1/188. Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/188. A surgical gauze appearing as a retrocardiac mass in a patient after coronary artery bypass surgery.Five years after open chest surgery because of three vessel coronary artery disease a patient was referred for progressing dyspnea and recent onset of atrial fibrillation. A retrocardiac mass was detected on chest X-ray and echocardiography. On CT-scan, the inhomogenous tumor made the diagnosis of a retained surgical gauze likely. Through a left incision the sponge was removed uneventfully and the dyspnea resolved.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/188. Thoracoscopic retrieval of foreign body after penetrating chest injury: report of two cases.Video-assisted thoracic surgery has proved to be valuable in many settings in thoracic surgery. The use of video-assisted thoracic surgery in trauma has recently rapidly increased. It is useful in acute or delayed management of patients with blunt and penetrating chest trauma. It is safe for removal of clotted hemothorax, treatment of thoracic empyema, treatment of persistent pneumothorax, treatment of chylothorax, and for diagnosis of diaphragmatic injury. We report two cases using thoracoscopy to remove intrathoracic metal fragments and avert the need for thoracotomy. In the first patient, a metal fragment injury was sustained via a penetrating wound from the supraclavicular notch to the right upper lung. The metal fragment was retrieved and the lung was repaired thoracoscopically using conventional suturing techniques. A second patient sustained a broken pin injury to the left upper mediastinum via a low neck wound. The pin was successfully removed under videothoracoscopy. Both patients recovered uneventfully and had shortened hospital stays. We feel that thoracoscopy offers a therapeutic as well as diagnostic benefit in stable patients with penetrating chest trauma.- - - - - - - - - - ranking = 6keywords = chest (Clic here for more details about this article) |
4/188. Unusual sites of uncommon endobronchial foreign bodies. Reports of four cases.Foreign body aspiration occurs most commonly in children and can have serious consequences. In adults, it is associated with surgery, trauma and accidents. We report four unusual cases of foreign body inhalation. In one case a spike of wild barley entered the trachea through a tracheostomy cannula and migrated from the chest wall. In the second case a piece of coarse cloth which was introduced through a tracheostomy stoma aided by a wood sliver was retained in the trachea. In another patient an inhaled sewing needle migrated to the pericardium, and in the fourth case the head of a metal stud penetrated the trachea percutaneously through the neck and lodged in the right main bronchus. The incidence, causes, complications and management of such cases are discussed and the literature is briefly reviewed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/188. Retained intrathoracic surgical swab: CT appearances.A retained surgical swab (gossypiboma) is a rare but important complication of intrathoracic surgery. The radiographic and computed tomography (CT) appearances are variable and depend on the chronicity and site of the swab within the chest. Two cases of retained swabs within the chest are reported. In both cases, the swab had become surrounded by lung. The swab within the pleural space acted as a nidus and resulted in infolding of the lung, superficially resembling an intrapulmonary abscess on CT.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
6/188. Intrapulmonary artery and intrabronchial migration and extraction of a fragment of J-shaped atrial pacing catheter.A fragment of a fractured Telectronics Atrial Accufix 330-801 lead asymptomatically perforated the adjacent bronchus and was detected on routine chest X-ray. The metallic fragment was located by chest CT scan and bronchial fluoroscopy to lie between the right lobar bronchus and the pulmonary artery, confirming bronchial perforation. The foreign body was removed without complication by direct visualisation with rigid bronchoscopy.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
7/188. Intrapericardial tumbling bullet.foreign bodies of the pericardium are rare and they are associated most commonly with significant trauma. The diagnosis of a pericardial foreign body can be difficult. One must distinguish between foreign matter in the cardiac chamber or free-floating in the mediastinum. Serial chest x-rays and fluoroscopy were most helpful to us. Neither CT scan nor an echocardiogram were particularly helpful. To prevent pericarditis, either sterile or non-sterile, with potential for other significant complications, removal of a pericardial foreign body is always indicated.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/188. Breaking the rules: a thoracic impalement injury.In the case of a patient with an impalement injury, the object should be removed in a controlled operating theatre environment. We report an 18-year-old man for whom this rule could not be followed. He was removed from a metal pipe transfixing his chest at the roadside.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/188. An unusual cause of tracheal stenosis.PURPOSE: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. CLINICAL FEATURES: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. CONCLUSION: The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/188. Respiratory distress due to esophageal perforation caused by ball point ingestion.A 15-month-old girl who developed respiratory distress which persisted for three days prior to admission demonstrated pleural effusion on the chest x-ray which was determined to be due to esophageal perforation caused by the ingestion of a ball point. A gastrotomy was performed to extract the ball point. A gastrostomy was performed and a chest tube was inserted. The esophagus was normal radiologically within one month. Foreign body ingestion may cause esophageal perforation in childhood. If it goes unnoticed and a diagnosis is delayed, there is danger of the more hazardous development of mediastinitis. It is important that a child with respiratory distress also be evaluated for esophageal foreign body ingestion.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
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