Penetrating Injuries

  • Eshan L. Senanayake
  • Timothy R. GrahamEmail author


The majority of penetrating injury results from stab injuries with a knife or gunshot wound injuries. Other penetrating injuries are less common; however the mechanism of injury is crucial in the diagnosis and subsequent exclusion of other thoracic injuries caused by penetrating trauma. Penetrating injuries to the thoracic cage are life-threatening and can result in all of the life-threatening thoracic trauma injuries: airway disruption, tension pneumothorax, open pneumothorax, massive haemothorax, flail chest and cardiac tamponade. Further potential life-threatening injuries such as oesophageal injury and aortic disruption are also possible with penetrating injuries to the thorax. These injuries should be dealt with in a systematic approach based on the principles of advanced trauma life support and should be managed in a definite centre of care, in the right environment, with the necessary expertise and equipment.


Cardiac tamponade Stab injury Chest drain Thoracic trauma Haemothorax Pneumothorax Aortic injury Thoracotomy Median sternotomy Gunshot wound 


  1. 1.
    Vij D, Simoni E, Smith RF, Obeid FN, Horst HM, Tomlanovich MC, et al. Resuscitative thoracotomy for patients with traumatic injury. Surgery. 1983;94(4):554–61.PubMedGoogle Scholar
  2. 2.
    Ivatury RR, Kazigo J, Rohman M, Gaudino J, Simon R, Stahl WM. “Directed” emergency room thoracotomy: a prognostic prerequisite for survival. J Trauma. 1991;31(8):1076–81; discussion 1081–2.CrossRefPubMedGoogle Scholar
  3. 3.
    Durham LA 3rd, Richardson RJ, Wall MJ Jr, Pepe PE, Mattox KL. Emergency center thoracotomy: impact of prehospital resuscitation. J Trauma. 1992;32(6):775–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Mejia JC, Stewart RM, Cohn SM. Emergency department thoracotomy. Semin Thorac Cardiovasc Surg. 2008;20(1):13–8. Epub 2008/04/19.CrossRefPubMedGoogle Scholar
  5. 5.
    Embrey R. Cardiac trauma. Thorac Surg Clin. 2007;17(1):87–93, vii. Epub 2007/07/27.CrossRefPubMedGoogle Scholar
  6. 6.
    Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44(6):1073–82. Epub 1998/06/24.CrossRefPubMedGoogle Scholar
  7. 7.
    Navid F, Gleason TG. Great vessel and cardiac trauma: diagnostic and management strategies. Semin Thorac Cardiovasc Surg. 2008;20(1):31–8. Epub 2008/04/19.CrossRefPubMedGoogle Scholar
  8. 8.
    Aaland MO, Bryan FC 3rd, Sherman R. Two-dimensional echocardiogram in hemodynamically stable victims of penetrating precordial trauma. Am Surg. 1994;60(6):412–5. Epub 1994/06/01.PubMedGoogle Scholar
  9. 9.
    Brinkman WT, Szeto WY, Bavaria JE. Overview of great vessel trauma. Thorac Surg Clin. 2007;17(1):95–108. Epub 2007/07/27.CrossRefPubMedGoogle Scholar
  10. 10.
    Senanayake EL, Jeyatheesan J, Rogers V, Wilson IC, Graham TR. Stab to the chest causing severe great vessel injury. Ann Thorac Surg. 2012;94(5):1716–8. Epub 2012/10/27.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Fulton JO, Brink JG. Complex thoracic vascular injury repair using deep hypothermia and circulatory arrest. Ann Thorac Surg. 1997;63(2):557–9. Epub 1997/02/01.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Demetriades D. Penetrating injuries to the thoracic great vessels. J Card Surg. 1997;12(2 Suppl):173–9; discussion 179–80. Epub 1997/03/01.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thorac Surg Clin. 2007;17(1):35–46. Epub 2007/07/27.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Inci I, Ozcelik C, Tacyildiz I, Nizam O, Eren N, Ozgen G. Penetrating chest injuries: unusually high incidence of high-velocity gunshot wounds in civilian practice. World J Surg. 1998;22(5):438–42. Epub 1998/05/02.CrossRefPubMedGoogle Scholar
  15. 15.
    Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007;17(1):47–55. Epub 2007/07/27.CrossRefPubMedGoogle Scholar
  16. 16.
    Cetindag IB, Neideen T, Hazelrigg SR. Video-assisted thoracic surgical applications in thoracic trauma. Thorac Surg Clin. 2007;17(1):73–9. Epub 2007/07/27.CrossRefPubMedGoogle Scholar
  17. 17.
    Flowers JL, Graham SM, Ugarte MA, Sartor WM, Rodriquez A, Gens DR, et al. Flexible endoscopy for the diagnosis of esophageal trauma. J Trauma. 1996;40(2):261–5; discussion 265–6. Epub 1996/02/01.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Queen Elizabeth Hospital, University Hospital Birmingham NHS FTBirminghamUK

Personalised recommendations