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A 22 year old male with a stab wound to the chest
Visual Journal of Emergency Medicine 8 (2017) 12–13
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
A 22 year old male with a stab wound to the chest a,⁎
b
a
Ethan Abbott , Matthew Moore , Rachel Augustine , Brian Chiong a b c
MARK c
Department of Emergency Medicine, SBH Health System, Bronx, NY, USA Department of Emergency Medicine, Orange Regional Medical Center, Middletown, NY, USA Department of Radiology, SBH Health System, Bronx, NY, USA
A R T I C L E I N F O Keywords: Scimitar syndrome PAPVR Dextrocardia
A 22 year old male with no known past medical history presented with a stab wound to the left chest wall. He was awake and alert on arrival. A physical exam revealed a 2.5 centimeter linear puncture wound near the mid-clavicular line just inferior to the left nipple and a 3 centimeter superficial laceration to left upper extremity. No other injuries were identified. A chest x-ray and FAST exam were performed in the trauma bay. A small amount of free fluid was noted in the pericardium, but with preserved cardiac function. There was no free fluid in the abdomen on ultrasound. The chest x-ray demonstrated a
right sided heart and a left sided aorta (Fig. 1, yellow arrow) with a curvilinear opacity (Fig. 1, green arrow) in the right lung field was consistent with a finding of Scimitar syndrome. The patient reported he was not aware of this anomaly. The patient also underwent a CT angiogram that demonstrated left pulmonary veins draining to the left atrium (Fig. 2, yellow arrow) and no pulmonary venous drainage to the left atrium from the right lung. A partial anomalous right pulmonary venous return (PAPVR) with right pulmonary veins draining into the inferior vena cava (IVC) was also seen (Fig. 3, yellow arrow). The remainder of the CT showed blood in the cardiophrenic space without any other injuries. The patient remained stable throughout his hospital course.
Fig. 1. CXR.
Fig. 2. CT angiogram of the chest, axial window.
⁎
Corresponding author. E-mail address: [email protected] (E. Abbott).
http://dx.doi.org/10.1016/j.visj.2017.02.002 Received 11 February 2017; Accepted 27 February 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 8 (2017) 12–13
E. Abbott et al.
inferior vena cava. This syndrome is often associated with dextrocardia, hypoplastic right lung and anomalous right pulmonary arterial supply.1 Named for a curved middle eastern sword called a Scimitar due to a characteristically curved anomalous pulmonary vein seen in the right chest on x-ray.2 Scimitar syndrome can have various presentations which include failure to thrive, recurrent pulmonary infection, heart failure and pulmonary hypertension in the infantile form3 but may also be asymptomatic and undiscovered until adulthood. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2017.02.002. References 1 Dupuis C, Charaf LA, Brevière G, Abou P, Rémy-Jardin M, Helmius G. The adult form of the Scimitar syndrome. Am J Cardiol. 1992;70(4):502–507. http://dx.doi.org/ 10.1016/0002-9149(92)91198-d. 2 Neill CA, Ferencz C, Sabiston DC, Sheldon H. The familial occurrence of hypoplastic right lung with systemic arterial supply and venous drainage “Scimitar syndrome”. Bull Johns Hopkins Hosp. 1960;107:1–21. 3 Sehgal A, Loughran-Fowlds A. Scimitar syndrome. Indian J Pediatr. 2005;72(3):249–251.
Fig. 3. CT angiogram of the chest, coronal window.
Scimitar syndrome is a rare congenital anomaly characterized by partial anomalous right pulmonary venous return (PAPVR) to the
13
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
A 22 year old male with a stab wound to the chest a,⁎
b
a
Ethan Abbott , Matthew Moore , Rachel Augustine , Brian Chiong a b c
MARK c
Department of Emergency Medicine, SBH Health System, Bronx, NY, USA Department of Emergency Medicine, Orange Regional Medical Center, Middletown, NY, USA Department of Radiology, SBH Health System, Bronx, NY, USA
A R T I C L E I N F O Keywords: Scimitar syndrome PAPVR Dextrocardia
A 22 year old male with no known past medical history presented with a stab wound to the left chest wall. He was awake and alert on arrival. A physical exam revealed a 2.5 centimeter linear puncture wound near the mid-clavicular line just inferior to the left nipple and a 3 centimeter superficial laceration to left upper extremity. No other injuries were identified. A chest x-ray and FAST exam were performed in the trauma bay. A small amount of free fluid was noted in the pericardium, but with preserved cardiac function. There was no free fluid in the abdomen on ultrasound. The chest x-ray demonstrated a
right sided heart and a left sided aorta (Fig. 1, yellow arrow) with a curvilinear opacity (Fig. 1, green arrow) in the right lung field was consistent with a finding of Scimitar syndrome. The patient reported he was not aware of this anomaly. The patient also underwent a CT angiogram that demonstrated left pulmonary veins draining to the left atrium (Fig. 2, yellow arrow) and no pulmonary venous drainage to the left atrium from the right lung. A partial anomalous right pulmonary venous return (PAPVR) with right pulmonary veins draining into the inferior vena cava (IVC) was also seen (Fig. 3, yellow arrow). The remainder of the CT showed blood in the cardiophrenic space without any other injuries. The patient remained stable throughout his hospital course.
Fig. 1. CXR.
Fig. 2. CT angiogram of the chest, axial window.
⁎
Corresponding author. E-mail address: [email protected] (E. Abbott).
http://dx.doi.org/10.1016/j.visj.2017.02.002 Received 11 February 2017; Accepted 27 February 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 8 (2017) 12–13
E. Abbott et al.
inferior vena cava. This syndrome is often associated with dextrocardia, hypoplastic right lung and anomalous right pulmonary arterial supply.1 Named for a curved middle eastern sword called a Scimitar due to a characteristically curved anomalous pulmonary vein seen in the right chest on x-ray.2 Scimitar syndrome can have various presentations which include failure to thrive, recurrent pulmonary infection, heart failure and pulmonary hypertension in the infantile form3 but may also be asymptomatic and undiscovered until adulthood. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2017.02.002. References 1 Dupuis C, Charaf LA, Brevière G, Abou P, Rémy-Jardin M, Helmius G. The adult form of the Scimitar syndrome. Am J Cardiol. 1992;70(4):502–507. http://dx.doi.org/ 10.1016/0002-9149(92)91198-d. 2 Neill CA, Ferencz C, Sabiston DC, Sheldon H. The familial occurrence of hypoplastic right lung with systemic arterial supply and venous drainage “Scimitar syndrome”. Bull Johns Hopkins Hosp. 1960;107:1–21. 3 Sehgal A, Loughran-Fowlds A. Scimitar syndrome. Indian J Pediatr. 2005;72(3):249–251.
Fig. 3. CT angiogram of the chest, coronal window.
Scimitar syndrome is a rare congenital anomaly characterized by partial anomalous right pulmonary venous return (PAPVR) to the
13