A Case of Deep Pulmonary Laceration Associated With Blunt Chest Trauma Treated by Emergency Room Thoracotomy

Left breath sounds were diminished, and subcutaneous emphysema was present in the left chest. In addition, he complained of back pain, and a lumbar compres-sion fracture was found. Blood gas analysis yielded a PaCO2 of 34 torr and PaO2 of 63 torr. Initial plain chest roentgenography revealed left pneumothorax with mild deviation of the mediastinal shadow toward the right, indicative of tension pneumothorax. The left upper lobe was mildly collapsed, and a small macular infiltrative shadow was seen in the left upper lobe. The left lower lobe showed generally decreaed radiolucency in the left thoracic cavity, suggesting mild intrathoracic hemorrhage. These findings led to a diagnosis of left DPL (Fig. 1). 10 minutes after arrival We inserted a drainage tube in the left thoracic cavity, and 500 mL of blood was obtained. However, the patient’s respiratory status worsened rapidly; we performed tracheal intubation and started artificial ventilation. 50 minutes after arrival Although we transfused 2,000 mL of crystalloid, 20 units of concentrated red cells, and 5,250 mL of 5% albumin preparation, a shock state developed; systolic blood pressure was 40 mmHg. Meanwhile, the volume of blood from the left drainage tube reached 1,000 mL, and we clamped the tube. Plain chest roentgen