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4.
5.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
9.
Am J Case Rep ; 19: 1434-1436, 2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30504758

RESUMO

BACKGROUND Lymphatic circulation in the thorax enters the systemic blood flow at the subclavian vein. Instances where diversion occurs leads to complications such as pleural effusion. A rare complication of lymphatic diversion results in fluid accumulation in the bronchial tree, causing plastic bronchitis. The following case is the first ever report of plastic bronchitis presenting with pneumopericardium. CASE REPORT A 24-year-old female presented to our Emergency Department with an asthma exacerbation. After initiating bronchodilators, a chest radiograph (CXR) showed extensive subcutaneous emphysema, pneumomediastinum, and pneumothorax with atelectasis of the left lung. Chest tomography supported the CXR findings, as well as a finding of pneumopericardium. A thoracostomy tube was placed and a mediastinal window and pericardial window procedure were performed in an attempt to relieve the pressure upon the collapsed lung. Despite these invasive procedures, there was minimal improvement of lung volume with further respiratory deterioration; the patient eventually required mechanical ventilation. Bronchoscopy was performed, which evacuated a white chalky and rubbery substance that created a mold of the bronchial airways. Following the bronchoscopy, the patient's respiratory status improved, requiring less ventilator support, and that patient was successfully extubated. CONCLUSIONS This case highlights the most crucial management of a patient presenting with pneumomediastinum, pneumothorax, and pneumopericardium due to plastic bronchitis. Plastic bronchitis should be high on the list of differential diagnoses. The management of plastic bronchitis with bronchoscopy is supported by the fact that no invasive therapy such as thoracostomy tube or mechanical ventilator alleviated the problem, however, bronchoscopy removed the worm-like cast lodged within the lumen of the bronchial tree.


Assuntos
Bronquite/etiologia , Linfa , Pneumopericárdio/etiologia , Bronquite/diagnóstico por imagem , Broncoscopia , Feminino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Pneumopericárdio/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Medicine (Baltimore) ; 97(46): e13222, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431599

RESUMO

RATIONALE: Pneumomediastinum and pneumopericardium refer to conditions in which air exists within the mediastinum and pericardium, respectively. There is the communication between the mediastinum, pericardium, and retroperitoneum. We present the first report of rare complications (pneumomediastinum and pneumopericardium) after retroperitoneal transpsoas lateral lumbar interbody fusion (LLIF) surgery. PATIENT CONCERNS: A 73-year-old female who underwent LLIF using the retroperitoneal approach complained of dysphagia but no other abnormal symptom after surgery. DIAGNOSIS AND INTERVENTIONS: A plain chest radiograph (CXR) taken immediately the following surgery did not show any unusual findings but CXR took on postoperative day (POD) 1 indicated pneumopericardium and pneumomediastinum with abnormal air density along the pericardium and mediastinum with subdiaphragmatic air density. A chest computed tomography revealed bilateral pleural effusion and abnormal air density (pneumopericardium and pneumomediastinum) connected to a large amount of air around the aorta and retroperitoneal space (pneumoretroperitoneum). OUTCOMES: The patient complained of no unusual symptom and the CXR on POD 6 indicated that no air density surrounding the mediastinum and pericardium was found. LESSONS: Pneumomediastinum and pneumopericardium should be considered possible complications of LLIF using retroperitoneal transpsoas approach. Such a condition may progress to fatal conditions without early recognition and rapid management.


Assuntos
Vértebras Lombares/cirurgia , Enfisema Mediastínico/etiologia , Pneumopericárdio/etiologia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Humanos , Músculos Psoas/cirurgia , Espaço Retroperitoneal/cirurgia , Fusão Vertebral/métodos
11.
BMJ Case Rep ; 20182018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30366893

RESUMO

Permanent pacemaker (PPM) implantation is an increasingly common procedure with complication rate estimated between 3% and 6%. Cardiac perforation by pacemaker lead(s) is rare, but a previous study has shown that it is probably an underdiagnosed complication. We are presenting a case of a patient who presented 5 days after PPM insertion with new-onset pleuritic chest pain. She had a normal chest X-ray (CXR), and acceptable pacing checks. However, a CT scan of the chest showed pneumopericardium and pneumothorax secondary to atrial lead perforation. The pain only settled by replacing the atrial lead. A repeat chest CT scan a few months later showed complete resolution of the pneumopericardium and pneumothorax. We believe that cardiac perforation can be easily missed if associated with normal CXR and acceptable pacing parameters. Unexplained chest pain following PPM insertion might be the only clue for such complication, although it might not always be present.


Assuntos
Dor no Peito/etiologia , Traumatismos Cardíacos/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso , Feminino , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Humanos , Dor Pós-Operatória/etiologia , Pneumopericárdio/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X
18.
Ann Card Anaesth ; 21(1): 99-100, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29336408

RESUMO

Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.


Assuntos
Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Pneumopericárdio/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Humanos , Pneumopericárdio/terapia , Complicações Pós-Operatórias/terapia
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