1/76. Hyperbaric chamber-related decompression illness in a patient with asymptomatic pulmonary sarcoidosis.An asymptomatic 46-yr-old male sustained an acute neurologic insult, appearing during the decompression phase of a 50-m dry hyperbaric chamber dive. The right hemisyndrome was most probably related to diving, since symptoms responded rapidly to the early commenced recompression therapy. Further diagnostics revealed a previously unknown pulmonary sarcoidosis with bilateral pulmonary opacities and pleural adhesions that might have predisposed to arterial gas embolism secondary to pulmonary barotrauma. This case may illustrate a potential risk of decompression illness even during dry chamber dives in patients suffering from asymptomatic pleuro-parenchymal pulmonary disease. The value of chest X-ray in the medical assessment of fitness to dive is therefore emphasized.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/76. Cerebral arterial gas embolism in air force ground maintenance crew--a report of two cases.Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest x-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.- - - - - - - - - - ranking = 2.1608145071155keywords = chest, pain (Clic here for more details about this article) |
3/76. Pulmonary cyst and cerebral arterial gas embolism in a hypobaric chamber: a case report.This is a report of an aircrew member who suffered a serious physiological incident in the form of pulmonary barotrauma and cerebral arterial gas embolism during hypobaric chamber training, and who subsequently was shown to have a cyst in the upper lobe of the left lung. The likely origin of the cyst is discussed, as well as the aeromedical disposition following thoracotomy and apical segmentectomy to remove the cyst.- - - - - - - - - - ranking = 0.018756899631235keywords = upper (Clic here for more details about this article) |
4/76. Favorable outcome in a large left heart air embolism: lessons from an unusual complication of a noninvasive chest scan.OBJECTIVE: To report an unusual life-threatening complication of the performance of a computed tomographic (CT) scan of the chest. DESIGN: Case report. SETTING: University hospital. PATIENT: An intubated patient with blunt thoracic trauma. INTERVENTION: Performance of a CT scan of the chest at full inspiration. MAIN RESULT: With air insufflation, a large left ventricular air embolism occurred as a consequence of an airway breach, revealed by the simultaneous existence of a mild bilateral anterior pneumothorax. CONCLUSION: CT scan of the chest in patients at risk of airway breach (patients with acute respiratory distress syndrome, trauma patients) should first be performed at full expiration, not full inspiration.- - - - - - - - - - ranking = 7keywords = chest (Clic here for more details about this article) |
5/76. Lung isolation for the prevention of air embolism in penetrating lung trauma. A case report.PURPOSE: To illustrate a new airway and ventilatory management strategy for patients with unilateral penetrating lung injury. Emphasis is placed on avoiding positive pressure ventilation (PPV)-induced systemic air/gas embolism (SAE) through traumatic bronchiole-pulmonary venous fistulas. CLINICAL FEATURES: A 14-yr-old male, stabbed in the left chest, presented with hypovolemia, left hemopneumothorax, an equivocal acute abdomen, and no cardiac or neurological injury. In view of the risk of SAE, we did not ventilate the left lung until any fistulas, if present, had been excised. After pre-oxygenation, general anesthesia was induced and a left-sided double-lumen tube (DLT) was placed to allow right-lung ventilation. bronchoscopy was performed. The surgeons performed a thorascopic wedge resection of the lacerated lingula. Upon completion of the repair, two-lung ventilation was instituted while the ECG, pulse oximetry, PETCO2, and blood pressure were monitored. Peak inflation pressure was increased slowly and was well tolerated up to 50 cm H2O. The patient's intravascular status was maintained normal. CONCLUSION: patients with lung trauma are at risk of developing SAE when their lungs are ventilated with PPV. In a unilateral case, expectant non-ventilation of the injured lung until after repair is recommended.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/76. Clinics in diagnostic imaging (53). Hepatic portal venous gas due to mesenteric infarction.A 43-year-old woman presented with acute abdominal pain and signs of ileus. CT scan of the abdomen showed hepatic portal venous gas. At surgery, a long segment of gangrenous bowel extending from the jejunum to the proximal hemicolon was found. The cause was superior mesenteric artery occlusion. The aetiology, imaging features and clinical significance of hepatic portal venous gas are discussed.- - - - - - - - - - ranking = 0.72176647927033keywords = abdominal pain, pain (Clic here for more details about this article) |
7/76. Successful resuscitation after catastrophic carbon dioxide embolism during laparoscopic cholecystectomy.A 92-year-old female was scheduled for laparoscopic cholecystectomy. Following intraperitoneal carbon dioxide insufflation and removal of her gallbladder, the patient developed serious haemodynamic deterioration associated with a decrease of both end-tidal carbon dioxide concentration (ETCO2) and chest compliance. carbon dioxide embolism was suspected and the diagnosis was confirmed by aspiration of 20 mL of foamy blood from the central venous line. The patient was successfully resuscitated after discontinuation of carbon dioxide insufflation and ventilation of the lungs with 100% oxygen. carbon dioxide embolization must always be suspected during laparoscopic surgery whenever sudden haemodynamic deterioration associated with a decrease in ETCO2 and chest compliance occur.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
8/76. Recurrent hepatic portal venous gas in a patient with hemodialysis- dependent chronic renal failure.We report a case of recurrent hepatic portal venous gas (HPVG). A 51-year-old woman who had been undergoing hemodialysis for 19 years was admitted with abdominal pain. Computed tomography (CT) scans revealed the presence of HPVG, and bowel necrosis was confirmed at operation. After 1 year, the abdominal pain recurred. CT scans on the second admission also revealed HPVG; however, an exploratory laparotomy was negative. Recurring presentation of HPVG in the same patient has not been described previously.- - - - - - - - - - ranking = 1.4435329585407keywords = abdominal pain, pain (Clic here for more details about this article) |
9/76. Venous air embolism in homicidal blunt impact head trauma. case reports.From 1992 through 1997, there were 41 deaths by homicidal blunt impact head trauma in Hillsborough County, florida. Twenty-one cases were excluded from the study because of putrefaction or survival beyond the emergency department doors, leaving 20 cases for the study. One of the 15 nonputrefied victims found dead at the scene and 1 of the 5 victims pronounced dead in the emergency department had definite venous air embolism. Victim 1 was found dead, bludgeoned with a concrete block, and had open vault and comminuted basilar skull fractures. The dura forming the right sigmoid sinus at the jugular foramen was lacerated. A preautopsy chest radiograph and examination under water documented gas in the pulmonary artery and right ventricle. Victim 2 was bludgeoned with a steel stake and was pronounced dead on arrival in the emergency department. He had open comminuted vault fractures, a transverse basilar skull fracture, and lacerations of the brain. Direct examination and preautopsy chest radiography revealed air in the right side of the heart. A third victim, with basilar fractures, had a small gas bubble in the pulmonary artery not detected by the case pathologist. A fourth victim, with a basilar skull fracture, had an unusual radiographic finding that was thought to be air in the posteromedial aspect of the lower lobe of the left lung but could not be excluded as an air embolus. Optimal postmortem documentation of venous air embolism includes the demonstration of the embolus and the site of air ingress. This study demonstrates that venous air embolism occurs in some victims of homicidal bludgeoning and suggests that when significant, it is easily demonstrated in the absence of putrefactive gas formation. The presence of venous air embolism can serve as evidence that a victim was alive and breathing at the time of the infliction of head wounds. In the belief that venous air embolism might be underdiagnosed in many medical examiner offices, the authors have sought to bring attention to the entity by publishing their experience with it in cases of bludgeoning.- - - - - - - - - - ranking = 13.285500467557keywords = breathing, chest (Clic here for more details about this article) |
10/76. Documented arterial gas embolism after spinal epidural injection.We report the case of a 90-year-old man with syncope, arrhythmia, cardiac ischemia, and neurologic deficit after undergoing spinal epidural injection for control of pain related to post-herpetic neuralgia. The diagnosis of arterial gas embolus was made after air was identified in the left ventricle of the heart on an abdominal computed tomographic scan. Emergency physicians should consider and rapidly diagnose this rare but potentially fatal complication of spinal epidural puncture.- - - - - - - - - - ranking = 0.16081450711554keywords = pain (Clic here for more details about this article) |
| | Next -> |