scholarly journals A lady with chest pain: Is there a clue in the chest radiograph?

2021 ◽  
Vol 73 ◽  
pp. S89-S90
Author(s):  
Deepanjan Bhattacharya ◽  
VIshwanatha Kartik Sambaturu ◽  
Kurup KN. Harikrishnan ◽  
V.K. Ajitkumar
Keyword(s):  
Chest Pain ◽  
Chest Radiograph

A Hypotensive 22-Year-Old Man With Chest Pain, Cough, and an Abnormal Chest Radiograph

CHEST Journal ◽  
2009 ◽  
Vol 135 (1) ◽  
pp. 228-232
Author(s):  
Nikolaos Anatoliotakis ◽  
Sian Chisholm ◽  
Latonia Moncur ◽  
Arpitha Ketty ◽  
James Cury
Keyword(s):  
Chest Pain ◽  
Chest Radiograph ◽  
Abnormal Chest

Suspecting a fatal condition on a plain chest radiograph; Boerhaave syndrome

2020 ◽  
pp. 003693302096118
Author(s):  
Muhammad Adeel Rizwan Hashmi ◽  
Moustafa El-Badawy ◽  
Adnan Agha
Keyword(s):  
Chest Pain ◽  
Chest Radiograph ◽  
Medical Condition ◽  
Organ Support ◽  
Chest Drain ◽  
Diagnostic Challenge ◽  
Plain Chest Radiograph ◽  
Pulmonary Angiogram ◽  
History Of ◽  
Boerhaave Syndrome

Spontaneous oesophagus rupture, also known as Boerhaave syndrome, is a rare but near-fatal medical condition and despite recent medical advancements, it remains a diagnostic challenge for front-door clinicians. The authors describe a similar presentation in an elderly gentleman who presented to the emergency department with sudden chest pain post vomiting. His initial chest radiograph showed bilateral dense consolidations and pleural effusions, and was treated as sepsis secondary to bilateral pneumonia. He underwent computed tomography pulmonary angiogram to rule out pulmonary embolism because of his chest pain with elevated D-dimer which confirmed the diagnosis of oesophagus rupture. His care was transferred to Surgical and Intensive care colleagues with plans for radiological chest drain insertion to limit contamination of mediastinum, however the patient became hypoxic and hypotensive and despite maximal organ support passed away within 6 hours of admission. Retrospect review of chest radiograph revealed Peri-oesophageal air tracking, a sign of Boerhaave syndrome. The aim of this case is to emphasise the importance of raising the suspicion of Boerhaave syndrome in patients with sudden chest pain, unexplained pleural effusion or pneumothorax with a history of recent vomiting as early diagnosis holds the key to prompt lifesaving management.

scholarly journals Endometriosis: An Unusual Cause of Bilateral Pneumothoraces

2020 ◽  
Vol 4 (1) ◽  
pp. 35-37
Author(s):  
Christopher Sampson ◽  
Kathleen White
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Respiratory Distress ◽  
Chest Radiograph ◽  
Spontaneous Pneumothorax ◽  
Sudden Onset ◽  
Shortness Of Breath ◽  
Pelvic Endometriosis ◽  
Catamenial Pneumothorax

A 27-year-old female presented to the emergency department with sudden onset shortness of breath. A diagnosis of bilateral catamenial pneumothoraces was made following chest radiograph. Catamenial pneumothorax is a recurrent spontaneous pneumothorax that occurs in 90% of affected women 24-48 hours after the onset of their menstruation; 30-50% of cases have associated pelvic endometriosis. Symptoms can be as simple as chest pain or as severe as the presentation of this patient who was initially found to be in significant respiratory distress.

scholarly journals Twiddler’s Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 299-300
Author(s):  
Jason Lesnick ◽  
Benjamin Cooper ◽  
Pratik Doshi
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Implantable Cardioverter Defibrillator ◽  
Chest Radiograph ◽  
Rare Condition ◽  
Operative Intervention ◽  
Cardioverter Defibrillator ◽  
Twiddler’S Syndrome ◽  
Automatic Implantable Cardioverter Defibrillator

Twiddler’s syndrome refers to a rare condition in which a pacemaker or automatic implantable cardioverter-defibrillator (AICD) malfunctions due to coiling of the device in the skin pocket and resultant lead displacement. This image is the chest radiograph (CXR) of a 54-year-old male who presented to the emergency department with chest pain five months after his AICD was placed. The CXR shows AICD leads coiled around the device and the absence of leads in the ventricle consistent with Twiddler’s syndrome. Patients with twiddler’s syndrome should be admitted for operative intervention.

Right Apical Opacification on a Chest Radiograph and Chest Pain

CHEST Journal ◽  
2003 ◽  
Vol 124 (3) ◽  
pp. 1143-1144
Author(s):  
Jonathan Spratt ◽  
Sylvia Worthy ◽  
Andrew Grainger ◽  
Stephen Bourke
Keyword(s):  
Chest Pain ◽  
Chest Radiograph

scholarly journals Simultaneous bilateral spontaneous pneumothorax

2018 ◽  
Vol 146 (3-4) ◽  
pp. 203-206
Author(s):  
Vanja Kostovski ◽  
Aleksandar Ristanovic ◽  
Nebojsa Maric ◽  
Natasa Vesovic ◽  
Ljubinko Djenic
Keyword(s):  
Chest Pain ◽  
Chest Radiograph ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Diagnostic Algorithm ◽  
Chest Drain ◽  
Initial Examination ◽  
Breath Sounds ◽  
Pleural Abrasion ◽  
Life Threatening

Introduction. Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlights the potential difficulties in diagnosis and management of patients with SBSP. Case outline. A 23-year-old female was urgently assessed because of a progressive dyspnoea of 2-day's duration with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During initial examination, there was the evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea and agitation. She was found to have type II respiratory failure with the following biochemical parameters: pH=7.34, PaCO2=6.3 kPa and PaO2=7.9 kPa. The chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, she subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies and pleural abrasion. Her chest drains were removed 3 days after surgery and a chest radiograph post-treatment demonstrated resolution of the pneumothoraces. She was discharged home without complications. Conclusion. Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.

Coronary Artery Occlusion after Cardiac Transplantation

2013 ◽  
Vol 16 (4) ◽  
pp. 237
Author(s):  
Ali Ghodsizad ◽  
Michael Koerner ◽  
Matthias Karck ◽  
Arjang Ruhparwar
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Chest Radiograph ◽  
Cardiac Transplantation ◽  
Chest Trauma ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Shortness Of Breath

Five months after undergoing orthotopic cardiac transplantation,<br />a 62-year-old woman was admitted to the hospital with<br />chest pain and shortness of breath. A well-demarcated foreign<br />body was apparent in the chest radiograph, on the left side of<br />the chest. An examination revealed no abnormal findings and<br />no signs of chest trauma.

Non-Cardiac Chest Pain

2019 ◽  
Vol 18 (4) ◽  
pp. 260-260
Author(s):  
Jacob F de Wolff ◽  
◽  
Katherine M. Fawcett ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Chest Radiograph ◽  
Specific Treatment ◽  
Modern Approach ◽  
Northwick Park Hospital ◽  
Wells Score ◽  
Medical Teams ◽  
The Uk ◽  
D Dimer

We read with interest “Non-Cardiac Chest Pain: Management in the Ambulatory Clinic setting” (Acute Med 2019;18(3)165-70). It is useful to know about the various musculoskeletal causes of chest pain, especially where specific treatment may be available. We were alarmed, however, about the discussion of pleural pain. This is a common presenting complaint to acute medical teams both on the acute medical take and on ambulatory care units. The authors do not list a differential diagnosis for pain of pleural origin, apart from pulmonary embolism. A chest radiograph is recommended, as well as either a WELL’s (sic) score or D-dimer. Furthermore, bedside lung ultrasound is recommended if the chest radiograph is normal, despite limited availability and training in the UK. Ironically, the reference provided (Aydogdu M et al, Tuberk Toraks 2014;62:12-21) is much more reflective of the modern approach to suspected pulmonary embolism. It discusses the PERC (PE rule-out criteria) which perform very well in people who present with chest pain, and reduces reliance on D-dimer testing. D-dimer testing should never be performed without determining a pre-test probability using validated scores such as the Wells score. As the authors suggest, not all chest pain that worsens with inspiration is “pleuritic”. In addition, substernal pain with a respiratory component does not increase the likelihood of PE, whereas lateral and posterior pain does (Kline J, Thomb Res 2018;163:207-20). Kind regards, Jacob F. de Wolff FRCP Katherine M. Fawcett FRCP Consultant Acute Physicians Northwick Park Hospital

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