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2.
Rev. patol. respir ; 23(3): 117-119, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198475

RESUMO

El hemotórax es una entidad causada habitualmente por traumatismos. Sin embargo, puede aparecer en el contexto de otras etiologías como las neoplasias, las coagulopatías o las enfermedades autoinmunes. Mujer de 77 años que acudió al Servicio de Urgencias por tos y disnea. La radiografía de tórax mostró derrame pleural izquierdo. Se colocó un drenaje pleural obteniendo contenido hemático. Se realizó una TAC que descartó patología torácica, pero mostró una neoplasia pancreática. La pleuroscopia confirmó la existencia de carcinomatosis pleural. El estudio anatomopatológico de las biopsias pleurales junto con los hallazgos clínicorradiológicos fueron altamente sugestivos de la etiología maligna pancreática como etiología del hemotórax. La etiología del hemotórax no traumático supone en ocasiones un reto diagnóstico. En pacientes con hemotórax y sin antecedentes traumáticos debe descartarse la etiología neoplásica del mismo


Haemothorax is more often caused by trauma. However, non-traumatic haemothorax has been associated to other aetiologies such as neoplasms, coagulopathy or autoimmune diseases. A 77-year-old woman was admitted to Hospital because of cough and dyspnoea. Chest-X-ray showed left pleural effusion. A chest tube revealed the presence of an haemothorax. A CT-scan dismissed thoracic aetiology of haemothorax but showed a pancreatobiliary neoplasm. Pleuroscopy confirmed pleural carcinomatosis. The anatomopathological features of pleural biopsies altogether with clinical and radiological findings suggested pancreatobiliary malignancy as the aetiology of the haemothorax. The aetiology of non-traumatic haemothorax is sometimes a diagnostic challenge. In patients with non-traumatic haemothorax, neoplastic aetiology should be always dismissed


Assuntos
Humanos , Feminino , Idoso , Hemotórax/diagnóstico por imagem , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Derrame Pleural Maligno/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Derrame Pleural Maligno/etiologia , Hemotórax/etiologia , Neoplasias dos Ductos Biliares/complicações , Neoplasias Pancreáticas/complicações , Carcinoma/complicações , Radiografia Torácica , Tomografia Computadorizada por Raios X , Toracoscopia , Biópsia
3.
Medicine (Baltimore) ; 99(28): e21205, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664170

RESUMO

RATIONALE: Vascular complications of transradial percutaneous coronary intervention (PCI) are rare and usually occur at the access site below the elbow. However, vessels along the tract of the wire or catheter can be injured at any point, causing various types of bleeding complications. PATIENT CONCERNS: A 57-year-old man visited due to chest discomfort. Coronary angiography showed significant stenosis at the distal right coronary artery (RCA). Immediately after the coronary guidewire was passed through the distal RCA, he started a vigorous cough. The voice changed, dyspnea occurred within minutes, and lip cyanosis and stridor were observed. After endotracheal intubation, successful stenting of the distal RCA was achieved. He was extubated at 30 minutes after coronary stenting, but 1-hour post-extubation, his blood pressure suddenly decreased to 70/50 mmHg. DIAGNOSIS: Mediastinal widening was newly noted on chest X-ray, and blood hemoglobin was decreased. Contrast-enhanced chest computed tomography showed mediastinal hematoma, tracheal compression, and hemothorax. Contrast extravasation was noted in the terminal branches of the inferior thyroid artery on brachiocephalic angiography. INTERVENTIONS: Successful hemostasis was achieved with endovascular embolization therapy using a Tornado embolization microcoil, Gelfoam gelatin sponge, and Histoacryl glue. The next day, the mediastinal hemorrhage was drained by mediastinoscopy. The endotracheal intubation and ventilator care were maintained for 2 days, and 6 units of packed red blood cells were transfused. Antithrombotics were used to prevent stent thrombosis, and antibiotics to control infection, respectively. OUTCOMES: After successful hemostasis, thrombocytosis and high on-treatment platelet reactivity that disappeared at 2 weeks post-discharge were noted. Follow-up chest imaging showed the normalized mediastinal widening. At 14 months post-discharge, the patient remains healthy. LESSONS: As life-threating vascular complications, such as brachiocephalic, subclavian vessel dissection, and vessel perforation in the internal mammary, costocervical, and thyrocervical arteries, can occur anytime during transradial PCI, the intervention cardiologist should be well aware of it and have the appropriate countermeasures implemented in the routine procedure.


Assuntos
Hematoma/etiologia , Hemotórax/etiologia , Doenças do Mediastino/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Doenças da Traqueia/etiologia , Perda Sanguínea Cirúrgica , Estenose Coronária/cirurgia , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade
4.
Ulus Travma Acil Cerrahi Derg ; 26(4): 531-537, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589244

RESUMO

BACKGROUND: This prospective study aims to investigate the effect of chest physiotherapy and analgesic therapy on the possible complications of isolated rib fractures attributable to blunt thoracic trauma, such as hemothorax and pneumothorax. METHODS: Patients who presented to Çanakkale Onsekiz Mart University School of Medicine Hospital's Emergency Department and Thoracic Surgery outpatient clinics within the first 24 hours of the post-traumatic period and did not have additional intrathoracic complications at presentation with blunt thoracic trauma and who were diagnosed with isolated rib fractures were enrolled in this prospective research study. The groups were designated as the patients who would receive analgesic treatment only (Group A) and the patients who would receive chest physiotherapy and analgesic treatment together (Group B). Patients who had first and second rib fractures or three or more rib fractures and who did not have additional organ injury were hospitalized in the Thoracic Surgery clinics; patients who had other organ trauma were hospitalized in related clinics. Patients were reassessed on their seventh and 30th post-traumatic days with physical examination and radiologic studies. RESULTS: The mean age of the 114 patients were 56.3±16.4 (22-87). There were 37 (32.5%) women and 77 (67.5%) men. Each group included 57 patients. The most common form of trauma was the same-level falls (31.6%). The mean number of rib fractures of all participants was 2.6±0.7 (1-10); the median number was 1.5. Fifty-two (45.6%) patients were hospitalized. The mean length of stay was 4.0±1.1 days. At the end of their treatment and follow-up periods, pleural effusion was found in 28 patients (24.6%) out of 114 enrolled at the side of trauma. Group B had a higher number of patients with pleural effusion (43.9%) than group A (5.3%). We performed tube thoracostomy in four patients, all of which were in group B (p<0.05). CONCLUSION: As a result of this study, chest physiotherapy maneuvers have increased the incidence of late hemothorax in patients with three or more isolated rib fractures. Also, minimal hemothoraces (<300 ml) may spontaneously regress, and no additional surgical treatment are required if the proper follow-up procedures are performed. It is advisable to hospitalize the blunt thoracic trauma patients who have three or more rib fractures and who are planned to undergo chest physiotherapy and or are prone to develop additional complications because of possible risks.


Assuntos
Analgésicos/uso terapêutico , Modalidades de Fisioterapia/efeitos adversos , Fraturas das Costelas , Ferimentos não Penetrantes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemotórax/etiologia , Hemotórax/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Estudos Prospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/terapia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Adulto Jovem
5.
Am J Emerg Med ; 38(9): 1963.e1-1963.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32518021

RESUMO

Chest pain in low risk patients is a common ED presentation. Rarely, these patients can have life-threatening conditions requiring timely diagnosis and intervention. There are currently standardized protocols for diagnosing cardiac ischemia, pulmonary embolus, and aortic dissection in low risk patients. Even more rare entities such as esophageal perforation, hemo/pneumothorax, and cardiac tamponade must also be kept in mind. We present the case of chest pain in a 33 year old male reporting no significant past medical history who developed spontaneous massive hemothorax while being evaluated in the ED. Subsequent investigation revealed that the patient had neurofibromatosis; the etiology of aneurysmal rupture in neurofibromatosis is discussed.


Assuntos
Dor no Peito/etiologia , Neurofibromatoses/complicações , Adulto , Dor no Peito/diagnóstico por imagem , Serviço Hospitalar de Emergência , Hemotórax/complicações , Hemotórax/diagnóstico , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Humanos , Masculino , Neurofibromatoses/diagnóstico , Neurofibromatoses/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X
7.
Am J Emerg Med ; 38(7): 1543.e3-1543.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305158

RESUMO

Patients with neurofibromatosis type 1 (NF1) can develop both benign and malignant tumors throughout their lives. A 49-year-old man was transferred to the emergency department with complaints of sudden right dorsal pain and respiratory discomfort. He was in shock on arrival. On finding significantly decreased permeability of the left lung field in chest X-ray, drainage was immediately performed. Subsequent computed tomography (CT; Lammert et al., 2005) angiography revealed the extravasation of contrast media from the deep carotid artery, a branch of subclavian artery. It suggested rupture of an aneurysm located at a rare site; the ruptured aneurysm penetrated the pleura, causing shock. The patient was resuscitated. Transcatheter arterial embolization (TAE; Evans et al., 2010) was successfully performed. Immediate drainage, resuscitation, and TAE 2 improved his condition. Most NF1 patients have café-au-lait macules; café-au-lait macules tend to fade with age. Importantly, café-au-lait macules, neurofibromas, and Lisch nodules were noticed at admission. NF1 patients are likely to have a malignant neoplasm when they are young. The patient had been diagnosed with thyroid cancer when he was young. As his deceased mother was an NF1 patient, we diagnosed him with NF1. Detailed patient history and early-stage examination led to the early diagnosis. NF1 should be considered as an early differential diagnosis to improve the outcome of patients in such cases.


Assuntos
Aneurisma Roto/etiologia , Artérias Carótidas/diagnóstico por imagem , Hemotórax/etiologia , Neurofibromatose 1/diagnóstico , Choque/etiologia , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade
8.
Am J Case Rep ; 21: e920196, 2020 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-32146480

RESUMO

BACKGROUND Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. CASE REPORT We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy. Angiography at that time revealed a pseudoaneurysm of the thyrocervical trunk, and coil embolization was performed to obliterate the pseudoaneurysm. CONCLUSIONS Thyrocervical trunk pseudoaneurysms can be asymptomatic, often have a delayed presentation, and can be life-threatening due to the risk of rupture and subsequent hemodynamic decline or airway compromise. While these pseudoaneurysms are well-known complications of deep penetrating injuries, they can also present following superficial penetrating injury to zone I of the neck. Selective angiography is the imaging modality of choice. Open surgical repair was traditionally the criterion standard for treatment; however, endovascular approaches are minimally invasive, feasible, and safer alternatives with reduced complications and are becoming more common.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Ferimentos Perfurantes/complicações , Adulto , Humanos , Masculino , Lesões do Pescoço/complicações , Toracostomia
9.
BMJ Case Rep ; 13(2)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32060114

RESUMO

Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes to its morbidity and mortality. The authors report a case of a 76-year-old patient who was referred to the emergency department for pain associated with the appearance of a mass with progressive growth for 2 days in the right subscapular region. The patient had no previous history of trauma, ecchymosis or noticeable skin changes. History included the use of acetylsalicylic acid and a history of heart failure, as well as haemodialysis due to stage 5 chronic renal disease. CT scan showed an active haemorrhage from an artery in the fifth intercostal space. Embolisation was performed with microspheres and microcoils. No complications or recurrent bleeding was observed. Spontaneous rupture of an intercostal artery is rare, but it is an emergency requiring immediate diagnosis and intervention.


Assuntos
Hematoma/etiologia , Hemorragia/etiologia , Hemotórax/etiologia , Artérias Torácicas , Doenças Vasculares/complicações , Idoso , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Humanos , Masculino , Microesferas , Ruptura Espontânea/complicações , Resultado do Tratamento
10.
Intern Med ; 59(10): 1283-1286, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32074575

RESUMO

Bronchial artery aneurysms (BAA) are a rare but potentially life-threatening complications because of the massive hemothorax or hemoptysis that occurs with ruptures. A 79-year-old woman was transferred to our hospital because of the sudden onset of back pain, syncope, and subsequent hypotension. Computed tomography showed a left BAA with bilateral hemothorax and hemomediastinum. Transcatheter bronchial artery embolization failed because of the anatomical location, and she went into cardiopulmonary arrest. Cardiopulmonary resuscitation was performed with successful revival. Urgent thoracic endovascular aortic repair to cover the root of the left bronchial artery was successful, and she survived without any neurological deficits.


Assuntos
Aneurisma Roto/cirurgia , Artérias Brônquicas/patologia , Artérias Brônquicas/cirurgia , Procedimentos Endovasculares/métodos , Idoso , Embolização Terapêutica/métodos , Feminino , Hemotórax/etiologia , Humanos , Ruptura Espontânea , Tomografia Computadorizada por Raios X/efeitos adversos
11.
Ann Thorac Surg ; 110(1): e31-e33, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31926159

RESUMO

Characterized by pleural and subpleural fibrosis with alveolar septal elastosis, pleuroparenchymal fibroelastosis is a rare restrictive lung disease. Symptoms are often subtle, including dyspnea, cough, and weight loss; while acute presentations of spontaneous pneumothorax have been recorded. We report a patient who developed a spontaneous hemothorax, who upon evacuation of the chest was found to have a hemorrhagic lower lobe mass consistent with pleuroparenchymal fibroelastosis. Various conditions are associated with pleuroparenchymal fibroelastosis, suggesting chronic lung injury as a factor in pathogenesis. Hemothorax of this magnitude with relatively no known inciting risk factors, represents an exceptionally rare case presentation.


Assuntos
Hemotórax/etiologia , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Doenças Pleurais/complicações , Fibrose Pulmonar/complicações , Adulto , Biópsia , Fibrose/complicações , Fibrose/diagnóstico , Hemotórax/diagnóstico , Hemotórax/cirurgia , Humanos , Masculino , Doenças Pleurais/diagnóstico , Fibrose Pulmonar/diagnóstico , Toracoscopia , Tomografia Computadorizada por Raios X
12.
J Trauma Acute Care Surg ; 88(2): 249-257, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804414

RESUMO

BACKGROUND: The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest. METHODS: Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared. RESULTS: One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02). CONCLUSION: In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest. LEVEL OF EVIDENCE: Therapeutic, level II.


Assuntos
Fixação de Fratura/métodos , Fraturas Múltiplas/cirurgia , Hemotórax/epidemiologia , Dor Pós-Operatória/diagnóstico , Fraturas das Costelas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico , Hemotórax/etiologia , Hemotórax/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Estudos Prospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
14.
A A Pract ; 14(4): 102-105, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31842197

RESUMO

Extrinsic compression of the heart consequent to intrapleural fluid is a rare cause of cardiac tamponade. Cases of massive hemothorax resulting in external cardiac tamponade due to injury of the internal thoracic artery (ITA) following blunt or penetrating trauma have been described in the literature. Here, we present a case of iatrogenic injury to the right ITA complicating mastectomy and deep inferior epigastric perforator flap reconstruction. It manifested as hemodynamic instability that persisted despite aggressive fluid resuscitation. Investigation with an intraoperative transesophageal echocardiogram demonstrated cardiac tamponade secondary to a massive hemothorax which resolved following surgical placement of an intercostal drain.


Assuntos
Neoplasias da Mama/cirurgia , Tamponamento Cardíaco/diagnóstico por imagem , Retalhos de Tecido Biológico/efeitos adversos , Artéria Torácica Interna/lesões , Mastectomia/efeitos adversos , Tamponamento Cardíaco/etiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Hemodinâmica , Hemotórax/complicações , Hemotórax/etiologia , Humanos , Doença Iatrogênica , Mamoplastia/efeitos adversos , Artéria Torácica Interna/diagnóstico por imagem , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Chest ; 157(3): 686-693, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31605700

RESUMO

BACKGROUND: There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort. METHODS: We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis. RESULTS: Among 30,570 patients, 49% underwent EBUS. Severe adverse events-pneumothorax, hemothorax, airway/vascular injuries, or death-were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776). CONCLUSIONS: When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.


Assuntos
Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Gastos em Saúde/estatística & dados numéricos , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Mediastinoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Broncoscopia/efeitos adversos , Broncoscopia/economia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hemotórax/epidemiologia , Hemotórax/etiologia , Humanos , Masculino , Mediastinoscopia/efeitos adversos , Mediastinoscopia/economia , Pessoa de Meia-Idade , Mortalidade , Estadiamento de Neoplasias , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/etiologia , Sistema Respiratório/lesões , Estudos Retrospectivos , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/etiologia , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologia
17.
Acta Chir Belg ; 120(1): 76-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31580201

RESUMO

Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs). These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited. We present the case of a 36-year old male without any relevant medical history or medication who was referred to our center. After lifting a heavy object, he experienced sudden onset pain on the right anterior chest, with associated shortness of breath. Computed tomography of the chest showed a significant hemothorax on the right side, compression atelectasis of the right lower lobe, and an anomalous fifth right rib - described as a bifid rib. A VATS resection of the bifid rib was performed.The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.


Assuntos
Hemotórax/etiologia , Lesão Pulmonar/etiologia , Costelas/anormalidades , Adulto , Hemotórax/diagnóstico por imagem , Humanos , Lesão Pulmonar/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
18.
Injury ; 51(1): 15-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493846

RESUMO

INTRODUCTION: Evaluation of immediate total-body CT (iTBCT) scouts during primary trauma care could be clinically relevant for early detection and treatment of specific major injuries. The aim of this study was to determine the diagnostic usefulness of TBCT scouts in detecting life-threatening chest and pelvic injuries. METHODS: All patients who underwent an iTBCT during their primary trauma assessment in one trauma center between April 2011 and November 2014 were retrospectively included. Two experienced trauma surgeons and two emergency radiologists evaluated iTBCT scouts with structured questionnaires. Inter-observer agreement and diagnostic properties were calculated for endotracheal tube position and identification of pneumo- and/or hemothorax and pelvic fractures. Diagnostic properties of iTBCT scouts for indication for chest tube placement and pelvic binder application were calculated in comparison to decision based on iTBCT. RESULTS: In total 220 patients with a median age of 37 years (IQR 26-59) were selected with a median Injury Severity Score of 18 (IQR 9-27). There was moderate to substantial inter-observer agreement and low false positive rates for pneumo- and/or hemothorax and for severe pelvic fractures by iTBCT scouts. For 19.8%-22.5% of the endotracheal intubated patients trauma surgeons stated that repositioning of the tube was indicated. Positive predictive value and sensitivity were respectively 100% (95%CI 52%-100%) and 50% (95%CI 22%-78%) for decisions on chest tube placement by trauma surgeon 1 and 67% (95%CI 13%-98%) and 22% (95%CI 4%-60%) for decisions by trauma surgeon 2. Only in one of 14 patients the pelvic binder was applied after iTBCT acquisition. CONCLUSIONS: iTBCT scouts can be useful for early detection of pneumo- and/or hemothorax and severe pelvic fractures. Decision for chest tube placement based on iTBCT scouts alone is not recommended.


Assuntos
Diagnóstico Precoce , Hemotórax/diagnóstico , Pneumotórax/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Ferimentos e Lesões/complicações , Adulto , Feminino , Seguimentos , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico
19.
Interact Cardiovasc Thorac Surg ; 30(3): 493-494, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31691801

RESUMO

Herein, we report the case of a 35-year-old female with a trapped right lung secondary to catamenial haemothorax. Following surgical decortication, re-expansion of the lung was not observed until postoperative day 81. This delay represents a heretofore unencountered complication that should be considered in the surgical management of catamenial haemothorax due to thoracic endometriosis syndrome.


Assuntos
Endometriose/complicações , Hemotórax/etiologia , Hemotórax/cirurgia , Pneumotórax/etiologia , Pneumotórax/cirurgia , Adulto , Feminino , Hemotórax/diagnóstico por imagem , Humanos , Pneumotórax/diagnóstico por imagem , Síndrome
20.
Reumatol. clín. (Barc.) ; 15(6): e128-e129, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189671

RESUMO

El síndrome de Ehlers-Danlos de tipo vascular (SED IV) se trata de una rara alteración genética causada por una alteración del gen COL3A1 que codifica el colágeno tipo III. Este es el tipo de colágeno más frecuente en los vasos de mediano calibre y en algunos órganos como intestino y útero. Su alteración produce, entre otros, aneurismas y roturas de vasos y órganos. Para su diagnóstico se requiere de un alto nivel de sospecha clínica. Se trata de una enfermedad de manejo complejo que requiere de un equipo multidisciplinar para tratar las diferentes complicaciones que pueden acontecer. Se presenta el caso de un paciente varón de 50 años diagnosticado de SED IV de forma incidental tras hemotórax secundario a acceso de tos


Vascular Ehlers-Danlos syndrome (EDS IV) is a rare genetic disorder characterized by an alteration in the COL3A1 gene which encodes type III collagen. It is the most common type of collagen in vessels of medium size and certain organs such as the intestines and the uterus. The alteration of this type of collagen produces aneurisms and ruptures of vessels and organs. A high level of clinical suspicion is required for diagnosis. It is a complex disease whose management requires a multidisciplinary team to treat the different complications that may occur. We report the case of a 50-year-old man diagnosed with EDS IV detected incidentally after hemothorax secondary to a coughing spell


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Ehlers-Danlos/complicações , Hemotórax/etiologia , Síndrome de Ehlers-Danlos/diagnóstico , Achados Incidentais
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