J Trauma
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Three consecutive successful repairs of innominate artery tears caused by blunt trauma are reported. Attention is called to the fact that the innominate artery is the second most common site of great vessel injury in this setting. ⋯ Median sternotomy, with a cervical extension if necessary, is the incision of choice. Successful repair is the usual outcome.
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Venous missile embolism is a rare complication of penetrating trauma which poses controversial management options. We report a case of hepatic vein bullet embolism treated by percutaneous transvenous basket relocation and extraction via femoral vein cutdown. ⋯ Delayed recognition of an asymptomatic bullet embolus demands further judgment in guiding selective operative removal. A management scheme based on time of recognition, patient status, and embolus characteristics is presented for this unusual problem.
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Blunt trauma to the chest and abdomen frequently results in cardiac injury. A wide spectrum of pathology can follow, including myocardial concussion and contusion, valvular disruption, and pericardial effusion and tamponade. ⋯ The various diagnostic studies utilized are frequently misinterpreted. The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.