Superior Vena Cava Laceration by Rib Fracture After Blunt Chest Trauma

A resuscitative clamshell thoracotomy was performed with aortic cross clamping, intra-cardiac massage, and packing of the right chest resulting in return of spontaneous circulation. In those individuals who present with hemodynamic sufficiency, imaging findings may be variable, ranging from a right hemothorax on plain chest x-ray to the presence of a pseudoaneurysm or subtle irregularities of a great vessel wall on cross-sectional imaging. 2 When surgical intervention is indicated, incision choice is often dictated by patient condition. Injuries to the intra- and extra-pericardial SVC may be repaired through a median sternotomy, right anterolateral thoracotomy, or resuscitative clamshell thoracotomy as in the present case. 4 However, often the source of intra-thoracic hemorrhage is not clear, and intervention is emergently warranted, making a sternotomy somewhat limiting. [...]an anterolateral thoracotomy with extensibility to a clamshell offers significantly broader exposure.