11/493. Suck and spit, don't blow: orbital emphysema after decompression surgery. PURPOSE: To describe the occurrence of vision-threatening orbital emphysema in patients awakening from orbital decompression surgery and to assess risk factors and preventive measures. DESIGN: Small noncomparative case series. PARTICIPANTS: Three patients undergoing bilateral orbital two-wall decompression experienced significant orbital emphysema associated with persistent coughing and Valsalva at the time of extubation. INTERVENTION: In two patients, symptoms resolved with simple observation, whereas one patient required sedation, topical anesthesia around the endotracheal tube, and needle decompression of trapped air. MAIN OUTCOME MEASURES: visual acuity, pupils, visual fields, and sensorimotor examination. RESULTS: No patient experienced a permanent deficit of visual or sensorimotor function. CONCLUSIONS: Acute orbital emphysema can occur after orbital decompression surgery despite the large bony opening created. Violent coughing spells at the time of extubation are more common in patients with a history of heavy tobacco use and may be causative. Opening the periorbita may be another specific predisposing risk factor. knowledge of this dangerous phenomenon, along with appropriate perioperative management, may prevent this complication from occurring. ( info) |
| A 60-year-old-man without a history of diabetes mellitus, or invasive manipulation or obstruction of the urinary tract was admitted for septic shock. Type I emphysematous pyelonephritis was clear in this case: gas within the renal parenchyma extending into the subcapsular region and the perirenal space was present on spiral computerised tomography (CT). Surgical nephrectomy was performed because biochemistry, urography and CT identified a damaged non-functioning left kidney. The outcome was favourable. All urine, blood and nephrectomy specimen cultures were positive for a specific escherichia coli which produced a high level of gas compared to a reference E. coli strain in the same standard medium, despite the absence of diabetes mellitus. Certain strains of bacteria are able to produce high levels of nitrogen, carbon dioxide and hydrogen and such fermentation in the absence of a high glucose serum level might explain the acute gas-producing bacterial renal infection. ( info) |
13/493. Sonographic "gastric corona sign": diagnosis of gastric pneumatosis caused by a penetrating gastric ulcer. We present a case of gastric pneumatosis associated with splenoportal venous gas caused by a giant penetrating gastric ulcer. On sonography, the gastric pneumatosis appeared as a circular hyperechoic band with distal reverberations due to gas collection in the gastric wall; we termed this appearance the "gastric corona sign. "awareness of this sonographic sign may aid in the early diagnosis of gastric pneumatosis. ( info) |
14/493. Bilateral orbital emphysema from compressed air injury. PURPOSE: To describe a patient who developed bilateral subconjunctival and orbital emphysema after an automobile tire explosion. METHOD: Case report. RESULTS: A 60-year-old man sustained bilateral ocular injury after a tire explosion. Ophthalmic examination disclosed bilateral subconjunctival air, with no visible conjunctival laceration. Computed tomography showed orbital emphysema, with no evidence of orbital fracture. Follow-up examination 2 weeks after the injury disclosed resolution of the subconjunctival air. Best-corrected visual acuity in the right eye was decreased after the explosion but improved to the baseline level of 20/40 2 weeks after the injury. CONCLUSION: Subconjunctival and orbital emphysema can occur from high-pressure air injury in the absence of an obvious entry site. ( info) |
15/493. Pneumoparotid due to spirometry. Pneumoparotid has been described in patients who generate increased intraoral pressures when playing wind instruments, while coughing, and when undergoing dental work. Some patients have intentionally created pneumoparotid to avoid duties at school or in the military, or to gain attention. We describe a patient who developed pneumoparotid during pulmonary function testing. The diagnosis of pneumoparotid depends on a suggestive clinical situation and glandular swelling with or without crepitus. observation of aerated saliva per Stensen's duct or air in the parotid duct and/or gland by any imaging study is diagnostic if infection with a gas-forming organism can be reasonably excluded. No specific treatment is required, other than the avoidance of predisposing activities. ( info) |
16/493. Emphysematous gastritis: report of a case. Emphysematous gastritis is a rare and frequently lethal disorder, characterized by phlegmonous gastritis caused by gas-forming organisms. A patient with this condition is described, in whom the ante-mortem diagnosis was made on clinical and radiological grounds. ( info) |
17/493. Surgical emphysema and pneumomediastinum in a child following minor blunt injury to the neck. Largyngotracheal and pharyngoesophageal tears following minor blunt trauma to the neck are uncommon. A child with such an injury is reported and the modes of diagnosis and management are discussed. patients may initially present with minimal signs and symptoms, but their condition may deteriorate rapidly or insidiously. In the absence of respiratory compromise, conservative management is appropriate, but all patients with significant blunt neck trauma should undergo early direct laryngoscopy under a general anaesthetic. ( info) |
18/493. Severe exertional dyspnea in a patient with localized emphysema. The case of a middle-aged, male smoker who presented with progressive severe dyspnea is described. The cause of the progressive severe dyspnea remained unexplained after a comprehensive history, physical examination, chest radiograph, electrocardiogram and spirometry. Subsequent investigations resulted in a diagnosis of localized pulmonary emphysema. Detailed exercise testing helped uncover the physiological basis of the patient's extreme dyspnea. ( info) |
19/493. Double cancers of the kidney and ureter complicated with emphysematous pyelonephritis within the parenchyma of the renal tumour. Emphysematous pyelonephritis and double cancers of the kidney and urinary tract are rare. We describe here a case of a diabetic man who had simultaneous renal cell carcinoma of the right kidney and transitional cell carcinoma of the right ureter complicated with emphysematous pyelonephritis within the tumour parenchyma of renal cell carcinoma. Imaging and pathology are demonstrated. ( info) |
20/493. lung volume reduction surgery: new hope for emphysema patients. lung volume reduction is a new surgical procedure for patients with severe emphysema. The hyperinflated portion of the lung or lungs is removed so the patient's chest wall and diaphragm can return to normal positions, easing breathing. This article describes the patient criteria, surgical procedure, and nursing problems and interventions related to the care of the lung volume reduction patient. ( info) |