Survival after suicide attempt – A pulmonary laceration caused by a penetrating thoracic gunshot, conservative treatment

Abstract text (incl. references and figure legends)

Suicide is an important worldwide mortality cause. In the USA, it is a leading cause of death, specially among youth. Access to fireguns is a high risk to consider. We hereby present, a case of a man, aged 22 years old, who is admitted in the emergency room for a penetrating trauma to the chest caused by a gunshot in a suicide attempt. He presented with tachycardia, tachypnea and hypotension. Glasgow coma scale score was 14. Objetively, entry and exit wounds were found on the fourth intercostal space and below the tip of the scapule on the left side of the chest, respectively. There were no signs of external hemorrhage. Chest x-ray showed hypotransparency. FAST ultrasound confirmed the presence of moderate amount of liquid, suggesting a hemothorax. A chest tube was inserted and 900 mL of blood were drained. The CT scan showed a linear densification between the superior and inferior lobes of the left lung, a moderate volume hemothorax, and a pseudoaneurysm in the parenchyma measuring 21x12 mm in the inferior lobe. There were no signs of injury of the great vessels nor presence of intra-thoracic active hemorrhage. He was kept under surveillance during 5 days in the Thoracic Surgery ward. Re-evaluation with blood analysis and CT scan had no alterations and he was discharged after psychiatric assessment. This is a successful case of a conservative treatment after a penetrating chest trauma. However, one should be aware of its severe complications during the acute and sub-acute phases (ie. laceration of great vessels and uncontrolled hemorrhage), during which the surgeon must decide when to operate. Plus, this patient committed suicide due to gambling issues, an important cause of attempt, so attention to this problem should be given in order to prevent future cases.

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