Video-Assisted Minithoracotomy for Pulmonary Laceration with a Massive Hemothorax

Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy. The safety and efficacy of video-assisted thoracoscopic surgery (VATS) techniques for this life-threatening condition have not been fully evaluated yet. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy). A 22-year-old man was transferred to our department after a falling accident. A diagnosis of right-sided pneumothorax was made on physical examination and urgent chest decompression was performed with a tube thoracostomy. Chest computed tomographic scan revealed pulmonary laceration with hematoma in the right lung. The pulmonary hematoma extending along segmental pulmonary artery in the helium of the middle lobe ruptured suddenly into the thoracic cavity, resulting in hemorrhagic shock on the fourth day after admission. Emergency right middle lobectomy was performed through video-assisted minithoracotomy. We used two cotton dissectors as a chopstick for achieving compression hemostasis during surgery. The patient recovered satisfactorily. Video-assisted minithoracotomy can be an alternative approach for the treatment of pulmonary lacerations with a massive hemothorax in hemodynamically unstable patients. 1. Introduction Pulmonary laceration is primarily associated with penetrating injuries and occurs less commonly in blunt trauma with a prevalence of 4.0–6.7% [1, 2]. Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy [3, 4]. Video-assisted thoracoscopic surgery (VATS) techniques have been widely applied in trauma patients [5]; however, little is known about their safety and efficacy for achieving surgical hemostasis of hemorrhage from pulmonary laceration in hemodynamically unstable patients. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy). 2. Case Presentation A previously healthy 22-year-old man fell from a fifth-floor apartment. He was transferred to our department with unstable cardiopulmonary condition: blood pressure, 72/60？mmHg; pulse rate, 120 beats/min; respiratory rate, 40