Brachiocephalic left trunk injury by gunshot wound. A case report.

Abstract

Objetive: To present a clinical case of the brachiocephalic left trunk injured by a gunshot. Patient and Methods: Male patient, 45 years, 15 minutes after suffered penetrating thoracic injury from a gunshot, is admitted at the Hospital Domingo Luciani, hemodynamically unestable with a unique gunshot wound (4th left intercostal space in posterior axillary line). Absence of left breath sounds. Left thoracostomy’s tube: hemothorax (1500cc). Negative pericardial ultrasonographic window. An universal left thoracotomy was done, findings: massive hemothorax, upper lobe lung injury, and upper mediastinum hematoma. Hemodynamical stabilization, then a median sternotomy was made, showing a brachiocephalic trunk injury, the incision was prolonged with a supraclavicular cervicotomy. A third proximal clavicle was incised until to the confluence vein. A brachiocephalic trunk ligation was done proximally and at the confluence vein end. Results: Satisfactory patient evolution. He was discharged at the 6th day from postoperatory. Conclusion: In hemodynamically unstable patients, the anterolateral
left thoracotomy is the approach of choice, because it provides rapid access to the thorax, reanimation, and eventual cardiac
reparation. A median sternotomy is the incision of choice for stable patients and it can be made easily with supraclavicular extension.