1/10. Potpourri aspiration presenting as tension pneumothorax.Foreign body aspiration in children is a relatively common occurrence, with peanuts, seeds, or other food particles representing the most common items. Because radiological findings such as mediastinal shift, postobstructive emphysema, and pneumonia are notoriously inconsistent, diagnosis hinges on an accurate history, which may be correlated by physical examination and radiography. We present the case of a 2-year-old girl with delayed treatment of a bronchial foreign body who presented with tension pneumothorax before endoscopy. After chest tube removal, her pneumothorax recurred, thereby bringing about the question of bronchial erosion. Furthermore, an uncommonly reported aspirated object, household potpourri, was encountered.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/10. Expanding the differential diagnosis of the acute scrotum: ventriculoperitoneal shunt herniation.An 18-month-old boy presented to the emergency department after 4 hours of inconsolability and acute scrotal swelling. The physical examination revealed a new scrotal hydrocele with migration of a ventriculoperitoneal shunt into the right hemiscrotum. The presence of a ventriculoperitoneal shunt has been associated with increased patency of the processus vaginalis and scrotal hydroceles. The presentation of an acute scrotum in a child with a ventriculoperitoneal shunt should be recognized as a possible shunt complication. Migration of the shunt through the processus vaginalis is an extremely uncommon event.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/10. The buried bumper syndrome: migration of internal bumper of percutaneous endoscopic gastrostomy tube into the abdominal wall.A percutaneous endoscopic gastrostomy tube was inserted in a 59-year-old man who was undergoing craniotomy due to subarachnoid hemorrhage, because it was estimated that he could not have oral intake for a period of 4 weeks. Seventy days after the insertion, the percutaneous endoscopic gastrostomy tube was replaced because of its accidental removal by the patient. Two months after the second insertion, the tube had to be replaced due to nonfunctioning. The buried bumper syndrome was diagnosed on physical examination, and was confirmed by endoscopy, with findings of mucosal dimpling and nonvisualization of the internal bumper. The tube was removed by external traction without any abdominal incision, and the same site was used for the insertion of a replacement tube over a guidewire. The patient remained symptom-free during 18 months of follow-up.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/10. Bilateral late posterior chamber intraocular lens dislocation with the capsular bag in a patient with gyrate atrophy.A pseudophakic patient with gyrate atrophy of the choroid and retina presented with bilateral intraocular lens (IOL) dislocation with the capsular bag several years after uneventful cataract surgery. The patient had not performed strenuous physical activity. One IOL was initially repositioned by nonsurgical manipulations, while the other required surgical repositioning. Eventually, IOL exchange was performed successfully in both eyes.- - - - - - - - - - ranking = 0.091986304538935keywords = physical (Clic here for more details about this article) |
5/10. Laparoscopic removal of a swallowed sewing needle that migrated into the greater omentum without clinical evidence.We report a case of a sewing needle, presumably originating from the transverse colon or the ligament of Treitz, that migrated to the greater omentum. A 24-year-old woman was referred to our clinic with a complaint of abdominal pain which was exacerbated by breathing or any physical activity. Abdominal plain x-ray showed a needle in the left upper abdominal area. Abdominal computed tomography (CT) and contrast enhanced x-ray studies was unable to reveal whether the needle was in the colonic lumen. Virtual colonoscopy examination demonstrated that the foreign body was not in the lumen. The foreign body was removed from the patient's greater omentum in a fluoroscopy- guided laparoscopic surgery. An accurate and rapid diagnosis of a perforation in the gastrointestinal tract as the result of an ingested foreign body is difficult in the absence of peritonitis or abscess formation. In such cases, the virtual colonoscopy is useful if there is uncertainty whether the foreign body is in the lumen. Perioperative fluoroscopy can be useful to overcome the lack of tactile discrimination in laparoscopy, in patients who have been scheduled for surgery who have no signs of the localization of the foreign body (such as abscess or solid organ migration).- - - - - - - - - - ranking = 0.091986304538935keywords = physical (Clic here for more details about this article) |
6/10. Complications of caval interruption by Greenfield filter in quadriplegics.patients with acutely injured spinal cords are thought to be at increased risk for thromboembolic disease and often have contraindications to anticoagulation therapy. From 1981 to 1986, 13 patients with quadriplegia at the new england Regional Model spinal cord Injury Center had caval interruption with a Greenfield filter. Twelve patients had deep venous thrombosis documented by venogram results and one had pulmonary embolism documented by arteriogram results. "Quad cough" chest physical therapy was required for mobilization of pulmonary secretions in nine patients. Follow-up abdominal x-ray results revealed significant abnormalities referrable to the filter in five patients having undergone "quad cough" therapy. Four patients had distal migration of the filter; three of the four had deformation of the filter. laparotomy for bowel perforation was required in two of these patients. quadriplegia requiring vigorous chest physical therapy ("quad cough") for pulmonary toilet may be a contraindication to caval interruption by Greenfield filter. Alternative techniques in the management of patients with quadriplegia and pulmonary compromise must be considered.- - - - - - - - - - ranking = 0.18397260907787keywords = physical (Clic here for more details about this article) |
7/10. Aspiration following a cave-in.Reported is a case of massive aspiration of particulate matter after a cave-in. A 14-year-old boy was buried beneath 18 inches of dirt while playing at a construction site. After extrication he was breathing spontaneously and was transported to the emergency department on supplemental oxygen. physical examination revealed cough, tachypnea, and diminished breath sounds of the right lung field. Chest radiographs showed multiple radiopaque densities filling the right mainstem bronchus and a left-to-right shift of the mediastinum. The patient was treated with bronchodilators followed by postural drainage and percussion. Chest radiographs and physical examination both returned to normal within 24 hours. Reports of massive aspiration of sand are scarce, and have emphasized the need for bronchoscopic removal of particles to restore ventilation. This case was managed with bronchodilators and postural drainage alone, with complete resolution of pulmonary abnormalities.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/10. Occult tooth fragments spontaneously extruded after six months.Fracture of one or more teeth is a frequent complication of trauma to the oral cavity. Broken teeth that are not accounted for are often presumed to be swallowed or lost. We report a case of fracture of incisors that were not located on physical examination following the trauma but were discovered six months later as hard, perforating papulonodules on the lower lip.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/10. Unilateral eyelid ptosis and a red eye.A 56-year-old woman presented with a unilateral ptosis induced by a nonembedded soft contact lens of approximately 2 years' duration. The unilateral ptosis most likely resulted form localized inflammation and the physical presence of the soft contact lens. The patient's symptoms resolved completely after double lid eversion and lens removal.- - - - - - - - - - ranking = 0.091986304538935keywords = physical (Clic here for more details about this article) |
10/10. Brillo pad crack screen aspiration and ingestion.crack cocaine is commonly smoked in a pipe with a metallic filter made from a steel wool scouring pad. We report an unusual complication of smoking crack cocaine: the aspiration and ingestion of a Brillo pad filter. A 34-year-old female presented 7 h after drinking beer and smoking crack. She was concerned that she might have inhaled the "screen" from her crack pipe, a piece of Brillo pad the size of her fingertip. She complained of "burning" in her throat, a foreign body sensation, and change in her voice, but no dyspnea, dysphagia, or abdominal pain. On physical examination, she was afebrile with a pulse of 105 beats/min and respiratory rate of 24 breaths/min. She was tearful and spoke in a whisper. There were no visible oropharyngeal burns and the lungs were clear to auscultation, but she had intermittent inspiratory stridor. The O2 saturation was 96%, and the ethanol concentration was 100 mg/dl. No foreign body or burn was seen on indirect laryngoscopy. A lateral neck x-ray study showed a normal epiglottis and no foreign body. Chest x-ray studies were unremarkable. Fiberoptic laryngoscopy showed left posterior arytenoid edema and swelling. An abdominal x-ray study revealed a foreign body in the right lower quadrant consistent with the Brillo pad filter. The next morning, the patient was asymptomatic and was discharged, recovering without sequellae. While crack pipe screen aspiration is a rarely reported event, physicians should be aware of the potential for foreign body aspiration and ingestion by this mechanism.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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