1/403. Tension pneumothorax complicating diagnostic upper endoscopy: a case report.Hypoxemia is common during various endoscopic procedures and may result from a variety of causes. These causes range from benign and otherwise easily reversible events like oversedation to potentially life threatening complications such as pneumothorax. Although pneumothorax has been reported secondary to gastrointestinal perforation as a complication of various therapeutic endoscopic procedures, there has been no report of pneumothorax without perforation. We report a case of a patient who developed severe hypoxemia and hemodynamic instability during diagnostic upper endoscopy as a result of pneumomediastinum and tension pneumothorax in the absence of any signs of gastrointestinal perforation and comment on various possible mechanisms. Immediate endotracheal intubation and bilateral chest tube placement resulted in prompt return of the patient's oxygenation and vital signs back to normal. This report enlarges the list of possible causes of hypoxemia during endoscopy and shows the importance of early and prompt recognition, which allowed directed therapy with a good outcome.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/403. pneumothorax due to electrical burn.A 25-year-old male developed early as well as delayed (15 days post burn) pneumothorax of right side following high voltage, 1100 KV, electrical burn of the right side of the chest wall. diagnosis was established by clinical examination and chest x-ray. Intercostal tube drainage with underwater seal relieved the patient of pneumothorax.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/403. Fragile lung in the marfan syndrome.Two cases of the marfan syndrome presented with spontaneous pneumothorax. Both had chest radiographs showing bilateral bullae in the upper lung zones and pulmonary function tests consistent with mild emphysema. There were dereases in forced expiratory flow rates at low lung volumes, carbon monoxide transfer factor, and lung elastic recoil. It is suggested that pneumothorax and bullous emphysema in this syndrome are caused by a weakness in the pulmonary connective tissue framework.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/403. Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.- - - - - - - - - - ranking = 1.1133380005765keywords = injury (Clic here for more details about this article) |
5/403. Chest wall arteriovenous fistula: an unusual complication after chest tube placement.Posttraumatic arteriovenous fistulas can form between vessels of the thorax that have sustained loss of integrity to the vessel wall. Although most are caused by injuries as a consequence of missile penetration or stab wounds, iatrogenic damage is a potential cause. Herein we present a case of a systemic arteriovenous fistula involving an intercostal artery and subcutaneous vein after chest tube placement.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
6/403. Use of postoperative chest x-ray after elective adult tracheotomy.Surgeons have been creating tracheotomies since at least 124 AD, when first reported by Asclepiades (Price HC, Postma DS. ear nose Throat J 1983;62:44-59). Intraoperative and postoperative complications specifically associated with this procedure have been well established. The incidence of pneumothorax ranges from 0% to 17%, depending on the age group studied. To evaluate this complication, it is generally accepted that a postoperative chest film should routinely be obtained after a tracheotomy in adult patients. In adult nonemergent tracheotomies, the routine use of a postoperative chest film has a low yield for detecting a pneumothorax in patients without clinical findings of pneumothorax. To evaluate the use of postoperative chest x-ray in adult tracheotomy patients, a retrospective review of tracheotomies performed at the boston Medical Center from January 1994 to June 1996 was undertaken. Data examined consisted of age, sex, surgical indication, urgency, operating service, intraoperative and postoperative complications, difficulty of procedure, anesthetic technique, findings on postoperative chest film, signs and symptoms of pneumothorax, and specific treatment of pneumothorax if present. In total, 250 patients were identified. The main indication for tracheostomy in this study was ventilator dependence, accounting for 77% of the procedures. A complication rate of 11.6% was encountered, with no deaths. postoperative hemorrhage was the most common complication (3.6%). pneumothorax was documented by chest x-ray in 3 (1.2%) patients, 1 of whom had bilateral pneumothoraces. The most common symptom of a pneumothorax was tachycardia, with 8.8% of the patients exhibiting at least 1 episode. Of the 3 cases of pneumothorax in this study, only 1 was clinically relevant and required treatment. Furthermore, the clinical signs and symptoms in this patient clearly supported the diagnosis of pneumothorax before a postoperative chest film was obtained. Thus postoperative chest radiographs did not change the treatment or outcome of any of the patients undergoing a tracheotomy. This suggests that postoperative chest x-ray after adult tracheotomy is not required in routine cases. Chest radiographs should be obtained after emergent procedures, after difficult procedures, or in patients exhibiting signs or symptoms of pneumothorax.- - - - - - - - - - ranking = 12keywords = chest (Clic here for more details about this article) |
7/403. New ECG changes associated with a tension pneumothorax: a case report.This case report reveals new ECG changes associated with a left tension pneumothorax, specifically, PR-segment elevation in the inferior leads and reciprocal PR-segment depression in the aVR lead. A mechanism of atrial injury and/or ischemia is proposed as the cause, and the ECG changes associated with a left tension pneumothorax are briefly reviewed.- - - - - - - - - - ranking = 0.22266760011531keywords = injury (Clic here for more details about this article) |
8/403. Tension pneumothorax.The diagnosis of tension pneumothorax has typically been taught as the presence of hemodynamic compromise with an expanding intrapleural space air mass. This may occur quickly or gradually, depending on the degree of lung injury and respiratory state of the patient. Experimentally, tension pneumothorax is a multifactorial event that manifests a state of central hypoxemia, compensatory mechanisms, and mechanical compression on intrathoracic structures. Studies using animal models suggest that over hypotension is a delayed finding that immediately precedes cardiorespiratory collapse. Recognition of early signs and symptoms associated with tension pneumothorax, e.g., progressive hypoxemia, tachycardia, and respiratory distress, can alert medical personnel to the need for rapid decompression before physiologic decompensation.- - - - - - - - - - ranking = 0.22266760011531keywords = injury (Clic here for more details about this article) |
9/403. pneumothorax after diagnostic laparoscopy.A case of laparoscopic-induced asymptomatic pneumothorax (PTX) is presented. Six hours postoperation, a chest x-ray revealed no evidence of PTX. The patient subsequently had a routine postoperation course. As the number of laparoscopic cases performed each year continues to rise, the surgeon must remain cognizant of all possible major and minor complications to keep laparoscopic surgery safe and effective.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/403. Macleod's syndrome presenting with spontaneous pneumothorax.A 19-year-old woman with a recent history of recurrent bronchitis presented with a spontaneous left pneumothorax. review of the chest radiographs revealed features of Macleod's syndrome on the same side, with unilateral lucency and hypoplastic hilar vessels. To our knowledge this is the first report of Macleod's syndrome presenting with spontaneous pneumothorax.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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