11/73. Hemorrhagic shock due to intrathoracic rupture of an osteosarcoma of the rib.A 13-year-old girl presented with dyspnea and chest pain. Chest radiography showed a massive left pleural effusion. Computed tomography revealed a tumor of the fourth rib. A large bloody effusion was drained. Her anemia worsened (hemoglobin: 4.8 g/dl), and hemorrhagic shock ensued. An emergency thoracotomy was performed. Bleeding from the ruptured tumor was identified. The fourth rib, the tumor, and the adjacent tissues were resected. Histopathologic examination revealed a ruptured primary osteosarcoma of the rib with pleural dissemination.- - - - - - - - - - ranking = 1keywords = chest, chest pain (Clic here for more details about this article) |
12/73. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 7keywords = chest, chest pain (Clic here for more details about this article) |
13/73. Multiple persistent circumscribed pulmonary hematomas due to a blunt chest trauma.A case of multiple sharply circumscribed pulmonary hematomas ("coin" lesions) following blunt, non-penetrating thoracic trauma, is reported. The finding mimicked cancerous "cannon ball" metastatic deposits. A computed tomographic scan combined with puncture biopsy provided the correct diagnosis. Spontaneous complete resolution of the hematomas took 3 years.- - - - - - - - - - ranking = 3.1724688786274keywords = chest (Clic here for more details about this article) |
14/73. Blunt chest trauma: review of selected pulmonary injuries focusing on pulmonary contusion.Pulmonary injuries resulting from blunt chest trauma remain a common clinical entity for critical care and emergency nurses. In this article, the epidemiology and mechanism of injury most often observed in patients with blunt chest trauma are reviewed. Selected pulmonary injuries are discussed in terms of mechanism of injuries, assessment and diagnostic modalities, standard therapies, and cutting-edge therapies used today with a focus on pulmonary contusion. Many advances and experimental therapies currently used in the management of the patient with severe lung injuries are discussed. A case study is presented highlighting a complicated case of a blunt chest injury resulting in severe pulmonary contusion.- - - - - - - - - - ranking = 5.5518205375979keywords = chest (Clic here for more details about this article) |
15/73. Delayed heart perforation after blunt trauma.A 33-year-old patient was hospitalized after a blunt chest trauma with a left flail chest. Six hours after admission to the intensive care unit the patient suddenly developed hypotension and tachycardia. His left chest tube drained 1.5 l of blood within minutes. Immediate resuscitation and emergency sternotomy with left anterolateral extension was performed for pericardial tamponade secondary to left ventricular perforation due to a sharp rib fragment. Outcome was favourable and the patient was operated on for his flail chest by internal stabilization the next day.- - - - - - - - - - ranking = 3.1724688786274keywords = chest (Clic here for more details about this article) |
16/73. Callus resection for brachial plexus compression following stress-induced first rib fracture.A 27-year-old man presented with a lower trunk brachial plexus injury due to excessive callus formation following a stress-induced first rib fracture. The callus, but not the first rib, was resected through a supraclavicular approach. His symptoms resolved in 2 months, and no recurrence was seen at 2 years follow-up.- - - - - - - - - - ranking = 0.098644624737356keywords = plexus (Clic here for more details about this article) |
17/73. Traumatic extrathoracic lung herniation.Traumatic extrathoracic lung herniation is an exceptional complication of blunt chest trauma. We report the case of a 46-year-old man who was involved in a motorcycle accident and who suffered a left clavicle fracture-dislocation associated with multiple rib fractures and massive herniation of the left upper lobe through an upper anterior chest wall defect. Immediate surgical repair through an atypical transcostal vertical thoracotomy resulted in full recovery of pulmonary function at 1 year.- - - - - - - - - - ranking = 1.5862344393137keywords = chest (Clic here for more details about this article) |
18/73. exsanguination due to right ventricular rupture during closed-chest cardiopulmonary resuscitation.We report on a 61-year-old woman in whom cardiopulmonary resuscitation (CPR) was unsuccessful. While the patient was initially resuscitated from the primary cardiac arrest, with evidence of neurologic recovery, she ultimately succumbed to injuries resulting directly from closed-chest CPR. autopsy revealed multiple rib fractures, a sternal fracture, pulmonary laceration, and cardiac rupture. In a patient with deteriorating vital signs following successful closed-chest CPR, such injuries should be considered.- - - - - - - - - - ranking = 4.7587033179411keywords = chest (Clic here for more details about this article) |
19/73. pneumocystis carinii, cytomegalovirus, and severe transient immunodeficiency.pneumocystis carinii infection is rare in infants, and raises strong concerns of immune deficiency. This report describes the unusual case of a male infant with concurrent chest infections caused by P carinii and cytomegalovirus. Investigation was complicated by the strong suspicion of non-accidental injury, including subdural haematomas. The case illustrates how to investigate for possible immunodeficiency. Low immune function tests at presentation slowly improved and have remained normal on longterm follow up. Possible explanations for the transient severe clinical immunodeficiency in this case are discussed.- - - - - - - - - - ranking = 0.79311721965684keywords = chest (Clic here for more details about this article) |
20/73. rupture of the descending thoracic aorta caused by blunt chest trauma: report of a case.A 66-year-old man fell from a tree and was diagnosed to have multiple fractured ribs and hemopneumothorax based upon the chest roentgenogram findings. He underwent chest tube drainage and evacuation using video-assisted thoracic surgery. One week after the operation, he exhibited recurrent hemothorax. He underwent a thoracotomy, and the hemothorax was found to be due to a penetration of the lower descending thoracic aorta by a fractured rib. We performed a direct closure of the penetrated portion of the descending thoracic aorta. The patient has remained well for 1 year following the second operation.- - - - - - - - - - ranking = 4.7587033179411keywords = chest (Clic here for more details about this article) |
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