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1.
Medicine (Baltimore) ; 99(16): e19869, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312012

RESUMO

INTRODUCTION: Klebsiella pneumoniae liver abscess (KPLA) is often associated with accompanying metastatic complications such as septic pulmonary embolism, brain abscess, and endophthalmitis. Pleural empyema secondary to a KPLA is a very unusual finding, made even more rare with the presence of a hepatopleural fistula. PATIENT CONCERNS: An 81-year-old woman presented with aggravated dyspnea. DIAGNOSIS: The patient was diagnosed with KPLA with empyema through computed tomography (CT) scan findings and pleural fluid culture. INTERVENTIONS: The empyema was drained by thoracostomy, and treatment with empirical antibiotics was initiated. After early removal of the chest tube, the liver abscess as well as the empyema increased. An additional liver abscess drainage procedure was performed. OUTCOMES: The fever resolved and dyspnea improved following drainage of effusion. Three days later, the follow-up chest radiograph showed decreased pleural effusion. CONCLUSION: Pleural empyema is a rare but fatal complication secondary to KPLA. Additionally, the discovery of a hepatopleural fistula on a CT scan (multiplanar reconstruction image) made this case even more rare. Both, the liver abscess and pleural empyema, were effectively drained through the fistula tract with drainage procedure, thoracostomy, and additional liver abscess drainage. Prompt diagnostic evaluation, using an imaging modality such as CT, and early drainage management with intravenous antibiotics can improve clinical outcome.


Assuntos
Empiema Pleural/etiologia , Klebsiella pneumoniae/isolamento & purificação , Abscesso Hepático/complicações , Abscesso Hepático/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Tubos Torácicos/efeitos adversos , Drenagem/métodos , Dispneia/etiologia , Empiema Pleural/diagnóstico por imagem , Empiema Pleural/terapia , Feminino , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/microbiologia , Toracostomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Am Surg ; 85(11): 1205-1208, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775959

RESUMO

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.


Assuntos
Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Emergências , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/mortalidade , Traumatismos Cardíacos/cirurgia , Humanos , Kentucky/epidemiologia , Pulmão/cirurgia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Toracostomia/métodos , Toracotomia/estatística & dados numéricos , Toracotomia/tendências , Fatores de Tempo , Tempo para o Tratamento , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
3.
Int J Surg ; 68: 85-90, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31229699

RESUMO

BACKGROUND: chest tube insertions are commonly performed in various scenarios. Although frequent, these procedures result in a significant complication rate, especially in the acute care setting. Ultrasonography has been incorporated to interventional procedures aiming to reduce the incidence of complications. However, little is known about the applications of ultrasound in tube thoracostomies. The aim of this systematic review is to present the potential applications of ultrasonography as an adjunct to the procedure. METHODS: we searched Medline/Pubmed, EMBASE and Scopus databases. Out of 3012 articles, we selected 19 for further analysis. Thirteen of those were excluded because they did not meet the inclusion criteria. Ultimately, 6 articles were thoroughly evaluated and included in the review. RESULTS: The included articles show that ultrasound can be used to correctly identify a safe insertion site, to accurately find a vulnerable intercostal artery, and is reliable for timely diagnosis of drain malpositioning. CONCLUSION: this systematic review highlights the potential benefits of incorporating ultrasonography in tube thoracostomies. No randomized clinical trials are available. However, it is reasonable to assume that proper use of ultrasound may reduce procedure-related complications.


Assuntos
Toracostomia/métodos , Ultrassonografia de Intervenção/métodos , Tubos Torácicos , Drenagem/efeitos adversos , Humanos , Toracostomia/efeitos adversos
4.
Am J Vet Res ; 80(7): 625-630, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31246126

RESUMO

OBJECTIVE: To determine the amount of negative pressure generated by syringes of various sizes with and without an attached thoracostomy tube and whether composition of thoracostomy tubes altered the negative pressure generated. SAMPLE: Syringes ranging from 1 to 60 mL and 4 thoracostomy tubes of various compositions (1 red rubber catheter, 1 polyvinyl tube, and 2 silicone tubes). PROCEDURES: A syringe or syringe with attached thoracostomy tube was connected to a pneumatic transducer. Each syringe was used to aspirate a volume of air 10 times. Negative pressure generated was measured and compared among the various syringe sizes and various thoracostomy tubes. RESULTS: The negative pressure generated decreased as size of the syringe increased for a fixed volume across syringes. Addition of a thoracostomy tube further decreased the amount of negative pressure. The red rubber catheter resulted in the least amount of negative pressure, followed by the polyvinyl tube and then the silicone tubes. There was no significant difference in negative pressure between the 2 silicone tubes. The smallest amount of negative pressure generated was -74 to -83 mm Hg. CONCLUSIONS AND CLINICAL RELEVANCE: Limited data are available on the negative pressure generated during intermittent evacuation of the thoracic cavity. For the present study, use of a syringe of ≥ 20 mL and application of 1 mL of negative suction volume resulted in in vitro pressures much more negative than the currently recommended pressure of -14.71 mm Hg for continuous suction. Additional in vitro or cadaveric studies are needed.


Assuntos
Tubos Torácicos/veterinária , Pressão , Sucção/veterinária , Seringas/veterinária , Toracostomia/veterinária , Técnicas In Vitro , Estudos Prospectivos , Sucção/métodos , Toracostomia/métodos
5.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936360

RESUMO

A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.


Assuntos
Diafragma/cirurgia , Hidrotórax/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Derrame Pleural/etiologia , Toracostomia/métodos , Idoso , Dispneia , Feminino , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/cirurgia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Resultado do Tratamento
6.
Scand J Trauma Resusc Emerg Med ; 27(1): 45, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992028

RESUMO

BACKGROUND: Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-based study evaluates chest wall thickness, width of the intercostal space (ICS) and risk of injury to vital structures by needle decompression in children. METHODS: Chest wall thickness, width of the intercostal space and depth to vital structures were measured and evaluated at 2nd ICS midclavicular (MCL) line and 4th ICS anterior axillary line (AAL) on both sides of the thorax using computed tomography (CT) in 139 children in three different age groups (0, 5, 10 years). RESULTS: Width of the intercostal space was significantly smaller at the 4th ICS compared to the 2nd ICS in all age groups on both sides of the thorax. Chest wall thickness was marginally smaller at the 4th ICS compared to the 2nd ICS in infants and significantly smaller at 4th ICS in children aged 5 years and 10 years. Depth to vital structure for correct angle of needle entry was smaller at the 4th ICS in all age groups on both sides of the thorax. Incorrect angle of needle entry however is accompanied by a higher risk of injury at 2nd ICS. Furthermore, in some children aged 0 and 5 years, the heart or the thymus gland were found directly adjacent to the thoracic wall at 2nd ICS midclavicular line. CONCLUSION: Especially in small children risk of iatrogenic injury to vital structures by needle decompression is considerably high. The 4th ICS AAL offers a smaller chest wall thickness, but the width of the ICS is smaller and the risk of injury to the intercostal vessels and nerve is greater. Deviations from correct angle of entry however are accompanied by higher risk of injury to intrathoracic structures at the 2nd ICS. Furthermore, we found the heart and the thymus gland to be directly adjacent to the thoracic wall at the 2nd ICS MCL in a few children. From our point of view this puncture site can therefore not be recommended for decompression in small children. We therefore recommend 4th ICS AAL as the primary site of choice.


Assuntos
Descompressão Cirúrgica/métodos , Serviços Médicos de Emergência/métodos , Agulhas , Pneumotórax/cirurgia , Parede Torácica/diagnóstico por imagem , Toracostomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pneumotórax/diagnóstico
7.
BMJ Case Rep ; 12(3)2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30837238

RESUMO

A 38-year-old woman developed a spontaneous right-sided tension pneumothorax during light aircraft travel. The aircraft was diverted to a regional centre, where emergent needle thoracostomy and chest tube insertion were performed. History suggested that this was the second episode of pneumothorax, with an untreated event with similar symptomatology during air travel 1 year ago. She was taken for surgical intervention. Intraoperative findings were of a large right middle lobe cyst of uncertain origin; the procedure was subsequently aborted. A CT chest demonstrated a large multiseptated air-filled pulmonary cystic lesion. Inpatient stay was notable for persistent right pneumothorax with interval cyst rupture. A right middle lobectomy was subsequently performed with histopathology showing a benign epithelioid bronchogenic cyst. Recovery was unremarkable with no residual pneumothorax or further episodes at 2 months postoperatively. Preventative excision of air-filled pulmonary abnormalities should be considered prior to air travel.


Assuntos
Cisto Broncogênico/diagnóstico , Dor no Peito/patologia , Dispneia/patologia , Pneumotórax/diagnóstico , Toracostomia/métodos , Adulto , Viagem Aérea , Cisto Broncogênico/fisiopatologia , Cisto Broncogênico/cirurgia , Dor no Peito/etiologia , Dor no Peito/cirurgia , Tubos Torácicos , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Gravitação , Humanos , Pneumotórax/fisiopatologia , Pneumotórax/cirurgia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Curr Opin Anaesthesiol ; 32(2): 213-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30817398

RESUMO

PURPOSE OF REVIEW: Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. RECENT FINDINGS: The typical indication for REBOA is a traumatic life-threatening hemorrhage below the diaphragm in patients unresponsive or only transiently responsive to the usual conservative therapeutic measures. REBOA appears to be a safe and effective procedure to reduce blood loss and stabilize the patient's hemodynamic status. However, surgical hemostasis has to be achieved within 30-60 min after occlusion of the aorta. Data on clear advantages of REBOA over resuscitative thoracostomy are inconclusive. SUMMARY: REBOA could play an important role in the management of the severely bleeding patient in the future. Together with transfusion and therapy of coagulation disorders, REBOA may be an additional tool in the anesthetist's hands for trauma management in interprofessional care concepts.


Assuntos
Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Hemorragia/terapia , Ressuscitação/métodos , Toracostomia/métodos , Ferimentos e Lesões/complicações , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Escala de Gravidade do Ferimento , Índice de Gravidade de Doença , Toracostomia/efeitos adversos , Fatores de Tempo , Tronco , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
9.
Mymensingh Med J ; 28(1): 200-205, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755570

RESUMO

We examined the hypothesis that the cross mattress for chest drain insertion site security is better than that of polypropylene horizontal mattress in chest trauma patient required tube thoracostomy at the Department of Casualty Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to June 2016. Accordingly we prospectively studied 50 consecutive patients who needed chest tube insertion. In 25 consecutive cases chest drain insertion site was secured with polypropylene horizontal mattress technique (Control- Group A) and another 25 consecutive patients had a cross-mattress with non-absorbable suture materials (Experimental- Group B). All chest tubes were inserted into the triangle of safety to following the BTS guideline. A baseline x-ray chest was compared with post-procedure chest x-ray. Male preponderance and young adults were comprised in both the groups; mean age in Group A and Group B was 38.7±15.5 and 37.3±14.1 respectively. Haemo-pneumothorax was the most common cause of tube thoracostomy among the trauma victims. This study shows that, polypropylene horizontal mattress results in increased chest tube site infection 52% in Control Group vs. 12% in Experimental Group (p=0.002). Although there was similar incidence of blood loss between the groups, the length of Hospital stay was significantly higher in Control Group. We conclude that cross mattress for chest drain insertion site security showed a better clinical outcome, less wound complications and less hospitalization.


Assuntos
Tubos Torácicos , Hemotórax/cirurgia , Pneumotórax/cirurgia , Sucção/métodos , Traumatismos Torácicos/cirurgia , Toracostomia/métodos , Bangladesh , Hemotórax/etiologia , Humanos , Masculino , Pneumotórax/etiologia , Estudos Prospectivos , Sucção/instrumentação , Traumatismos Torácicos/complicações , Toracostomia/instrumentação , Adulto Jovem
10.
Cochrane Database Syst Rev ; 2: CD011724, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30707441

RESUMO

BACKGROUND: Pneumothorax occurs more frequently in the neonatal period than at any other time of life and is associated with increased mortality and morbidity. It can be treated with either aspiration with a syringe (using a needle or an angiocatheter) or a chest tube inserted in the anterior pleural space and then connected to a Heimlich valve or an underwater seal with continuous suction. OBJECTIVES: To compare the efficacy and safety of needle aspiration (either with immediate removal of the needle or with the needle left in situ) to intercostal tube drainage in the management of neonatal pneumothorax (PTX). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 4 June 2018), Embase (1980 to 4 June 2018), and CINAHL (1982 to 4 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Randomised controlled trials, quasi-randomised controlled trials and cluster trials comparing needle aspiration (either with the needle or angiocatheter left in situ or removed immediately after aspiration) to intercostal tube drainage in newborn infants with pneumothorax. DATA COLLECTION AND ANALYSIS: For each of the included trials, two authors independently extracted data (e.g. number of participants, birth weight, gestational age, kind of needle and chest tube, choice of intercostal space, pressure and device for drainage) and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcomes considered in this review are mortality during the neonatal period and during hospitalisation.We used the GRADE approach to assess the quality of evidence. MAIN RESULTS: Two randomised controlled trials (142 infants) met the inclusion criteria of this review. We found no differences in the rates of mortality when the needle was removed immediately after aspiration (risk ratio (RR) 3.92, 95% confidence interval (CI) 0.88 to 17.58; participants = 70; studies = 1) or left in situ (RR 1.50, 95% CI 0.27 to 8.45; participants = 72; studies = 1) or complications related to the procedure. With immediate removal of the needle following aspiration, 30% of the newborns did not require the placement of an intercostal tube drainage. None of the 36 newborns treated with needle aspiration with the angiocatheter left in situ required the placement of an intercostal tube drainage. Overall, the quality of the evidence supporting this finding is very low. AUTHORS' CONCLUSIONS: There is insufficient evidence to establish the efficacy and safety of needle aspiration and intercostal tube drainage in the management of neonatal pneumothorax. The two included trials showed no differences in mortality; however the information size is low. Needle aspiration reduces the need for intercostal tube drainage placement. Limited or no evidence is available on other clinically relevant outcomes.


Assuntos
Tubos Torácicos , Agulhas , Pneumotórax/terapia , Toracentese/métodos , Tubos Torácicos/estatística & dados numéricos , Remoção de Dispositivo , Hemorragia/etiologia , Mortalidade Hospitalar , Humanos , Recém-Nascido , Pneumotórax/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Sucção/instrumentação , Sucção/métodos , Sucção/mortalidade , Toracentese/instrumentação , Toracentese/mortalidade , Toracostomia/efeitos adversos , Toracostomia/métodos
12.
Injury ; 50(1): 90-95, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30143233

RESUMO

BACKGROUND: Complications related to incorrect positioning of tube thoracostomy (TT) have been reported to be as high as 30%. The aim of this study was to assess the feasibility of flexible videoscope guided placement of a pre-loaded chest tube, permitting direct intrapleural visualization and placement (Video-Tube Thoracostomy [V-TT]). METHODS: A prospective, single centre, phase 1 pilot study with a parallel control group was undertaken. The population studied were adult thoracic trauma patients requiring emergency TT who were haemodynamically stable. The intervention performed was VTT. Patients in the control group underwent conventional TT. The primary outcome was tube position as defined by a consultant radiologist's interpretation of chest x-ray (CXR) or CT. The trial was registered with ANZCTR.org.au (ACTRN: 12,615,000,870,550). RESULTS: There were 37 patients enrolled in the study - 12 patients allocated to the VTT intervention group and 25 patients allocated to conventional TT. Mean age of participants was 48 years (SD 15) in intervention group and 46 years (SD 15) years in the control group. In the VTT group all patients were male; the indications were pneumothorax (83%), haemothorax (8%) and haemopneumothorax (8%). The median injury severity score was 23 (16-28). There were 1 positional and 1 insertional complications. In the control group 72% of patients were male, the indications were pneumothorax (56%), haemothorax (4%) and haemopneumothorax (40%). The median injury severity score was 24 (14-36). There were 8 (32%) positional complications and no insertional complications. CONCLUSION: V-TT was demonstrated to be a feasible alternative to conventional thoracostomy and merits further investigation.


Assuntos
Tubos Torácicos/efeitos adversos , Competência Clínica/estatística & dados numéricos , Radiografia Torácica/métodos , Ressuscitação , Traumatismos Torácicos/diagnóstico por imagem , Toracostomia/métodos , Feminino , Hemopneumotórax/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pneumotórax/diagnóstico por imagem , Estudos Prospectivos , Toracostomia/efeitos adversos
13.
Scand J Trauma Resusc Emerg Med ; 26(1): 110, 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587216

RESUMO

BACKGROUND: The technique of tube thoracostomy has been standardized for years without significant updates. Alternative procedural methods may be beneficial in certain prehospital and inpatient environments with limited resources. We sought to compare the efficacy of chest tube insertion using a novel, endoscopic device (The Reactor™) to standard, open tube thoracostomy. METHODS: Novice users were randomly assigned to pre-specified sequences of six chest tube insertions performed on a human cadaver model in a crossover design, alternating between the Reactor™ and standard technique. All subjects received standardized training in both procedures prior to randomization. Insertion site, which was randomly assigned within each cadaver's hemithorax, was marked by the investigators; study techniques began with skin incision and ended with tube insertion. Adequacy of tube placement (intrapleural, unkinked, not in fissure) and incision length were recorded by investigators blinded to procedural technique. Insertion time and user-rated difficulty were documented in an unblinded fashion. After completing the study, participants rated various aspects of use of the Reactor™ compared to the standard technique in a survey evaluation. RESULTS: Sixteen subjects were enrolled (7 medical students, 9 paramedics) and performed 92 chest tube insertions (n = 46 Reactor™, n = 46 standard). The Reactor™ was associated with less frequent appropriate tube positioning (41.3% vs. 73.9%, P = 0.0029), a faster median insertion time (47.3 s, interquartile range 38-63.1 vs. 76.9 s, interquartile range 55.3-106.9, P < 0.0001) and shorter median incision length (28 mm, interquartile range 23-30 vs. 32 mm, interquartile range 26-40, P = 0.0034) compared to the standard technique. Using a 10-point Likert scale (1-easiest, 10-hardest) participants rated the ease of use of the Reactor™ no different from the standard method (3.8 ± 1.9 vs. 4.7 ± 1.9, P = 0.024). The Reactor™ received generally favorable scores for all parameters on the post-participation survey. CONCLUSIONS: In this randomized, assessor-blinded, crossover human cadaver study, chest tube insertion using the Reactor™ device resulted in faster insertion time and shorter incision length, but less frequent appropriate tube placement compared with the standard technique. Additional studies are needed to evaluate the efficacy, safety and potential advantages of this novel device.


Assuntos
Tubos Torácicos , Endoscopia/métodos , Toracostomia/métodos , Toracotomia/métodos , Adulto , Cadáver , Competência Clínica , Estudos Cross-Over , Feminino , Humanos , Masculino , Método Simples-Cego
15.
Medicine (Baltimore) ; 97(45): e13188, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407357

RESUMO

RATIONALE: Spontaneous hemothorax is a subcategory of hemothorax which can be life threatening. The etiology of spontaneous hemothorax can be various, and in some rare cases the causes remained unknown. Hence, it is quite difficult to establish the diagnosis. Here, we report a case of spontaneous hemothorax in a young female patient who was recently diagnosed with anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDAR encephalitis). PATIENT CONCERNS: A 20-year-old female was transferred to emergency department of our hospital from local hospital presented with insomnia, mood lability, tonic-clonic seizure, and decreased level of consciousness. DIAGNOSES: The diagnosis of anti-NMDAR encephalitis was established by detection of cerebrospinal fluid (CSF) and serum antibodies to the NMDA receptor. During the hospital stay, the patient developed massive spontaneous hemothorax and was confirmed by closed-tube thoracostomy. INTERVENTIONS AND OUTCOMES: Video-assisted thoracotomy was performed to evacuate the blood clots and also to obtain pleural biopsy specimen for diagnostic evaluation. However, the reason of hemothorax remained idiopathic. The postoperative status of this patient was uneventful, and she was discharged on postoperative day 45 as her mental status improved markedly. LESSONS: In this case, the patient had both anti- NMDAR encephalitis and autoimmune thyroid disease. Based on it, we suspected that the patient subjected to severe autoimmune response and inflammatory reaction, which might explain the pathologic changes of parietal pleura and visceral pleura. We recommend the suspicion of spontaneous hemothorax should be considered when the patients with autoimmune diseases present with hemorrhage-related signs or symptoms.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Hemotórax/etiologia , Receptores de N-Metil-D-Aspartato/imunologia , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Autoanticorpos/sangue , Feminino , Glucocorticoides/uso terapêutico , Hemotórax/cirurgia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Pleura/patologia , Cirurgia Torácica Vídeoassistida/métodos , Toracostomia/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
JNMA J Nepal Med Assoc ; 56(210): 621-624, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30376008

RESUMO

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial "glue" compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse. Keywords: inhalant abuse; pneumothorax; solvent.


Assuntos
Antibacterianos/administração & dosagem , Dor no Peito/diagnóstico , Abuso de Inalantes/complicações , Derrame Pleural , Pneumonia , Pneumotórax , Toracostomia , Dor no Peito/etiologia , Tubos Torácicos , Humanos , Abuso de Inalantes/diagnóstico , Pulmão/diagnóstico por imagem , Masculino , Oximetria/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/fisiopatologia , Derrame Pleural/terapia , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Pneumonia/fisiopatologia , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Toracostomia/instrumentação , Toracostomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
17.
Vet Surg ; 47(8): 1046-1051, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30302761

RESUMO

OBJECTIVE: To describe and compare fluoroscopic guidance for placement of wide-bore thoracostomy tubes (FGTT) to traditional, blind placement of thoracostomy tubes (BPTT). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty client-owned dogs. METHODS: Dogs requiring medical management of pleural effusion received a BPTT, whereas dogs undergoing postoperative management of pneumothorax and/or pleural fluid after lateral thoracotomy received an FGTT. Time of placement, accuracy of positioning, radiation exposure, and complications were compared between groups. RESULTS: Initial placement of BPTT took a mean of 168 seconds (range, 89-197), whereas adequate placement was radiographically confirmed at 20 minutes and 38 seconds (range, 7 minutes and 57 seconds to 39 min). Initial placement of FGTT took a mean time of 108 seconds (range, 50-341, P = .17), and adequate placement was confirmed at 125 seconds (range, 50-341, P < .001). Major errors in placement requiring removal and replacement occurred in 2 dogs for BPTT and in none for FGTT. Procedural complications did not differ between groups, and no postoperative complication occurred within the first 12 hours after placement. Radiation entrance surface dose was lower in the BPTT group (P = .004), but stochastic radiation doses did not differ. CONCLUSION: Fluoroscopic guidance of wide-bore thoracostomy tubes accelerated the time to accurate tube placement and alleviated the requirement for removal and replacement in this population. Although use of fluoroscopy increased radiation entrance surface dose, the dose was not clinically significant. CLINICAL SIGNIFICANCE: Fluoroscopic guidance of wide-bore thoracostomy tubes should be considered as an alternative to traditional, blind placement.


Assuntos
Tubos Torácicos/veterinária , Doenças do Cão/terapia , Fluoroscopia/veterinária , Pneumotórax/veterinária , Toracostomia/veterinária , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Humanos , Masculino , Pneumotórax/terapia , Complicações Pós-Operatórias/veterinária , Estudos Prospectivos , Toracostomia/instrumentação , Toracostomia/métodos , Resultado do Tratamento
18.
J Med Case Rep ; 12(1): 291, 2018 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-30292243

RESUMO

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 Penetrantes
19.
J Emerg Med ; 55(3): 366-371, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29958708

RESUMO

BACKGROUND: Tube thoracostomy has long been the standard of care for treatment of tension pneumothorax in the hospital setting yet is uncommon in prehospital care apart from helicopter emergency medical services. OBJECTIVE: We aimed to evaluate the performance of simple thoracostomy (ST) for patients with traumatic cardiac arrest and suspected tension pneumothorax. METHODS: We conducted a retrospective case series of consecutive patients with traumatic cardiac arrest where simple thoracostomy was used during the resuscitation effort. Data were abstracted from our Zoll emergency medical record (Zoll Medical Corp., Chelmsford, MA) for patients who received the procedure between June 1, 2013 and July 1, 2017. We collected general descriptive characteristics, procedural success, presence of air or blood, and outcomes for each patient. RESULTS: During the study period we performed ST on 57 patients. The mean age was 41 years old (range 15-81 years old) and 83% were male. Indications included 40 of 57 (70%) blunt trauma and 17 of 57 (30%) penetrating trauma. The presenting rhythm was pulseless electrical activity 65%, asystole 26%, ventricular tachycardia/fibrillation 4%, and nonrecorded 5%. Eighteen of 57 (32%) had air return, 14 of 57 (25%) return of spontaneous circulation, with 6 of 57 (11%) surviving to 24 h and 4 of 57 (7%) discharged from the hospital neurologically intact. Of the survivors, all were blunt trauma mechanism with initial rhythms of pulseless electrical activity. There were no reported medic injuries. CONCLUSIONS: Our data show that properly trained paramedics in ground-based emergency medical services were able to safely and effectively perform ST in patients with traumatic cardiac arrest. We found a significant (32%) presence of pneumothorax in our sample, which supports previously reported high rates in this patient population.


Assuntos
Serviços Médicos de Emergência/métodos , Parada Cardíaca/terapia , Pneumotórax/terapia , Toracostomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Parada Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos e Lesões/complicações
20.
Ultrasound Q ; 34(4): 226-232, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30020274

RESUMO

Primary spontaneous pneumothorax (PSP) is a common cause of presentation to emergency departments and subsequent hospitalization. Patients with large PSP are treated with tube thoracostomy (TT) and followed up with x-rays. In this study, we investigated the efficiency of bedside ultrasound and compared it with x-ray imaging for the clinical follow-up of PSP patients treated with TT.This is a prospective observational study. After ethical committee approval and written informed consent were obtained, patients who were treated with TT because of PSP were screened. In the follow-up of these patients, a bedside lung ultrasound (BLUS) was performed before every chest x-ray by an emergency physician experienced in performing BLUSs. The performance of BLUSs in detecting free air in the pleural cavity was compared statistically with that of x-rays.Sixty-two patients were enrolled in the study. In total, 166 BLUSs and x-rays were compared. The sensitivity of BLUS was 95.65% (85.20-99.50), specificity was 100% (79.40-100.00), positive predictive value was 100% (92-100), negative predictive value was 88.90% (65.30-98.60), and the area under the curve was 0.99 (0.974-1.000; P = 0.001) for detecting air in the pleural cavity. These results showed that there was no statistically significant difference between BLUS and x-ray methods for detecting air in the pleural cavity.Our study revealed that BLUS can be safely used for the follow-up of PSP patients treated with TT to determine if air is present in the pleural cavity. Further studies are needed.


Assuntos
Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Testes Imediatos , Toracostomia/métodos , Adulto , Tubos Torácicos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Toracostomia/instrumentação , Resultado do Tratamento , Ultrassonografia/métodos , Adulto Jovem
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