TITLE:
Shrapnel superior vena cava injury: Case report
AUTHORS:
Abdulsalam Y. Taha
KEYWORDS:
Superior Vena Cava; Shrapnel; Injury
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.2,
February
8,
2014
ABSTRACT: Shrapnel injuries of the superior vena cava (SVC) are
extremely rare and highly lethal. The true incidence is not known since many
patients succumb shortly after injury. The high fatality is due to difficulty in
diagnosis, technical problems with repair and consequences of SVC clamping.
Literature review revealed no shrapnel SVC injury reported before. This is a
report of 30-year-old man from Kirkuk, Iraq, a victim of terroristic attack who
was admitted to Sulaimania Teaching Hospital (STH) on June 2007 with shock,
massive right-side haemothorax and a wound at base of neck following a shrapnel
injury. Emergency right thoracotomy revealed clotted haemothorax and big
shrapnel partly sealing a tear in SVC just above the entrance of the azygos
vein. Severe bleeding ensued after extraction of the shrapnel. Attempts to
control the hemorrhage and repair of the injury failed and unfortunately, the
patient expired in the theatre. Though there is no pathognomonic sign of SVC
injury, it should be suspected in patients presenting with shock and
haemothorax. Successful repair is achievable with early diagnosis, aggressive
resuscitation, early exploration, optimum operating conditions and special
measures such as auto-transfusion and cardiopulmonary bypass.