Injury of the pulmonary artery and its branches due to penetrating chest trauma

This study describes the treatment of seven wounds involving the pulmonary artery or its main branches in six men (36 +/- 12 years). Injury was associ ated with hemoptysis or massive hemothorax in four patients, three of whom had arrest on the way to the operating room. The mean interval between inju ry and admittance and between injury and surgery was 18 +/- 8 min and 39 +/ - 14 min, respectively. Wounds were located on the left pulmonary artery in two cases, right pulmonary artery in two cases, intermediate branch of the pulmonary artery in one case and right upper mediastinal branch of the pul monary artery in two cases. Injuries involved penetration of only one side of the vessel in three cases, transfixion of two sides of the vessel in one case, and complete disruption of the vessel in three cases. Treatment requ ired pneumonectomy in two cases presenting complex lesions involving both v essels and lung structures. In the remaining five cases, arterial repair wa s achieved by resection-anastomosis (n = 2) and lateral suture (n = 3). Our results show that isolated injuries of the pulmonary artery are amenable t o surgical repair and have a good prognosis. Mortality appears to be high i n patients presenting complex lesions involving vascular and pulmonary stru ctures that require pneumonectomy to achieve hemostasis and in patients pre senting associated cardiovascular lesions. DOI: 10.1007/s00169910089.