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Case 84


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60-year-old male patient, victim of a motor vehicle accident, was transported to a public hospital. After primary evaluation, a chest computed tomography (CT) was carried out.

Which of the following findings is NOT observed in this patient’s chest CT?

a) Subcutaneous emphysema


b) Pneumomediastinum


c) Pneumothorax


d) Hypertensive pneumothorax



- The primary evaluation of polytrauma patients should be done following ATLS guidelines.

- The main pulmonary conditions which might lead to respiratory distress in traumatized patients include open or hypertensive pneumothorax, flail chest and hemothorax.

- The most common causes of hemodynamic compromise in patients with thoracic trauma are hemothorax, cardiac tamponade and traumatic aortic rupture.

- The hypertensive pneumothorax might interfere with both hemodynamic and respiratory stability.

- Most of the patients with life-threatening thoracic injuries are managed with chest drainage.

- After primary evaluation and normalization of vital signs, a detailed medical history should be taken and a thorough physical examination performed. If necessary, complementary investigations may be ordered.


- ATLS. Advanced Trauma Life Support. Colégio Americano de Cirurgiões. 10ª edição. Editora
Elsevier, Rio de Janeiro, 2010.

- Legome, E; Hammel, JM. Initial evaluation and management of chest wall trauma in adults. Up To Date. Available at: chest-wall-trauma-in-adults


Fabiana Resende, 5th year medical student of UFMG School of Medicine. E-mail: fabianaresende1[at]


Dr. Clécio Piçarro, member of the Department of Surgery (UFMG School of Medicine). E-mail: clecio[at]

Dr. Fabiana Paiva, member of the Complementary Propaedeutics Department (UFMG School
of Medicine). E-mail: fabpaivamartins[at]


Camila Gomes, Daniel Moore (students) and Professor Viviane Parisotto.

Translated by

Lucas Resende Lucinda, 5th year medical student of UFMG School of Medicine. E-mail: lucasresendebh[at]


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