commonly affected, with the thoracic region having the highest mortality rate (approximately 35%) TABLE 115.1 THORACIC TRAUMA INJURIES REQUIRING OPERATIVE INTERVENTION Injury Signs and symptoms Tracheal/bronchial Active chest tube air leak, pneumothorax not resolved rupture Lung parenchyma, Chest tube bleeding greater than 2–3 mL/kg/hr or internal mammary hypotension unresponsive to transfusions artery laceration, intercostal artery laceration Esophageal Abnormal esophagram (uncontained leak) or disruption esophagoscopy Gastric contents in the chest tube Diaphragmatic Abnormal gas pattern in the hemithorax hernia Displaced nasogastric tube in the hemithorax Pericardial Positive pericardiocentesis tamponade Great vessel Widened mediastinum laceration Tracheal or nasogastric tube deviation Blurred aortic knob Abnormal CT angiogram The patient’s signs and symptoms will depend on the region injured Patients with an esophageal rupture in the cervical region may complain of neck stiffness or neck pain They may regurgitate bloody material and have cervical subcutaneous emphysema or odynophagia A lateral neck radiograph may show retroesophageal emphysema In the thoracic region, patients may present with abdominal spasms and guarding, chest pain, subcutaneous emphysema,