Injuries to the Chest Part 2 : Mediastinal Injuries

Blunt thoracic trauma comprises approximately 8% of all traumatic admissions in the United States. While chest wall injuries comprise much of this burden, mediastinal injuries, including cardiac and great vessel injuries, are being recognized more frequently given the diagnostic capabilities of modern CT imaging. In penetrating trauma, close proximity of structures in the mediastinal space, comes with a higher incidence of injury to multiple structures. Further, cardiac injury is estimated to comprise 10% of the mortality of gunshot wound victims, while more than 90% of great vessel injury is associated with penetrating injury, representing a significant burden of disease. Management and care of these injuries requires consideration of multiple details and exposure techniques. This article will address diagnosis, management and repair of esophageal, thoracic duct, cardiac, and great vessel injuries. This review contains 4 figures, 2 tables, and 49 references. Keywords: Mediastinal structures, esophageal injury, esophageal repair, thoracic duct injury, thoracic duct ligation, blunt cardiac injury, penetrating cardiac injury, blunt aortic injury, great vessel injury, endovascular stenting