1/404. Tension pneumothorax complicating diagnostic upper endoscopy: a case report.Hypoxemia is common during various endoscopic procedures and may result from a variety of causes. These causes range from benign and otherwise easily reversible events like oversedation to potentially life threatening complications such as pneumothorax. Although pneumothorax has been reported secondary to gastrointestinal perforation as a complication of various therapeutic endoscopic procedures, there has been no report of pneumothorax without perforation. We report a case of a patient who developed severe hypoxemia and hemodynamic instability during diagnostic upper endoscopy as a result of pneumomediastinum and tension pneumothorax in the absence of any signs of gastrointestinal perforation and comment on various possible mechanisms. Immediate endotracheal intubation and bilateral chest tube placement resulted in prompt return of the patient's oxygenation and vital signs back to normal. This report enlarges the list of possible causes of hypoxemia during endoscopy and shows the importance of early and prompt recognition, which allowed directed therapy with a good outcome.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/404. pneumothorax due to electrical burn.A 25-year-old male developed early as well as delayed (15 days post burn) pneumothorax of right side following high voltage, 1100 KV, electrical burn of the right side of the chest wall. diagnosis was established by clinical examination and chest x-ray. Intercostal tube drainage with underwater seal relieved the patient of pneumothorax.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/404. Fragile lung in the marfan syndrome.Two cases of the marfan syndrome presented with spontaneous pneumothorax. Both had chest radiographs showing bilateral bullae in the upper lung zones and pulmonary function tests consistent with mild emphysema. There were dereases in forced expiratory flow rates at low lung volumes, carbon monoxide transfer factor, and lung elastic recoil. It is suggested that pneumothorax and bullous emphysema in this syndrome are caused by a weakness in the pulmonary connective tissue framework.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/404. Chest wall arteriovenous fistula: an unusual complication after chest tube placement.Posttraumatic arteriovenous fistulas can form between vessels of the thorax that have sustained loss of integrity to the vessel wall. Although most are caused by injuries as a consequence of missile penetration or stab wounds, iatrogenic damage is a potential cause. Herein we present a case of a systemic arteriovenous fistula involving an intercostal artery and subcutaneous vein after chest tube placement.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
5/404. Use of postoperative chest x-ray after elective adult tracheotomy.Surgeons have been creating tracheotomies since at least 124 AD, when first reported by Asclepiades (Price HC, Postma DS. Ear nose Throat J 1983;62:44-59). Intraoperative and postoperative complications specifically associated with this procedure have been well established. The incidence of pneumothorax ranges from 0% to 17%, depending on the age group studied. To evaluate this complication, it is generally accepted that a postoperative chest film should routinely be obtained after a tracheotomy in adult patients. In adult nonemergent tracheotomies, the routine use of a postoperative chest film has a low yield for detecting a pneumothorax in patients without clinical findings of pneumothorax. To evaluate the use of postoperative chest x-ray in adult tracheotomy patients, a retrospective review of tracheotomies performed at the boston Medical Center from January 1994 to June 1996 was undertaken. Data examined consisted of age, sex, surgical indication, urgency, operating service, intraoperative and postoperative complications, difficulty of procedure, anesthetic technique, findings on postoperative chest film, signs and symptoms of pneumothorax, and specific treatment of pneumothorax if present. In total, 250 patients were identified. The main indication for tracheostomy in this study was ventilator dependence, accounting for 77% of the procedures. A complication rate of 11.6% was encountered, with no deaths. postoperative hemorrhage was the most common complication (3.6%). pneumothorax was documented by chest x-ray in 3 (1.2%) patients, 1 of whom had bilateral pneumothoraces. The most common symptom of a pneumothorax was tachycardia, with 8.8% of the patients exhibiting at least 1 episode. Of the 3 cases of pneumothorax in this study, only 1 was clinically relevant and required treatment. Furthermore, the clinical signs and symptoms in this patient clearly supported the diagnosis of pneumothorax before a postoperative chest film was obtained. Thus postoperative chest radiographs did not change the treatment or outcome of any of the patients undergoing a tracheotomy. This suggests that postoperative chest x-ray after adult tracheotomy is not required in routine cases. Chest radiographs should be obtained after emergent procedures, after difficult procedures, or in patients exhibiting signs or symptoms of pneumothorax.- - - - - - - - - - ranking = 12keywords = chest (Clic here for more details about this article) |
6/404. Catamenial pneumothorax--3 case reports and view of literature.INTRODUCTION: The unusual correlation between chronic recurring spontaneous pneumothorax and the menstrual cycle, was first presented by Maurer in 1958. In our clinic we had 3 cases in 5 years. The anamnesis shows that this syndrome is unknown to many of our colleagues. Not mentioned in several standard textbooks, warrants our attention. methods: In 5 years we had 3 cases of C.P., all of them had already on admission, at least one recurrence; all of them had right sided thoracic pain and dyspnoea. They undergone video-assisted thoracoscopy, with histological examination of diaphragm specimen. Gynaecological consultations was followed by hormonal therapy and follow up. RESULTS: In all 3 cases we found no signs of lung defects or bullae, instead, we identified diaphragm defects of different extension, even a liver prolapse in one of the cases. endometriosis extra genitalis could be diagnosed in only one case which undergone a hysterectomy 8 years before. CONCLUSION: A spontaneous pneumothorax which recurs in correlation with menses has a pathogenesis which concern only women, that is why is referred to as catamenial. Our experience supports the hypothesis, that air in the pleural cavity originates from the peritoneal one, arriving here via uterus and tuba. Beside the symptomatic therapy ther is an etiological one, by inhibition the menstrual cycle. Thoracosurgical intervention could help preventing recurrence, and contributes in clarifying the pathogenesis.- - - - - - - - - - ranking = 0.0043508094140588keywords = pain (Clic here for more details about this article) |
7/404. pneumothorax after diagnostic laparoscopy.A case of laparoscopic-induced asymptomatic pneumothorax (PTX) is presented. Six hours postoperation, a chest x-ray revealed no evidence of PTX. The patient subsequently had a routine postoperation course. As the number of laparoscopic cases performed each year continues to rise, the surgeon must remain cognizant of all possible major and minor complications to keep laparoscopic surgery safe and effective.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/404. Macleod's syndrome presenting with spontaneous pneumothorax.A 19-year-old woman with a recent history of recurrent bronchitis presented with a spontaneous left pneumothorax. review of the chest radiographs revealed features of Macleod's syndrome on the same side, with unilateral lucency and hypoplastic hilar vessels. To our knowledge this is the first report of Macleod's syndrome presenting with spontaneous pneumothorax.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/404. Tension pneumoperitoneum associated with a pleural-peritoneal shunt.The differential diagnosis of pneumoperitoneum is broad. We report a case of tension pneumoperitoneum in a patient on mechanical ventilation with initially unrecognized pneumothorax who had an indwelling pleural-peritoneal shunt. The patient developed ventilatory and hemodynamic collapse as air was diverted from the pleural space into the peritoneal cavity. Subsequent abdominal exploration revealed the source of the intra-abdominal air. Placement of a chest thoracostomy tube and removal of the pleural-peritoneal catheter resulted in significant clinical improvement. We suggest that it is important to recognize that pleural-peritoneal catheters may cause tension pneumoperitoneum without obvious concurrent pneumothorax.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/404. Pulmonary lymphangioleiomyomatosis. A study of 69 patients. Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).Pulmonary lymphangioleiomyomatosis (LAM) is a rare disorder of unknown cause characterized by peribronchial, perivascular, and perilymphatic proliferation of abnormal smooth muscle cells leading to cystic lesions. The hypothesis of hormonal dependence and the effectiveness of hormonal therapy have not yet been demonstrated conclusively, and the prevalence of extrathoracic manifestations and the survival of patients with LAM are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features, the diagnostic procedures, the associated lesions, and, above all, the management and course of LAM in a large homogeneous series of 69 stringently selected patients, with a majority of cases diagnosed since 1990. The aim of the study, based on a review of the literature, also was to provide a comprehensive view of this uncommon disease. The clinical features were in keeping with previous studies, but we found that exertional dyspnea and pneumothorax were the most common features, and chylous involvement was less frequent. LAM was diagnosed after menopause in about 10% of cases. The onset of LAM occurred during pregnancy in 20% of cases, and a clear exacerbation of LAM was observed in 14% of cases during pregnancy. Pulmonary LAM was diagnosed on lung histopathology in 83% of cases, but renal angiomyolipoma, observed in 32% of our patients, may be a useful diagnostic criterion when associated with typical multiple cysts on chest CT scan or with chylous effusion. Chest CT scan was more informative than chest X-ray (normal in 9% of cases), and may be indicated in spontaneous pneumothorax or renal angiomyolipoma in women of childbearing age. About 40% of the patients had a normal initial spirometry, while an obstructive ventilatory defect (44%), a restrictive ventilatory defect (23%), was observed in other patients. Initial diffusing capacity for carbon monoxide was frequently decreased (82%). Hormonal therapy was administered in 57 patients, but a clear > or = 15% improvement of FEV1 was observed in only 4 evaluable patients, treated with tamoxifen and progestogens (n = 2), progestogen (n = 1), and oophorectomy (n = 1). Probably 1 of the most urgent needs for clinical research in LAM is to test the currently available hormonal treatments in the context of international multicenter prospective controlled studies. pleurodesis was performed in 40 patients. lung transplantation was performed in 13 patients, 7.8 /- 5.2 years after onset of LAM, in whom the mean FEV1 was 0.57 /- 0.15 L. After a follow-up of 2.3 /- 2.2 years, 9 patients were alive. Mean follow-up from onset of disease to either death or closing date was 8.2 /- 6.3 years. overall survival was better than usually reported in LAM, and Kaplan-Meier plot showed survival probabilities of 91% after 5 years, 79% after 10 years, and 71% after 15 years of disease duration.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
| | Next -> |