A 27-year-old male presented to the emergency room with a penetrating neck injury and later developed shortness of breath and chest pain. A CT scan showed a right-sided hemothorax. A chest tube was inserted and the patient was transferred to the ICU. Over several days, the chest tube output decreased. The patient was later discharged but returned with similar symptoms. A second CT scan showed a right-sided pleural effusion, which was drained. The patient's condition improved and he was discharged.

1. General surgery department –PMC
Dr.Nadeem Al-Masri

2. History of present illness
 27 years old Patient presented on 15/08/2023 to ER, after
penetrating trauma by metallic object to the right side of
the neck
 O/E : Patient was stable vitally , BP 123/75, HR 90, O2sat 95
on room air.
 With Puncture wound on Zone 1 of the right side of the
neck .
 Past medical and surgical history were free .

3. 6 hrs later on the same day, patient presented to ER
again complaining from SOB and Rt Chest pain.
O/E
 patient was conscious, alert, oriented
 Vital signs : HR: 105 , sat o2 89%, BP 92/55, RR 22
 decrease air entry upon auscultation at right side
 otherwise, normal findings
Grade 2 Haemorrhagic Shock

5.  Chest CT Scan : Right Side Hemothorax
 Chest Tube Was Applied
 Gush Of 1000 cc Blood and tube was Clamped

6.  Then patient transferred to ICU for 3 days : close
monitoring
 kept npo and was stable vitally and serial hgb : 10 ,
9.4 , 9.5,9.7.
 Started in IV fluid 3000 cc R/L , Rocephin 1g*2,
perfalagan 1g*3, nexium 40mg*1, pethidine 50mg*2

7.  ON DAILY BASIS THERE WAS DECREASE IN CHEST
TUBE OUTPUT
 DISCHARGE WAS SEROSANGUINOUS
 800 TO 300 TO NILL ON 19-8-2023
 THERE WAS NO DROP IN HGB UPON SERIAL CBC
 SO PATIENT TRANSFERED TO WARD ON 20-8-2023
AND DISCHARGED ON 22-8-2023

8.  AFTTER ONE WEEK PATIENT RETURNED TO OPC
COMPLAINING FROM SAME SYMTOPMS
 CHEST CT SCAN WAS DONE : SHOWED RIGHT
SIDED LOCALIZED PLEURAL EFFUSION

 PATIENT ADMITTED FOR THORACOCENTESIS,
ROCHEPIN 1G*2 AND PERFALGAN 1G IV PRN WERE
GIVEN

9.  ON 27-9-2023
 PATIENT WAS DOING WELL, KEPT IN SEMI
SITTING POSITION AND GENERAL DIET AS
TOLERATED
 UNDER LOCAL ANESTHESIA CENTRAL LINE
INSERTED INTO RIGHT PLEURAL SPACE WITH
DRAINAGE OF BLOODY FLUID & KEPT ON FREE
DRAINAGE

10.  FOLLOW UP ON 17-10-2023
 ON CXR THERE WAS MINIMAL RIGHT SIDED
EFFUSION.

11.  ON 5-9-2023
 CENTRAL THORACIC LINE REMOVED AND
PATIENT DISCHARGE IN STABLE CONDITION

12. Case Discussion

14. Neck Anatomy
 For descriptive and clinical management purposes, the
neck is divided into three zones: zones 1, 2, and 3.

29. Take home massage
 Since physical examination may not be reliable in ruling
out injuries in patients with neck trauma, one should
consider a low threshold for obtaining additional imaging
studies and/or surgical consultation.
 Periodic examination is required to identify deterioration
in clinical status.
 Obtain anterior and lateral neck and chest radiographs in
any patient presenting with significant neck trauma and
look for hemothorax, pneumothorax, or
pneumomediastinum. These should be obtained especially
for patients with zone 1