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Terrorism in Paris: An Atypic Pulmonary Embolism
IMAGES IN CARDIOTHORACIC SURGERY
Terrorism in Paris: An Atypic Pulmonary Embolism Guillaume Lebreton, MD, Jeremy Bardet, Philippe Cluzel, MD, PhD, and Pascal Leprince, MD, PhD
FEATURE ARTICLES
Cardio-Thoracic Surgery Department and Interventional Radiology Department, Piti e-Salpetri ere Hospital, Paris, France
Fig 1.
D
uring the terrorist attacks in Paris on November 13, 2015, a 56-year-old woman, who was working as a waitress in a bar, was the victim of a bomb explosion. A terrorist blew himself up next to her when the patient was taking his order. The patient was evacuated in emergency. The lesions assessment (Fig 1A, chest radiograph on admission) found multiple thoracoabdominal and left upper limb wounds. The computed tomographic scan (Fig 1B) revealed a left hemothorax, pericardial effusion, and intrathoracic foreign objects (projectiles). Sternotomy was performed to drain the haemopericardium and to
Address correspondence to Dr Lebreton, Department of Cardio-Thoracic Surgery, Piti e-Salp etri ere Hospital, 47-83 Bd de l’Hopital, 75013 Paris, France; email: [email protected]. ˇ
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
explore the thoracic cavity. A heart wound was highlighted in the right ventricle (Fig 1C), with no outlet. Transesophageal echocardiography did not reveal an intracardiac projectile. The pleural cavities were explored, revealing evacuation of a large left hemothorax (haemopericardium drained into the pleura) without a parenchymal lung wound and no bullet in the pleural cavity, despite the demonstration of a projectile in right hilar. The diagnosis of right pulmonary embolism by the projectile penetrating the right ventricle was then discussed. An arteriogram was performed to confirm the diagnosis (Fig 1D). The projectile was extracted endovascularly (Fig 1E). The patient also received abdominal and orthopedic surgery. The patient was discharged from the hospital on December 18, 2015.
Ann Thorac Surg 2016;102:314 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2016.04.045
Terrorism in Paris: An Atypic Pulmonary Embolism Guillaume Lebreton, MD, Jeremy Bardet, Philippe Cluzel, MD, PhD, and Pascal Leprince, MD, PhD
FEATURE ARTICLES
Cardio-Thoracic Surgery Department and Interventional Radiology Department, Piti e-Salpetri ere Hospital, Paris, France
Fig 1.
D
uring the terrorist attacks in Paris on November 13, 2015, a 56-year-old woman, who was working as a waitress in a bar, was the victim of a bomb explosion. A terrorist blew himself up next to her when the patient was taking his order. The patient was evacuated in emergency. The lesions assessment (Fig 1A, chest radiograph on admission) found multiple thoracoabdominal and left upper limb wounds. The computed tomographic scan (Fig 1B) revealed a left hemothorax, pericardial effusion, and intrathoracic foreign objects (projectiles). Sternotomy was performed to drain the haemopericardium and to
Address correspondence to Dr Lebreton, Department of Cardio-Thoracic Surgery, Piti e-Salp etri ere Hospital, 47-83 Bd de l’Hopital, 75013 Paris, France; email: [email protected]. ˇ
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
explore the thoracic cavity. A heart wound was highlighted in the right ventricle (Fig 1C), with no outlet. Transesophageal echocardiography did not reveal an intracardiac projectile. The pleural cavities were explored, revealing evacuation of a large left hemothorax (haemopericardium drained into the pleura) without a parenchymal lung wound and no bullet in the pleural cavity, despite the demonstration of a projectile in right hilar. The diagnosis of right pulmonary embolism by the projectile penetrating the right ventricle was then discussed. An arteriogram was performed to confirm the diagnosis (Fig 1D). The projectile was extracted endovascularly (Fig 1E). The patient also received abdominal and orthopedic surgery. The patient was discharged from the hospital on December 18, 2015.
Ann Thorac Surg 2016;102:314 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2016.04.045