1/20. pneumothorax during anesthesia with changes in ECG.A patient known to suffer from CNSLD was to undergo cervical lymph node dissection for gingival carcinoma. pneumothorax developed immediately after introduction of anesthesia. In addition to the usual physical diagnostic signs, an abrupt decrease in amplitude of the QRS- complex and T -waves was observed in the ECG on the scope, the sensitivity of which remained unchanged. The ECG changes disappeared after abolition of the pneumothorax.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/20. Severe transmyocardial ischemia in a patient with tension pneumothorax.OBJECTIVE: To report tension pneumothorax (TP) as a cause of severe myocardial ischemia. DESIGN: Clinical case report. SETTING: Medical intensive care unit of a university hospital. patients: One patient with severe shock attributable to right TP after unsuccessful percutaneous central venous catheterization. INTERVENTIONS: blood pressure, electrocardiogram (ECG), chest radiograph, and echocardiography during and after shock. MEASUREMENTS AND MAIN RESULTS: On admission the patient was in profound state of shock (heart rate 140 beats/min, blood pressure 65/30 mm Hg). Twelve-lead ECG showed pronounced ST segment elevation in leads II, III, aVF, and V4-V6. Chest radiograph revealed right TP with complete displacement of the mediastinum and the heart to the left side. Immediate right-sided tube thoracostomy resulted in reexpansion of the lung followed by instantaneous hemodynamic and respiratory improvement as well as nearly complete resolution of the ECG changes. Peak value of the creatine phosphokinase was 4140 U/L without significant elevation of the MB isoenzyme at any time. Moreover, the initial hypokinesia of the posterior and lateral left ventricular wall resolved completely, as demonstrated by echocardiography. CONCLUSION: The specific condition of TP may lead to impaired systolic and diastolic coronary artery blood flow affecting ventricular repolarization and T-wave configuration in ECG indicative of transmyocardial ischemia. General symptoms, namely hypotension, tachycardia, and hypoxemia, are likewise typical for cardiogenic shock attributable to myocardial infarction. Yet any therapeutic measure directed toward revascularization, such as thrombolysis or even percutaneous transluminal coronary angioplasty, would have had devastating consequences. Therefore, thorough physical examination of our patient was pivotal in disclosing the true origin of profound shock.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
3/20. 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 = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
4/20. Pyopneumothorax: a complication of streptococcus pyogenes pharyngitis.A 20-y-old African-American female with streptococcus pyogenes pharyngitis presented with tension pyopneumothorax. Her illness began with fever and sore throat that persisted for several days. She then developed a left neck swelling, followed by difficult swallowing and cough. Subsequently, she developed shortness of breath that became severe. On physical examination fever (39.2 degrees C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. Chest X-ray revealed left side pneumothorax, air-fluid level and near-complete collapse of the left lung with displacement of the heart and trachea to the right. Computed tomography scan of the neck revealed swelling and enhancement of the sternocleidomastoid muscle with loculated fluid collection, inflammation in the left anterior medial neck displacing the trachea extending into the mediastinum and the left apex. Thoracentesis revealed purulent fluid; Gram stain showed gram-positive cocci in chains; culture yielded pure growth of streptococcus pyogenes. She was treated with high dose penicillin, several chest tubes and intra-pleural injections of streptokinase with gradual resolution. This complication has not been described previously in streptococcus pyogenes pharyngitis.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
5/20. pneumothorax complicating pulmonary emphysema.Clinical and roentgenographic findings were compared in patients 40 years of age and over and in those under 40 who were treated for acute unilateral pneumothorax. dyspnea and anxiety were pominent in the older individuals, although pneumothoraces were usually small. Because physical findings were often unreliable, roentgenograms were required. In the presence of pulmonary emphysema, loss of retractility prevented total collapse of the underlying lung. Increased intrapleural pressure caused over-expansion of the chest wall and the depression of the diaphragm without much mediastinal shifting. Partial collapse of emphysematous lobes demonstrated bullae that were not previously obvious. Respiratory failure developed in five patients over 40 years of age, but four of them recovered after relief of the pneumothorax. mortality for the group was low and related to associated pulmonary diseases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/20. Wegener's granulomatosis with parotid gland involvement and pneumothorax.OBJECTIVE: Wegener's granulomatosis is a systemic vasculitis characterized by necrotizing granulomatous lesions mostly involving the upper and lower respiratory tract. The disease rarely causes parotid gland involvement and pneumothorax. We report a case of Wegener's granulomatosis involving parotid gland, and complicated with a pneumothorax. CLINICAL PRESENTATION: A 45-year-old man admitted with a 3-week history of painful left parotid gland enlargement and hemoptysis. On physical examination a painful and hard mass was detected on the left pre-auricular area. Cervical CT revealed a 2 x 1.5 cm hypodense lesion mimicking an abscess on the left parotid gland. Chest radiograph and thorax CT demonstrated nodular and cavitating opacities on the right and left upper zones. There were numerous erythrocytes in urine sediment. The drained pus material from the parotid abscess demonstrated only gram-positive cocci (staphylococcus aureus). Two weeks treatment with teicoplanin resulted in no improvement. Meanwhile, parotid gland biopsy revealed necrotizing granulomatous inflammation. There was a sixfold increase in serum cANCA levels. With the diagnosis of Wegener's granulomatosis, cyclophosphamide and prednisolone were initiated. However, 1 month later, pneumothorax developed as a complication of rupture of a cavitary lesion. CONCLUSION: parotid gland swelling may be the initial presenting symptom of Wegener's granulomatosis. It can be confused with infectious or malignant diseases of the gland, and the lung involvement may be complicated with pneumothorax.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
7/20. Are electrocardiogram changes the first sign of impending peri-operative pneumothorax?A patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of an arteriovenous fistula. All haemodynamic and respiratory values, including peak inspiratory pressure, were within normal limits and unchanged from baseline measurements. However, following the position change we noted that the amplitude of the electrocardiogram complexes were dramatically reduced. Our differential diagnosis included the possibility of a pneumothorax, which was subsequently confirmed by both physical examination and chest X ray. A chest drain was planned to be inserted at the end of the surgery, but 25 min after the electrocardiogram changes were noted, the patient's vital signs suddenly deteriorated. emergency treatment for pneumothorax was instituted with good effect. The diagnostic use of the electrocardiogram and the treatment of this intra-operative pneumothorax are discussed.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
8/20. sports-related pneumothorax in children.pneumothorax after blunt chest trauma in the absence of rib fractures is uncommon and has only rarely been reported as a result of sporting activity. Presentation may vary from an apparently normal physical examination in the presence of a small pneumothorax to hemodynamic compromise in the presence of a tension pneumothorax. High fitness levels in athletes may result in failure to recognize symptoms and delay diagnosis, potentially increasing morbidity. It is imperative for the emergency physician to exclude pneumothorax in children who present with chest pain after blunt chest trauma from sports injury. We report our experience with and the management of 3 patients with pneumothoraces.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
9/20. Giant bulla mimicking pneumothorax.It is usually thought by emergency physicians that the diagnosis of a pneumothorax is straightforward and easy to make and to treat, but the diagnosis may sometimes pose a challenge. The present report describes a case of a giant pulmonary bulla in a 40-year-old man that progressed to occupy almost the entire left hemithorax and also subsequently ruptured to produce a large left pneumothorax. The giant bulla was diagnosed only as a pneumothorax, and initially managed with a chest tube only. The differentiation between pneumothorax and a giant bulla can be very difficult, and often leads to inaccurate diagnosis and management. This case report demonstrates the clinical presentation of giant bulla and its complications such as pneumothorax and also highlights the difficulty in making this diagnosis and appropriately treating it. In this article, we emphasized how to differentiate between giant bulla and pneumothorax utilizing history, physical examination, and radiological studies including computed tomography (CT) scan.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
10/20. Conservative treatment of a closed fracture of the clavicle complicated by pneumothorax: a case report.Isolated clavicle fractures are frequently encountered in the accident and emergency department. Complications of isolated clavicle fractures are rare. pneumothorax as a complication of a clavicle fracture has only been reported five times in English literature. In all five cases the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, both pneumothorax and clavicle fracture were treated conservatively with good result. Although isolated clavicle fractures rarely present with complications and normally heal with routine immobilisation, we must be aware of the serious complications that may occur, which require urgent treatment. Thorough history, physical examination, with particular attention to the neurovascular and chest examinations and radiographs of the clavicle are necessary to prevent overlooking these potentially serious complications.- - - - - - - - - - ranking = 13.854491619301keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |