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Trauma Pediatric - part 7

hành lập chẩn đoán (74). Các chấn thương khác như đụng dập phổi, hemothorax, và gãy xương sườn có thể được hiển nhiên. Chẩn đoán phân biệt để được xem xét bao gồm vỡ cơ hoành, tràn khí màng phổi, và thủng thực quản. Pneumatoceles thường giải quyết một cách tự nhiên (độ phân giải trong 3-4 tháng | Pediatric Thoracic Trauma 253 establishing the diagnosis 74 . Other injuries such as pulmonary contusion hemothorax and rib fractures may be evident. The differential diagnosis to be considered includes diaphragmatic rupture pneumothorax and esophageal perforation. Pneumatoceles usually resolve spontaneously resolution in 3-4 months though rapid enlargement and death from a tension-like mechanism has been reported 66 73 . Serial chest radiographs should be obtained at least until a reduction in size is documented. Lung abscess and diffuse intravascular coagulation DIC may rarely follow infection of a traumatic pneumatocele 74 . LUNG PARENCHYMAL AND HILAR VESSEL LACERATION Most 85-90 pulmonary injuries are managed expectantly or with a chest drain as a maximum intervention. When operative intervention is required the patient is often unstable and the mortality associated with emergency pneumonectomy is as high as 70 76 . This dismal outcome has driven the development of a number of operative maneuvers to allow expeditious and safe control of hemorrhage. Anatomic segmental resection can be time consuming and is also associated with significant mortality 76-78 . Simple stapled wedge excision of peripheral injuries has become routine. Deep parenchymal lacerations can be controlled by a non-anatomic exposure of the laceration track or path tractotomy using a hemostatic linear stapling device and subsequent direct repair or ligation of exposed bleeding vessels. Some authors feel that infective complication rates with this technique do not justify its use 79 . The pulmonary hilar twist has proved to be a useful damage control maneuver for hilar injuries providing rapid occlusion of the hilar vessels 48 . Staged repair or pneumonectomy can be performed when the patient is resuscitated and rewarmed 76 . The progressive adoption of these operative techniques has led to a continued improvement in outcomes 78 . It should not be forgotten that temporary chest closure .