1/6. The use of high positive end-expiratory pressure for respiratory failure in abdominal compartment syndrome.We report a case in which a non-trauma patient suffering hematemesis and undergoing massive volume resuscitation developed abdominal compartment syndrome (ACS). The abdominal distension severely compromised his pulmonary functioning: a chest radiograph showed low lung volumes and dense bilateral parenchymal opacities. His blood oxygen saturation reached as low as 32%. Because he was hemodynamically unstable and coagulopathic, decompressive surgery was not possible. We gradually raised the ventilator settings to reinflate the lungs (positive end-expiratory pressure [PEEP] was raised to 50 cm H(2)O, peak inspiratory pressure to 100 cm H(2)O, and plateau inspiratory pressure to 80 cm H(2)O) and continued fluid resuscitation, and within an hour his blood oxygen saturation increased to 100%. In this case high PEEP was beneficial in a situation in which decompressive surgery was not feasible, but we do not suggest that high PEEP necessarily improves survival or that high PEEP is better than surgical decompression. On the contrary, high-pressure ventilation can be harmful in the setting of acute lung injury and acute respiratory distress syndrome, so we do not advocate high PEEP for all patients with hypoxemia and ACS, especially considering that many of the conditions associated with ACS can also precipitate acute lung injury and acute respiratory distress syndrome. As well, high-pressure ventilation can increase the risk of hypotension by impairing venous return. However, our case suggests that high PEEP may temporize in certain situations in which ACS causes life-threatening hypoxia but surgical decompression is not possible.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/6. Fatal delayed esophageal rupture following aortic clamping for treatment of Stanford type B dissection.A 65-year-old man underwent a thromboexclusion operation for management of chronic Stanford type B dissecting aneurysm in 1991. However, long-term follow-up CT scans after the operation revealed that the ascending aorta gradually enlarged and was eventually complicated by recurrent aortic dissection. The patient complained of frequent bloody sputum, whereas chest roentogenography showed no pulmonary abnormalities. Subsequent swallow esophagogram demonstrated that the upper esophagus was deviated to the right and the middle esophagus was greatly compressed by the aortic clamp. Esophageal endoscopy showed a bloody inner surface and marked swelling of the middle esophagus. The patient eventually died of massive hematemesis in 2001. We describe the imaging features of unanticipated complications such as recurrent dissecting aneurysm or impending esophageal rupture. Furthermore, we discuss the cause of hematemesis and document that the aortic clamp migrated and resulted in development of a recurrent aneurysmal dissection, which in turn resulted in esophageal rupture with aneurysmal disruption.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/6. hematemesis as a presenting symptom of lung cancer with synchronous metastases to the esophagus and stomach. A case report.A rare case of upper gastrointestinal hemorrhage due to synchronous metastases to the esophagus and stomach from an asymptomatic lung cancer is reported. A 51-year-old white man presented with hematemesis and an emergency endoscopy revealed submucosal tumorous lesions with central ulcerations in the esophagus and stomach. A needle aspiration biopsy revealed the presence of cellular proliferation of adenocarcinoma, which led to the diagnosis of lung cancer, along with a chest radiograph revealing a tumor in the right middle lung field. The importance of conducting an upper gastrointestinal endoscopic examination for staging of patients with lung cancer is stressed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/6. Fatal haematemesis in childhood associated with aorto-oesophageal fistula.A case of fatal haematemesis associated with a non-traumatic, non-tuberculous aorto-oesophageal fistula in a 9-year-old Nigerian boy is presented. autopsy revealed two inflamed and ulcerated mild-oesophageal pulsion diverticula, one of which had eroded into the right pleura as a sinus track. The second diverticulum had perforated and caused mediastinitis and eventually aorto-oesophageal fistula which led to the fatal haematemesis. A mild chest injury is seen as a precipitating factor of the haematemesis and not the initiator of the pathology.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/6. Aortoesophageal fistula. review of clinical, radiographic, and endoscopic features.Primary aortoesophageal fistula is a rare cause of severe and often fatal gastrointestinal bleeding. The classic diagnostic triad consists of midthoracic pain and sentinel hemorrhage, followed by fatal exsanguination. A prompt, definitive diagnosis at the time of the initial bleeding episode is essential for timely, life-saving surgery. Any combination of low-grade, intermittent hematemesis, with midthoracic chest pain, dysphagia, or a mediastinal mass, should alert the physician to this diagnosis, and an aggressive diagnostic and therapeutic approach. In this article, we report a case of aortoesophageal fistula and present photographs.- - - - - - - - - - ranking = 27.894388263634keywords = chest pain, chest (Clic here for more details about this article) |
6/6. Spontaneous intramural haematoma of the oesophagus: radiologic recognition.Spontaneous intramural haematoma of the oesophagus (SIHO) is an uncommon disorder. It presents usually with acute chest pain followed by dysphagia. This condition may mimic spontaneous rupture of the oesophagus (Boerhaave syndrome), dissection of the thoracic aorta or acute myocardial infarction. Hence early accurate confirmation of the diagnosis by radiology is vital for the appropriate acute management. The condition is frequently mistaken for acute myocardial infarction which may prompt inappropriate thrombolytic therapy. The appearances on contrast studies of oesophagus and on CT scanning are characteristic. Despite this, the diagnosis may easily be missed, if appropriate careful radiological technique is not used. This paper reports three consecutive cases of SIHO managed in one institution. These cases illustrate that early gastrografin contrast radiology followed by barium contrast radiology and if necessary by thoracic CT is diagnostic in all cases of this condition.- - - - - - - - - - ranking = 27.894388263634keywords = chest pain, chest (Clic here for more details about this article) |