RESUMO
Neurofibromatosis type 1 is a rare disorder that occurs secondary to pathogenic variants in the NF1 tumor suppressor gene on chromosome 17. Characteristic clinical manifestations include multiple hyperpigmented macules, axillary and inguinal freckling, optic gliomas, and numerous skin neurofibromas. Vasculopathies are a rare complication of this disease and can affect vessels ranging from the proximal aorta to small arterioles, with pathology including arterial stenosis, aneurysms, and arteriovenous malformations. Aneurysms in these patients are often asymptomatic, and most patients with this complication appear for treatment after vessel rupture. We describe a 33-year-old man with neurofibromatosis type 1 who presented with chest pain and was ultimately found to have a ruptured left subclavian artery branch pseudoaneurysm leading to a large hemothorax.
Assuntos
Falso Aneurisma , Aneurisma Roto , Embolização Terapêutica/métodos , Hemotórax , Neurofibromatose 1/complicações , Artéria Subclávia/diagnóstico por imagem , Toracentese/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/cirurgia , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Procedimentos Endovasculares/métodos , Hemodinâmica , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/terapia , Humanos , Masculino , Neurofibromatose 1/diagnóstico , Radiografia Torácica/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery and diaphragmatic damage caused by minor blunt trauma. CASE PRESENTATION: An 83-year-old Japanese man was transported to our hospital 3 hours after falling out of bed. Computed tomography revealed hemothorax and multiple rib fractures. He underwent fluid resuscitation and a tube thoracostomy, but he became hemodynamically unstable. Contrast-enhanced computed tomography revealed worsening hemothorax with contrast extravasation 4 hours after arrival at the hospital. Emergency angiography indicated hemorrhage in the area supplied by the tenth intercostal artery. Transcatheter arterial embolization stabilized his vital signs for a short period. However, further hemodynamic stabilization required a thoracotomy, which revealed diaphragmatic trauma, which was removed and sutured before fixing his fractured ribs. His postoperative course was uneventful, and he was transferred to another hospital for rehabilitation without complications on hospital day 29. CONCLUSIONS: Minor mechanisms of blunt trauma can cause rib fractures and massive hemothorax. Traumatic diaphragm injury should be considered a differential diagnosis if hemodynamic instability persists after transcatheter arterial embolization in patients with lower level rib fractures.
Assuntos
Diafragma , Embolização Terapêutica/métodos , Hemotórax , Fraturas das Costelas , Toracostomia/métodos , Toracotomia/métodos , Idoso de 80 Anos ou mais , Angiografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/lesões , Diafragma/cirurgia , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Fixação de Fratura/métodos , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/terapia , Humanos , Masculino , Intensificação de Imagem Radiográfica/métodos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/cirurgia , Artérias Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos não PenetrantesAssuntos
Hemotórax/etiologia , Veia Safena/lesões , Idoso , Angiografia por Tomografia Computadorizada/métodos , Ponte de Artéria Coronária/métodos , Diagnóstico Diferencial , Dispneia/etiologia , Hemotórax/diagnóstico , Hemotórax/fisiopatologia , Humanos , Masculino , Pneumonia/diagnóstico , Pneumonia/fisiopatologia , Veia Safena/fisiopatologiaRESUMO
BACKGROUND: Osteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically. CASE REPORT: We report the unusual occurrence of a large hemothorax and lacerated right diaphragm in a 41-year-old woman caused by vertebral osteochondroma affecting the eleventh thoracic vertebra. Thoracoscopic exploration with resection of the osteochondroma and repair of the diaphragm was performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous hemothorax is a potential life-threatening condition when the initial diagnosis is postponed and hemodynamic instability and hypovolemic shock occurs. Osteochondroma as a cause of spontaneous hemothorax is uncommon but may require urgent surgical intervention with video-assisted thoracoscopic surgery of thoracotomy to control the hemorrhage and prevent recurrence.
Assuntos
Dor no Peito/etiologia , Hemotórax/etiologia , Osteocondroma/complicações , Ruptura Espontânea/fisiopatologia , Adulto , Dor no Peito/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hemotórax/fisiopatologia , Humanos , Recidiva Local de Neoplasia/patologia , Osteocondroma/diagnóstico , Osteocondroma/fisiopatologia , Radiografia/métodos , Ruptura Espontânea/diagnóstico , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: The aim of this study was to determine the incidence of delayed complications, specifically hemothorax, and functional outcome in patients with isolated sternal fracture discharged from the emergency department (ED) compared to patients with other minor thoracic trauma. METHODS: This prospective cohort study was conducted in four university-affiliated Canadian EDs. Patients ages 16 and older discharged from the ED with an isolated minor thoracic injury were included and categorized as isolated sternal fracture, rib fracture, or no fracture. A standardized clinical and radiological follow-up was performed at 7 and 14 days as well as a phone follow-up at 30 and 90 days post-injury. Functional outcome was determined using the Medical Outcome Short-Form Health Survey (SF-12). RESULTS: A total of 969 patients were included, of whom 32 (3.3%) had an isolated sternal fracture, 304 (31.3%) had rib fracture, and 633 (65.3%) had no fracture. Within 14 days, 112 patients presented with a delayed hemothorax: 12.5% of sternal fracture patients, 23% of rib fracture(s) patients, and 6% of minor thoracic injury patients without fracture (p<0.05). At 90 days, 57.1% of patients with sternal fracture had moderate to severe disability compared to 25.4% and 21.2% for both of the other groups, respectively (p<0.001). CONCLUSION: In this prospective study, we found that 12.5% (n=4, p<0.05) of patients with sternal fracture developed a delayed hemothorax, but the clinical significance of this remains questionable. The proportion of patients with sternal fracture who had moderate to severe disability was significantly higher than that of patients with other minor thoracic trauma.
Assuntos
Serviço Hospitalar de Emergência , Fraturas Ósseas/complicações , Hemotórax/fisiopatologia , Esterno/lesões , Centros Médicos Acadêmicos , Adolescente , Adulto , Canadá , Distribuição de Qui-Quadrado , Estudos de Coortes , Diagnóstico Tardio , Avaliação da Deficiência , Feminino , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico , Hemotórax/etiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos , Recuperação de Função Fisiológica , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Medição de Risco , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapiaAssuntos
Hematopoese Extramedular/fisiologia , Hemotórax/etiologia , Adulto , Hemotórax/diagnóstico por imagem , Hemotórax/fisiopatologia , Humanos , Masculino , Derrame Pleural/etiologia , Derrame Pleural/fisiopatologia , Tomografia Computadorizada por Raios X , Talassemia beta/complicações , Talassemia beta/fisiopatologiaAssuntos
Falso Aneurisma , Aneurisma da Aorta Torácica , Ruptura Aórtica , Hemotórax , Enxerto Vascular/métodos , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/complicações , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/fisiopatologia , Ruptura Aórtica/cirurgia , Hemotórax/diagnóstico , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/cirurgia , Humanos , Masculino , Placa Aterosclerótica/complicações , Tomografia Computadorizada Espiral , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate whether minor thoracic injuries (MTIs) relate to subsequent functional limitations. BACKGROUND: Approximately 75% of patients with an MTI are discharged after an emergency department (ED) visit, whereas significant functional limitations can occur in the weeks that follow. METHODS: A 19 months' prospective cohort study with a 90-day follow-up was conducted at 4 university-affiliated EDs. Patients 16 years and older with an MTI were assessed at initial ED visit, 7, 14, 30, and 90 days after injury. Functional outcome was measured using the SF-12 scale. General linear model were used to assess outcome. RESULTS: A total of 482 patients were included, of whom 127 (26.3%) were 65 or older. Overall, 147 patients (30.5%) presented with at least 1 rib fracture and 59 subjects (12.2%) with delayed hemothorax. At 90 days, 22.8% of patients still had severe or moderate disabilities on global physical health score. Patients with solely delayed hemothorax and no rib fracture had the lowest global physical health score (46.4 vs 61.1, P < 0.01, effect sizeâ=â -2.60) than patients with simple MTI. Generally, functional limitations also increase with increments of number of rib fracture detected on radiograph. Outcomes were not different among patients 65 years or older when compared to their younger counterparts. CONCLUSIONS: In this prospective study of MTIs, severe to moderate disabilities were present in nearly 1 patient out of 5 at 90 days. The presence of delayed hemothorax and the number of rib fracture were associated with increased functional limitations after a MTI.
Assuntos
Avaliação da Deficiência , Traumatismos Torácicos/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Inquéritos Epidemiológicos , Hemotórax/etiologia , Hemotórax/fisiopatologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Fraturas das Costelas/complicações , Fraturas das Costelas/fisiopatologia , Traumatismos Torácicos/complicações , Índices de Gravidade do Trauma , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Hemotórax/complicações , Hemotórax/diagnóstico , Exostose/complicações , Exostose/cirurgia , Exostose , Osteocondroma/complicações , Hemotórax/fisiopatologia , Hemotórax , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão , Visualização de DadosAssuntos
Antibacterianos/administração & dosagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Hemotórax , Pleurisia , Infecção da Ferida Cirúrgica , Acinetobacter baumannii/isolamento & purificação , Idoso , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Terapia Combinada , Enterobacter cloacae/isolamento & purificação , Feminino , Hemotórax/etiologia , Hemotórax/fisiopatologia , Hemotórax/cirurgia , Humanos , Pleurisia/etiologia , Pleurisia/fisiopatologia , Pleurisia/terapia , Radiografia , Reoperação/métodos , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Infecção da Ferida Cirúrgica/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The impact on respiratory function of gunshot injuries to the chest is unknown. The objective is to assess pulmonary function and respiratory muscle strength (RMS) in patients who have recently sustained an isolated gunshot injury to the chest. METHODS: After institutional review board approval, patients with isolated gunshot injuries to the chest were prospectively identified. Study patients underwent pulmonary function testing and an assessment of RMS and gas exchange. RESULTS: Ten male patients sustaining an isolated pulmonary gunshot wound were prospectively enrolled with a mean age of 29 years ± 10 years and mean Injury Severity Score of 15 ± 5. All patients had an associated pneumothorax (n = 1), hemothorax (n = 4), or a combination of both (n = 5). After removal of all thoracostomy tubes and before discharge [7.4 days ± 5.4 days (range, 2-21 days)], patients underwent respiratory function testing. Lung volume subdivisions were reduced by 25% to 60% of predicted and diffusion capacity by 37% with preservation of the normal ratio of diffusion capacity to alveolar volume. In the six subjects able to perform spirometry in seated and supine postures, forced vital capacity decreased by 20% when changing posture (p = 0.046). Arterial blood gas analysis showed significant reduction in the P(AO)2/FIO2 ratio (or increase in AaDO2). Maximal respiratory pressures were severely reduced from predicted values, the maximal inspiratory pressure by 60% and the maximal expiratory pressure by 78%. CONCLUSIONS: Lung volumes and RMS are decreased moderately to severely in patients who have sustained an isolated pulmonary gunshot wound. Expiratory muscle force generation is more severely affected than inspiratory muscle force. Further investigation of the long-term impact of these injuries on respiratory function is warranted.
Assuntos
Hemotórax/fisiopatologia , Força Muscular/fisiologia , Pneumotórax/fisiopatologia , Testes de Função Respiratória , Músculos Respiratórios/fisiopatologia , Traumatismos Torácicos/fisiopatologia , Ferimentos por Arma de Fogo/fisiopatologia , Adolescente , Adulto , Gasometria , Hemotórax/terapia , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Pneumotórax/terapia , Estudos Prospectivos , Mecânica Respiratória/fisiologia , Traumatismos Torácicos/terapia , Ferimentos por Arma de Fogo/terapia , Adulto JovemAssuntos
Tubos Torácicos , Fibrinolíticos/administração & dosagem , Hemotórax/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Estreptoquinase/administração & dosagem , Coagulação Sanguínea , Cardiopatias Congênitas/cirurgia , Hemotórax/complicações , Hemotórax/fisiopatologia , Humanos , Recém-Nascido , Instilação de Medicamentos , Masculino , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Tomografia Computadorizada por Raios XRESUMO
Diaphragmatic injuries are difficult to diagnose if not associated with conditions that require exploration even with the noninvasive and minimally invasive tools available in evaluation of the trauma patient. The diaphragm anatomically and physiologically separates the largest body cavities making it vulnerable to penetrating injuries to the thoracoabdominal region. Its structural and functional importance is reflected in the serious consequences that can result after missed injury. This injury has a highly varied clinical and radiological presentation, and can remain occult. We present a case of diaphragmatic laceration discovered after exploratory thoracotomy for delayed hemothorax.
Assuntos
Diafragma/lesões , Hemotórax/diagnóstico , Adulto , Diafragma/fisiopatologia , Diafragma/cirurgia , Hemotórax/fisiopatologia , Hemotórax/cirurgia , Humanos , Masculino , Toracotomia , Fatores de TempoRESUMO
Massive hemorrhagic ascites (4470 mL, range 1-10 L) in women with endometriosis is a rare condition occurring predominantly in black women. Of the 43 case reports published, 42 are compatible with the hypothesis that the hemorrhagic ascites is predominantly a consequence of excessive ovarian transudation similar to a Meigs syndrome. Indeed, bilateral ovariectomy cures the condition without recurrences, whereas after unilateral ovariectomy or cystectomy recurrence rate is more than 50%; during ovarian suppression by luteinizing hormone-releasing hormone agonist ascites disappears, but reappears after treatment. Superficial pelvic endometriosis also contributes to the ascites because after superficial endometriosis destruction the recurrence rate is only 4 in 14. Based on these data, it is suggested, to scrutinize the ovaries for tumors given the analogy with Meigs syndrome. In women desiring fertility, conservative treatment with destruction of endometriosis only can be attempted given the cure rate of some 20%. It is unknown what the effect of ovulation induction would be.
Assuntos
Ascite/fisiopatologia , Endometriose/fisiopatologia , Hemorragia/epidemiologia , Ciclo Menstrual/fisiologia , Adulto , Ascite/epidemiologia , Endometriose/complicações , Feminino , Hemorragia/fisiopatologia , Hemotórax/fisiopatologia , Humanos , Inflamação/fisiopatologia , Pessoa de Meia-Idade , Adulto JovemAssuntos
Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/secundário , Hemotórax/etiologia , Neoplasias Hepáticas/patologia , Costelas , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Progressão da Doença , Serviço Hospitalar de Emergência , Evolução Fatal , Hemotórax/diagnóstico por imagem , Hemotórax/fisiopatologia , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Raras , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To determine the best timing for thoracoscopic drainage of clotted hemothorax in order to ensure safe and effective results and to identify risk factors associated with drainage failure. MATERIALS AND METHODS: Cohort retrospective study of 139 consecutive patients who underwent thoracoscopic retained hemothorax drainage between April 1997 and May 2005. RESULTS: The procedure was successful in 102 patients (73.4%), in whom complete evacuation was achieved, with no accumulation of fluid in the pleural cavity requiring reintervention. Conversion to thoracotomy was required in 22 patients (15.8%) because of the inability to attain adequate drainage of clots and collections and lung re-expansion. Fifteen patients (10.8%) required reintervention as a result of fluid accumulation in the pleural cavity and lung collapse, and thoracotomy was performed in all those cases. The best results were obtained when thoracoscopic drainage was performed before the fifth day. There were 33 major post-operative complications including 20 cases of empyema of which 10 required thoracotomy, and 13 bronchopleural leaks, four of which required open surgery. There were no fatal outcomes in the study group. CONCLUSIONS: Videothoracoscopy must be considered the procedure of choice for the treatment of retained post-traumatic hemothorax. It is a safe and effective procedure allowing the successful treatment of up to 73.4% of patients. Best results are obtained when drainage is performed within the first five days after trauma.
Assuntos
Drenagem/métodos , Hemotórax/cirurgia , Traumatismos Torácicos/complicações , Cirurgia Torácica Vídeoassistida/métodos , Adolescente , Adulto , Idoso , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Hemotórax/etiologia , Hemotórax/fisiopatologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Probabilidade , Estudos Retrospectivos , Fatores de Risco , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Toracoscopia/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
We present a case report of spontaneous hemothorax associated with neurofibromatosis. On review of the literature, a significant mortality rate of 36% is revealed in addition to a surgical mortality of 33%. Treatment options are reviewed and potential management strategies are discussed.
Assuntos
Hemotórax/etiologia , Neurofibromatoses/complicações , Reanimação Cardiopulmonar , Feminino , Hidratação , Hemodinâmica , Hemotórax/patologia , Hemotórax/fisiopatologia , Hemotórax/terapia , Humanos , Intubação Intratraqueal , Pessoa de Meia-Idade , Neurofibromatoses/patologia , Neurofibromatoses/fisiopatologia , Neurofibromatoses/terapia , Toracotomia , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
BACKGROUND: Transient tachypnea of the newborn (TTN) is a mild form of neonatal respiratory distress which early in its course needs to be differentiated from other severe respiratory disorders. At present the diagnosis is based on radiological findings and clinical course. Lung sonography in TTN has not yet been assessed. OBJECTIVES: The aim of the study was to define the ultrasonographic appearance of TTN and evaluate its clinical relevance. METHODS: Lung sonography was performed in 32 newborn infants with radiological and clinical signs of TTN within the first hour after birth and the findings were compared with those of 60 normal infants, 29 with respiratory distress syndrome, 6 with pneumonia, 5 with pulmonary hemorrhage and 5 with atelectasis. RESULTS: In the infants with TTN, lung sonography showed a difference in lung echogenicity between the upper and lower lung areas. There were very compact comet-tail artifacts in the inferior fields while these were rare in the superior fields. We designated this finding the 'double lung point' and it was not observed in healthy infants, infants with respiratory distress syndrome, actelectasis, pneumothorax, pneumonia, or pulmonary hemorrhage. Sensitivity and specificity of the double lung point was 100% for the diagnosis of TTN. CONCLUSION: We found lung sonography reliable for the early diagnosis of TTN. We suggest that it should become the first approach for imaging of neonatal respiratory distress although further prospective studies with good blinding need to be performed.