Objective: Contrecoup injuries are well-known lesions in the neurosurgical practice, while their existence in other medical disciplines is lacking. Another term of confusion is the contralateral lesion that is ill defined when compared to the contrecoup injury. A nomenclature, mechanism, and clinical significance of such lesions in cardiothoracic trauma patients are warranted. Patients and Methods: Only one patient with thoracic contracoup injuries was found in a retrospective review of 477 patients with significant cardiothoracic trauma managed during a 10-year period, between January 1988 and December 1997, at Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. The other four cases with contrecoup injuries were encountered in a prospective manner in different places both in Sweden and Norway. All the four prospective cases were witnessed and well documented during trauma occurrence and management. Results: All patients developed significant contralateral chest wall symptoms and signs requiring treatment. One patient developed huge contrecoup pneumothorax. Two patients developed contrecoup hemothoraces. One patient developed contrecoup cardiac injury. One patient developed contralateral chest wall rib fractures. Two patients developed contralateral sternal fractures; one of them was unstable and required surgical fixation. Conclusions: Nomenclatures to what are have called contrecoup and contralateral lesions in cardiothoracic practice are suggested. Discrepancy between the trauma side of the chest and the resulting lesions exactly on the contralateral part may make the diagnosis difficult to understand and could give a suspicion concerning the trauma site, and whether the patient was conscious or simply not telling the truth as in case of trauma with medicolegal aspects.

Damage control as a management strategy for the most severely injured and metabolically depleted patients was first utilized for penetrating abdominal trauma. The principles are early hemorrhage control, limiting enteric contamination, resuscitation in the intensive care unit and, a delayed, definitive re-operation when normal physiology is restored. Since its initial use over two decades ago, the principles of damage control have been successfully utilized in the management of vascular and orthopedic injuries, and more recently in volume resuscitation. There has been a slower adoption of damage control approach to thoracic trauma, primarily due to concerns of cardiac tamponade and impaired pulmonary physiology, both the result of packing the pleural space. This review article describes philosophy, techniques and outcomes of damage control thoracic surgery.

Cardiac tamponade resulting from blunt chest trauma is an emergent and life-threatening condition. Cardiac rupture from blunt chest trauma is not a common presentation, and more so in the absence of rib or sternal fracture. We present a case of blunt chest trauma, who presented with features of cardiac tamponade. Emergency sternotomy revealed a right atrial rupture near the appendage which was surgically repaired. The patient also underwent simultaneous splenectomy for Grade 4 splenic injury. The patient recovered uneventfully. Prompt recognition of the injury based on a high index of suspicion must lead to immediate surgical intervention in order for these patients to survive, even in the absence of specialized imaging investigations.

We report here the case of a 28-year-old pregnant woman who developed adult respiratory distress syndrome, ventilator-associated injury, and sepsis following H1N1 virus infection. She presented with rapidly worsening breathlessness and a 4-day history of fever. Initial computed tomography scan of the chest showed right mid and lower zone alveolar infiltrates. Immediate postadmission, she was tachypneic and required high concentration oxygen to maintain saturations. The patient recovered following prolonged ventilator support, moderate inotrope support, and 6 weeks of hospital stay. The study highlights the significance of prompt diagnosis and management of tension pneumomediastinum to prevent any life-threatening complications.

A 27-year-old male had a stab wound on the anterior chest. The patient was hemodynamically stable. Vital signs were normal in the beginning. Breath and cardiac sounds were normal. Chest X-ray revealed no signs of hemothorax or pneumothorax. Focused Assessment Sonography for Trauma (FAST) was negative. Reevaluated after 2 h, he continued apparently stable, and only his blood pressure was a little lower 100 × 60 mmHg. Second FAST was positive. He had a punctate ventricular lesion, corrected with horizontal suture. We reinforce the importance of reevaluation of the patient and systematically do the FAST or pericardial window in patients with suspected cardiac lesion.