Case report
A concealed atriopleural fistula resulting from a cardiac stab wound
Fístula átrio-pleural/aurículo pleural oculta resultante de uma facada cardíaca penetrante/profunda
María Elena Arnáiz-Garcíaa,
, Javier Arnáizb, Alejandro Pontónc, Ivana Pulitanic, Jose María González-Santosa, Adolfo Arévalo-Abascala, María E. Bueno-Codoñera, Ana María Arnáiz-Garcíad
Corresponding author
a Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain
b Radiology Department, University Hospital Marqués de Valdecilla, Santander, Spain
c Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain
d Infectious Diseases Unit, Internal Medicine Department, University Hospital Marqués de Valdecilla, Santander, Spain
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"apellidos" => "Bueno-Codoñer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Ana María" "apellidos" => "Arnáiz-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiology Department, University Hospital Marqués de Valdecilla, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Infectious Diseases Unit, Internal Medicine Department, University Hospital Marqués de Valdecilla, Santander, Spain" "etiqueta" => "d" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Fístula átrio-pleural/aurículo pleural oculta resultante de uma facada cardíaca penetrante/profunda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1785 "Ancho" => 2500 "Tamanyo" => 491227 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computed tomography images showing (A) chest stab wound (arrow) and severe secondary right hemothorax with different densities inside suggesting different stages of bleeding (*) and (B) no pericardial effusion; (C) median sternotomy showing parasternal stab wound with no active bleeding (arrow); (D) active bleeding stab wound in the right atrium (arrow); the right lung is covered by the pleura (*); **: pericardial membrane; (E) stab wound in the right atrium sutured with a polypropylene suture buttressed with Teflon felt (arrow). The right lung is visible as the pericardium and right pleura are open (**). RA: right atrium; RL: right lung; RV: right ventricle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 36-year-old-male, previously healthy, was admitted to the emergency department presenting a right parasternal knife stab wound in the third intercostal space after a street fight. On physical examination, no other lesions was detected except for ecchymotic lesions around the face and both arms. The patient remained hemodynamically stable. Despite the location and depth of the stab wound, the patient presented no clinical signs of cardiac trauma (no jugular distention, hypotension or tachycardia), normal ECG and no increase in cardiac enzymes. The initial chest radiography showed no abnormalities and transthoracic echocardiography showed no pericardial effusion. Because of the patient's hemodynamic stability and uneventful initial course, conservative management was adopted. However, three hours after admission signs of progressive anemia and low hematocrit in laboratory tests were observed (hematocrit 24%; hemoglobin 8 g/dl), suggesting internal bleeding. Echocardiography was accordingly repeated, which remained normal. A chest computed tomography (CT) scan was then performed to investigate internal bleeding, which showed the trajectory of the chest stab wound and severe right-sided hemothorax. No pericardial tamponade was detected by echocardiography (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B). The patient was immediately taken to the operating room for surgical review, via a median sternotomy because of the stab wound trajectory. A 1-cm parasternal incised wound was located crossing the chest (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C). No pericardial effusion or cardiac tamponade was seen. However, a concealed active bleeding atriopleural fistula connecting the right atrium (RA) and draining into the right pleural cavity was detected (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D). The wound path crossed the mediastinum and pleura and reached the RA manifesting as an atriopleural fistula. Massive right-sided hemothorax was confirmed. The wound in the RA had presumably been draining into the right pleural cavity from the time of the street fight until surgery, due to the negative pressure generated by respiratory movements. The size of the pleural cavity enabled a large quantity of blood to accumulate without hemodynamic instability. This mechanism caused a massive pleural effusion and prevented initial cardiac tamponade, and was the reason that the patient remained hemodynamically stable during the first hours after the fight. The injury to the RA was repaired by direct suture with a non-absorbable 4-0 polypropylene suture buttressed with Teflon felt, and the right pleural effusion was drained (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E). A chest drain was placed and removed two days after surgery. The patient was discharged uneventfully five days after surgery.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of penetrating traumas, particularly stab wounds, is increasing; they are the major cause of cardiac trauma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Potentially deadly, stab wounds need rapid management to reduce complications and alleviate any bleeding.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">When the wound is located in the chest, any life-threatening involvement of the heart or great vessels must be ruled out. Generally, when a patient is unstable, the diagnosis is straightforward, and a severe lesion in the heart or great vessels is easily suspected. Pericardial tamponade is the most frequent mechanism that leads to secondary clinical instability.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6</span></a> However, if the patient remains hemodynamically stable, it is possible to underestimate the severity of the lesions and the associated risk. Internal bleeding can manifest differently from bleeding from the heart to the pleura. Although such bleeding may initially be well tolerated in a young patient, it can lead to a misdiagnosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Even if all initial examinations are normal, the lesion must not be underestimated and other mechanisms of injury should be considered, since hemodynamic stability can rapidly reverse and become an emergency.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Correct diagnosis is thus essential. Chest computed tomography is a useful modality for the evaluation of cardiac injuries in high-risk stable patients.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> Our intention with this case report is to highlight the importance of close monitoring of patients during the first hours after the event to detect any signs that could indicate a severe complication and to ensure proper treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres373996" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec353043" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres373995" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec353044" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-03-04" "fechaAceptado" => "2014-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec353043" "palabras" => array:4 [ 0 => "Atriopleural fistula" 1 => "Stab wound" 2 => "Treatment" 3 => "Surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec353044" "palabras" => array:4 [ 0 => "Fístula atrio-pleural/aurículo pleural" 1 => "Facada cardíaca" 2 => "Tratamento" 3 => "Cirurgia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Um jovem foi transferido para o serviço de emergência da nossa instituição com uma facada paraesternal direita. A radiografia de tórax foi normal. A ecocardiografia transtorácica descartou a presença de derrame pericárdico. Manteve-se hemodinamicamente estável até ao fim de três horas, após o que o paciente começou a apresentar sinais de anemia progressiva. Foi realizada tomografia computadorizada de tórax que mostrou hemotórax maciço. O paciente foi encaminhado urgentemente para cirurgia cardíaca. Observou-se hemorragia ativa através de uma fístula corte pleural ligando o átrio direito/a aurícula direita e drenagem pleural direita, resultado da pressão negativa da pleura durante a respiração. Este mecanismo impediu o tamponamento cardíaco e explica a estabilidade hemodinâmica inicial.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arnáiz-García ME, Arnáiz J, Pontón A, Pulitani I, González-Santos JM, Arévalo-Abascal A, et al. Fístula átrio-pleural/aurículo pleural oculta resultante de uma facada cardíaca penetrante/profunda 2014. Rev Port Cardiol. 2014;33:567.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1785 "Ancho" => 2500 "Tamanyo" => 491227 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Computed tomography images showing (A) chest stab wound (arrow) and severe secondary right hemothorax with different densities inside suggesting different stages of bleeding (*) and (B) no pericardial effusion; (C) median sternotomy showing parasternal stab wound with no active bleeding (arrow); (D) active bleeding stab wound in the right atrium (arrow); the right lung is covered by the pleura (*); **: pericardial membrane; (E) stab wound in the right atrium sutured with a polypropylene suture buttressed with Teflon felt (arrow). The right lung is visible as the pericardium and right pleura are open (**). RA: right atrium; RL: right lung; RV: right ventricle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penetrating cardiac trauma: 20-y experience from a university teaching hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.M. Pereira" 1 => "V.B. Nogueira" 2 => "T.R. Calderan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jss.2013.02.015" "Revista" => array:6 [ "tituloSerie" => "J Surg Res" "fecha" => "2013" "volumen" => "183" "paginaInicial" => "792" "paginaFinal" => "797" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23522451" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A concealed penetrating cardiac injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Cingoz" 1 => "H. Bingol" 2 => "E. 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Jacoby" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "1996" "volumen" => "14" "paginaInicial" => "743" "paginaFinal" => "745" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8969998" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stab wound of the neck with contralateral hemo-pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O.P. Sharma" 1 => "J. Blaney" 2 => "M.F. Oswanski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2007.04.008" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2010" "volumen" => "39" "paginaInicial" => "e135" "paginaFinal" => "e138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17976811" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic pseudoaneurysm of the aortic arch with aortovenous fistula" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Whitehouse" 1 => "S.D. Galvin" 2 => "C. Horrocks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8191.2012.01485.x" "Revista" => array:6 [ "tituloSerie" => "J Card Surg" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "609" "paginaFinal" => "610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22757610" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Penetrating cardiac injury and the significance of chest computed tomography findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.S. Plurad" 1 => "S. Bricker" 2 => "T.L. Van Natta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10140-013-1113-0" "Revista" => array:6 [ "tituloSerie" => "Emerg Radiol" "fecha" => "2013" "volumen" => "20" "paginaInicial" => "279" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23471527" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000009/v1_201410030041/S2174204914002153/v1_201410030041/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000009/v1_201410030041/S2174204914002153/v1_201410030041/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002153?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
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| 2024 November | 5 | 2 | 7 |
| 2024 October | 34 | 28 | 62 |
| 2024 September | 43 | 24 | 67 |
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| 2024 May | 48 | 15 | 63 |
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| 2024 February | 26 | 24 | 50 |
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| 2023 December | 31 | 22 | 53 |
| 2023 November | 35 | 26 | 61 |
| 2023 October | 49 | 20 | 69 |
| 2023 September | 37 | 16 | 53 |
| 2023 August | 47 | 16 | 63 |
| 2023 July | 62 | 12 | 74 |
| 2023 June | 45 | 9 | 54 |
| 2023 May | 63 | 28 | 91 |
| 2023 April | 45 | 8 | 53 |
| 2023 March | 48 | 17 | 65 |
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| 2023 January | 47 | 19 | 66 |
| 2022 December | 54 | 16 | 70 |
| 2022 November | 70 | 27 | 97 |
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| 2022 July | 56 | 32 | 88 |
| 2022 June | 50 | 19 | 69 |
| 2022 May | 28 | 21 | 49 |
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| 2021 July | 22 | 27 | 49 |
| 2021 June | 29 | 11 | 40 |
| 2021 May | 23 | 29 | 52 |
| 2021 April | 35 | 31 | 66 |
| 2021 March | 54 | 20 | 74 |
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| 2020 July | 40 | 2 | 42 |
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| 2020 May | 35 | 5 | 40 |
| 2020 April | 36 | 16 | 52 |
| 2020 March | 57 | 10 | 67 |
| 2020 February | 117 | 24 | 141 |
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| 2019 December | 33 | 7 | 40 |
| 2019 November | 26 | 1 | 27 |
| 2019 October | 32 | 7 | 39 |
| 2019 September | 27 | 5 | 32 |
| 2019 August | 32 | 7 | 39 |
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| 2019 June | 23 | 12 | 35 |
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| 2018 December | 39 | 12 | 51 |
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| 2018 August | 50 | 8 | 58 |
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| 2018 June | 78 | 7 | 85 |
| 2018 May | 83 | 15 | 98 |
| 2018 April | 78 | 10 | 88 |
| 2018 March | 73 | 10 | 83 |
| 2018 February | 32 | 4 | 36 |
| 2018 January | 42 | 11 | 53 |
| 2017 December | 77 | 5 | 82 |
| 2017 November | 26 | 11 | 37 |
| 2017 October | 24 | 10 | 34 |
| 2017 September | 39 | 6 | 45 |
| 2017 August | 35 | 18 | 53 |
| 2017 July | 34 | 11 | 45 |
| 2017 June | 32 | 14 | 46 |
| 2017 May | 33 | 10 | 43 |
| 2017 April | 37 | 3 | 40 |
| 2017 March | 45 | 38 | 83 |
| 2017 February | 35 | 5 | 40 |
| 2017 January | 40 | 5 | 45 |
| 2016 December | 46 | 9 | 55 |
| 2016 November | 25 | 6 | 31 |
| 2016 October | 25 | 4 | 29 |
| 2016 September | 15 | 3 | 18 |
| 2016 August | 10 | 7 | 17 |
| 2016 July | 15 | 4 | 19 |
| 2016 June | 7 | 3 | 10 |
| 2016 May | 18 | 1 | 19 |
| 2016 April | 11 | 11 | 22 |
| 2016 March | 26 | 12 | 38 |
| 2016 February | 21 | 19 | 40 |
| 2016 January | 26 | 20 | 46 |
| 2015 December | 24 | 16 | 40 |
| 2015 November | 21 | 5 | 26 |
| 2015 October | 26 | 17 | 43 |
| 2015 September | 31 | 9 | 40 |
| 2015 August | 25 | 8 | 33 |
| 2015 July | 18 | 5 | 23 |
| 2015 June | 13 | 1 | 14 |
| 2015 May | 17 | 5 | 22 |
| 2015 April | 12 | 13 | 25 |
| 2015 March | 25 | 8 | 33 |
| 2015 February | 18 | 4 | 22 |
| 2015 January | 25 | 6 | 31 |
| 2014 December | 34 | 9 | 43 |
| 2014 November | 23 | 8 | 31 |
| 2014 October | 31 | 14 | 45 |
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