Penetrating Trauma of the Chest

Penetrating thoracic trauma may present with multiple immediate threats to patient survival. Prompt recognition and treatment of life-threatening injuries is critical in minimizing morbidity and mortality. Injuries may occur to pulmonary parenchyma, heart, tracheobronchial tree, esophagus, great vessels, or thoracic duct. Tube thoracostomy and FAST exams in the trauma bay may prove to be a useful adjunct in early diagnosis and treatment. Patients suffering penetrating trauma to the thoracic cavity with cardiovascular collapse may benefit from emergency department thoracotomy. Hemodynamically stable patients can benefit from the availability of multidetector CT scan to delineate the extent of injuries as well as potentially guide endovascular therapy. Optimal surgical approaches for intrathoracic injuries depend on an accurate assessment of the injured structures. Early diagnosis and intervention remains key in salvaging this patient population.