DELAYED HEMOTHORAX RESULTING FROM STAB WOUNDS TO THE INTERNAL MAMMARYARTERY

Massive delayed hemothorax as a result of stab mounds to the internal mammary artery have not recently been reported, A patient who died aft er such an injury prompted a 10-year retrospective review. During that time period, 88 patients with stab wounds to the chest mere identifie d. Thirty-five of these involved injuries to the parasternal region. T his region is described as being located below the clavicles, between the midclavicular lines, and above the costal margins. We identified 5 patients with internal mammary artery injuries: 4 had massive delayed bleeding and 2 died. Our current recommendations for managing stable patients with parasternal stab wounds include maintaining a high index of suspicion, intensive care monitoring, and placement of chest tubes for monitoring. Should delayed bleeding occur, a prompt thoracotomy i s mandatory.