Stable Stable patients will be evaluated with CT, ultrasound, chest x ray as the institution's protocol specifies. When this initial survey is negative, patient can be observed with conservative management. In many cases, chest tubes are required due to concomitant lesions in the pleural cavity. If possible lesions are<unk>  (for example, a missile track near the trachea or esophagus, or pneumomediastinum) further investigation will follow with oesophagography, esophagoscopy, angiography, bronchoscopy as needed to rule out or confirm such a lesion, and decide whether surgical repair is warranted. Unstable Unstable patients are managed by operative exploration of the mediastinum. Moribund patients will go through an emergency department thoracotomy. This measure is taken because at their arrival in the emergency room, these patients are in such critical condition that they<unk>  not survive long enough to be transferred to an operating room. Outcome is very poor. Burack et al. reported only 2.8 survival of such patients in his study. In a study by Van Waes et al., (which included all thoracic penetrating injuries, not just<unk>  survival after emergency department thoracotomy was 25 percent. In other circumstances the unstable patient is immediately transferred to the operating room for exploration by thoracotomy or sternotomy. Survival rate has been reported as high as 75 percent when the patient is able to reach the OR.
Transmediastinal gunshot wound
Thoracic aorta injury
Pulmonary laceration
Mediastinal lymphadenopathy
Tracheoinnominate fistula
Esophageal rupture
Exercise-induced laryngeal obstruction
Retropharyngeal abscess