ISSN 2398-2950      

Thorax: trauma

ffelis

Introduction

  • Cause: usually road traffic accident (RTA)/hit-by-car (HBC) or high-rise fall.
  • Signs: respiratory compromise, may be cardiac compromise (and pain); multiple and segmental fractures   →   'flail chest'.
  • Diagnosis: depends on lesions and systems affected; radiography.
  • Treatment: restore cardiopulmonary function, with initial emphasis on maintaining and supporting respiration and circulation; stabilize fractures; oxygen and analgesia.
  • Always handle chest injury cats with extreme care.
    In all cases of trauma discuss with owner the potential complications at the time of injury.

Pathogenesis

Etiology

  • Trauma, usually HBC (RTA).
  • Sometimes "high rise" injuries.
  • Occasional gunshot wound, cat or dog bite.

Pathophysiology

  • Pneumothorax Pneumothorax, diaphragmatic rupture Diaphragm: hernia, hemothorax Pleural effusion, chylothorax Chylothorax  →   decreased lung volume.
  • Closure of glottis during compression of thorax   →   increased intrathoracic pressure   →   rupture of alveoli, bronchi and blood vesels   →   pulmonary contusion, lung cysts and secondary edema   →   decreased functional alveoli.
  • Thoracic cage injury   →   multiple/segmental rib fracture   →   severe instability   →   'paradoxical' movement, thoracic wall sucked in on inspiration and blown out on expiration ('flail chest')   →   hypoxia, hypercapnia Hypercapnia.
  • Hemorrhage Lung: pulmonary hemorrhage, tracheal rupture Trachea: rupture - repair   →   airway obstruction.
  • Hemothorax Pleural effusion  →   hypovolemic shock.
  • Cardiac trauma from compression and/or ischemia   →   arrhythmias usually ventricular up to 3 days later. Note: may occur without rib fractures.

Timecourse

  • Acute.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sigrist N E, Doherr M G & Spreng D E (2004) Clinical findings and diagnostic value of post traumatic thoracic radiographs in dogs and cats with blunt trauma. J Vet Emerg Crit Care 14 (4), 259-268 VetMedResource.
  • Kraje B J, Kraje A C, Rohrbach B W et al (2000) Intrathoracic and concurrent orthopedic injury associated with traumatic rib fracture in cats - 75 cases (1980-1998). J Am Vet Med Assoc 216 (1), 51-4 PubMed.
  • Lawrence D T, Lang J, Culvenor J et al (1999) Intrathoracic tracheal rupture. J Feline Med Surg​ (1), 43-51 PubMed.
  • Fullington R J, Otto C M (1997) Characteristics and management of gunshot wounds in dogs and cats - 84 cases (1986-1995). JAVMA 210 (5), 658-662 PubMed.
  • Smeak D D (1997) Traumatic separation of the annular cartilage from the external auditory meatus in a cat. JAVMA 211 (4), 448-450 PubMed.
  • White R N & Milner H R (1995) Intrathoracic tracheal avulsion in three cats. JSAP 36 (8), 343-347 PubMed.
  • Spencer C P, Ackerman N (1980) Thoracic and abdominal radiography of the trauma patient. Vet Clin North Am Small Anim Pract 10 (3), 541-559 PubMed.

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