Abstract text (incl. references and figure legends)
Case history: A 28-year old male was admitted to the Emergency Unit after he was stabbed in the chest and found by the side of the road.
Clinical findings: Upon admission patient presented with 2 cm long entry wound approximately 2 cm superior to the xyphoid and the clinical signs of haemorrhagic shock.
Investigation/Results: A chest X-ray and FAST revealed massive right haemothorax and cardiac tamponade.
Diagnosis: According to the clinical findings and imaging investigations the baseline diagnosis was heart wound with subsequent cardiac tamponade and massive right haemothorax that indicated emergency surgery.
Therapy and Progressions: During the emergency total sternotomy two wounds in the heart were found and sutured. Additionally, massive right haemothorax was evacuated and small lung laceration close to the right hilum was sutured. Total blood loss was 5 litres. The next day patient presented with persisting hypoxemia despite the ventilation with 100 % oxygen. TEE showed the posibility of right-to-left shunt at the level of pulmonary circulation and CT pulmonary angiography confirmed fistula between the right pulmonary artery and upper pulmonary vein. A multidisciplinary team decided to resolve the fistula surgically. Fistula was closed with suture through the right hemiclamshell incision after assuring intrapericardial control of PA trunk and pulmonary vein with a vascular sling. After fistula closure hypoxemia immediately resolved and patient gradually recovered and was discharged on day 12 after fistula closure.
Comments: Traumatic pulmonary AV fistula is extremely rare condition. In our case fistula became clinically apparent very early after the trauma and caused severe hypoxemia. It was successfully resolved by surgical closure. Adequate clinical judgement and use of right diagnostic tools play key role in the successful management.
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