Transmediastinal Gunshot Wound in a Pregnant Patient with Stable Hemodynamics

Abstract Transmediastinal gunshot wounds (TGWs) may lead to life-threatening injuries of vital organs such as large vessels, the esophagus, and lungs. Although they are not commonly encountered in pregnant women, additional caution should be given to these patients. Physical examination for the diagnosis and the choice of treatment modality contain controversial points in hemodynamically stable patients, and resuscitation has excessive importance due to physiological changes in pregnancy. We present a hemodynamically stable 26-week pregnant woman brought to the emergency department for TGW. She had a 1-cm diameter of bullet entrance hole on the right anterior 4th intercostal space, 2 cm lateral to the sternum, and a 3-cm diameter exit hole on the right posterior 12th intercostal space on the midscapular line.With our conservative approach, she had an uncomplicated pregnancy period, and gave birth to a healthy baby at term.

摘要：经纵隔枪伤（Transmediastinal gunshot wounds, TGWs）可导致大血管、食管及肺脏等重要脏器出现致命性损伤。尽管此类损伤在孕妇群体中较为少见，但仍需对这类患者格外谨慎。对于血流动力学稳定的患者，诊断相关体格检查及治疗方式的选择均存在争议；而由于妊娠带来的生理改变，复苏救治的重要性尤为凸显。本文报告1例因经纵隔枪伤送至急诊的血流动力学稳定的26周妊娠孕妇。该患者于胸骨旁2cm处的右前胸第4肋间可见直径1cm的枪弹入口创口，于肩胛线上的右后第12肋间可见直径3cm的枪弹出口创口。经保守治疗后，患者妊娠过程顺利无并发症，并于足月诞下健康婴儿。