RESUMO
Detection of diaphragmatic hernia in the acute setting is problematic and diagnosing diaphragmatic hernia as hydropneumothorax is not an uncommon mistake. We present a series of four such cases diagnosed over a 7-year period, from December 2004 to January 2011 and analyse them for how this mistake can be avoided. In case of all the patients reported by us the initial radiographs were technically compromised because the patient could not be positioned properly. Also they were examined by non-radiologists. We feel that treating surgeons in emergency department tend to overdiagnose pneumothorax as it is a life-threatening condition. We feel that in the appropriate setting suspicion of diaphragmatic hernia should be raised in patients having fractured ribs associated with homogenous opacity, which cannot be differentiated from the diaphragm. Evidence of loculation of hydropneumothorax in the appropriate setting should also raise the possibility of diaphragmatic hernia.
Assuntos
Hérnia Diafragmática/diagnóstico , Hidropneumotórax/diagnóstico , Criança , Diagnóstico Diferencial , Erros de Diagnóstico , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Oral manifestations of tuberculosis are quite rare with an incidence rate of 1.4%. The tongue is the most common site of oral tuberculosis having varied presentations. Lingual tuberculosis is a diagnostic dilemma because of its rarity, particularly in immunocompetent patients. We are reporting a rare case of primary tuberculosis of the tongue in a 38 year old male diagnosed on fine needle aspiration cytology.
Assuntos
Doenças da Língua/patologia , Tuberculose Bucal/patologia , Adulto , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Granuloma/tratamento farmacológico , Granuloma/microbiologia , Granuloma/patologia , Humanos , Imunocompetência , Masculino , Doenças da Língua/tratamento farmacológico , Doenças da Língua/microbiologia , Resultado do Tratamento , Tuberculose Bucal/tratamento farmacológico , Tuberculose Bucal/microbiologia , Úlcera/tratamento farmacológico , Úlcera/microbiologia , Úlcera/patologiaRESUMO
Esophageal injury following blunt trauma to chest is an extremely rare event, with only a limited number of cases being reported in the world literature. We report a case of perforation of the lower thoracic esophagus following a crush injury to the chest in a 14 year old child. An appropriately placed chest drain and decompression gastrostomy resulted in complete resolution of the esophageal leak within four weeks. This case report demonstrates that a conservative approach to lower thoracic esophageal perforations can be carried out successfully without the added morbidity of thoracotomy and risks of direct repair.
