancy between symptoms, clinical findings and the high severity of the acute pathology. Also the case is unique from another point of view: after history, clinical examination, blood tests and imaging tests, we were able to establish the diagnosis and to provide the emergency treatment but we could not identify the primary cause of liver abscess.

Keywords: trauma, NT-pro BNP, cardiac tamponade, hepatic abscess.

List of abbreviations:

CT – Computed Tomography ER- Emergency Room

A&E – Accident & emergency department ICU- Intensive care unit

GCS – Glasgow Coma Scale Hb – Hemoglobin

SP O2 – O2 saturation WBC – White Blood Cells

NT-pro BNP- N-terminal pro B-type natriuretic peptide INR- International Normalised Ratio

ACS- Acute coronary syndrome MI- Myocardial infarction

CBC- Complete blood count

CPR – cardiopulmonary resuscitation

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Cristina Ramona Sutu and Mircea Badauta

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