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      Pneumopericárdio após traumatismo penetrante: relato de três casos Translated title: Pneumopericardium after penetrating trauma: report of three cases

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          Translated abstract

          Pneumopericardium after penetrating wound represents a high suspicion for cardiac wound. Some authors recommend thoracotomy to discharge a cardiac lesion. We present three cases of post-traumatic pneumopericardium one following a gunshot wound and two following a stab wound and discuss about diagnosis and treatment. None showed clinical signs of cardiac tamponade. Diagnosis was made by chest x-ray. Pneumopericardium was identified at the initial evaluation in two patients, who had concomitant hemothorax and underwent chest drainage. The patient with penetrating thoracic wound by gunshot pneumopericardium developed 24h after trauma. Treatment was directed to the associated lesions without specific measurements for pneumopericardium. This aproach was safe in these patients.

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          Most cited references5

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          Reconstruction of right ventricular outflow and pulmonary artery with a composite pericardial monocusp patch: an experimental study.

          A composite bovine pericardial monocusp patch was implanted in the right ventricular outflow tract of 30 dogs. The monocusp patch incorporates a molded sinus of Valsalva designed according to a computer-analyzed study of the normal anatomy. Twenty-two dogs survived the operation and were killed between 1 and 34 months postoperatively (mean, 19.5 +/- 3.5 months). Two implants showed signs of infective endocarditis 2 and 2.5 months, respectively, after operation; 1 was thrombosed at 7 months, and 1 was calcified 8 months postoperatively. In the remaining 18 animals, there was no stenosis, thrombosis, or degeneration of tissue in the monocusp. Macroscopic and microscopic studies of these grafts showed normal structure and pliability of the monocusp valve up to 34 months after operation.
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            Pneumopericardium following penetrating chest injuries.

            The presence of pneumopericardium following penetrating injuries of the chest is highly suggestive of a cardiac injury. For this reason, it is generally considered that its presence should be an indication for surgery. In the present study 20 patients with pneumopericardium were selected for conservative treatment. All patients were closely observed by means of clinical examination, serial chest roentgenography, electrocardiography, and Doppler echocardiography. In five patients the electrocardiogram showed pericarditis, and in three patients the echocardiogram demonstrated small pericardial effusions. One patient developed tension pneumopericardium 36 hours after admission and required surgical intervention. The remaining 19 patients had an uneventful recovery. We suggest that the presence of a pneumopericardium following penetrating chest trauma is not an absolute indication for surgery. Electrocardiographic and echographic studies may help in the selection of patients for conservative treatment; but the final decision should be made on the basis of clinical signs and symptoms.
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              Penetrating cardiac injuries: seletive conservatism - favorable or foolish?

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro )
                1809-4546
                December 2001
                : 28
                : 6
                : 466-469
                Affiliations
                [1 ] Hospital da Restauração Brazil
                [2 ] Universidade Federal de Pernambuco Brazil
                [3 ] SUS/PE
                Article
                S0100-69912001000600016
                10.1590/S0100-69912001000600016
                241e16c7-4297-450f-9d6f-05486dc5e998

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-6991&lng=en
                Categories
                SURGERY

                Surgery
                Penetrating thoracic trauma,Pneumopericardium
                Surgery
                Penetrating thoracic trauma, Pneumopericardium

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