Acute Abdominal Pain and an Abnormal Chest X-ray

A woman presented to our hospital with acute abdominal pain 7 months following an oesophagectomy. A chest X-ray revealed a new elevation of the left diaphragm. CT demonstrated a large left diaphragmatic hernia incarcerated with non-enhancing transverse colon and loops of small bowel. She deteriorated rapidly into obstructive shock and was urgently brought to the operating room for a laparotomy. The diaphragmatic orifice was identified in a left parahiatal position, consistent with a parahiatal hernia. Incarcerated necrotic transverse colon and ischaemic loops of small bowel were resected, and the diaphragmatic defect was closed primarily. Because of haemodynamic instability, the abdomen was temporarily closed, and a second look was performed 24 hours later, allowing anastomosis and definitive closure. Parahiatal hernias are rare complications following surgical procedures and can lead to devastating life-threatening complications, such as an obstructive shock. Expeditious diagnosis and management are required in the acute setting.

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Abnormal chest X-ray in a patient with carcinoma of the cervix.

Postgraduate Medical Journal ◽

10.1136/pgmj.73.864.671 ◽

1997 ◽

Vol 73 (864) ◽

pp. 671-673

Author(s):

P. Aggarwal ◽

R. Handa ◽

J. P. Wali ◽

N. Wig ◽

A. Kumar

Keyword(s):

X Ray ◽

Abnormal Chest ◽

Chest X Ray

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Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

Journal of Intensive Care Medicine ◽

10.1177/0885066618807859 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1032-1038 ◽

Cited By ~ 1

Author(s):

Aaron S. Weinberg ◽

William Chang ◽

Grace Ih ◽

Alan Waxman ◽

Victor F. Tapson

Keyword(s):

Pulmonary Embolism ◽

Chest Radiograph ◽

High Probability ◽

Hemodynamic Instability ◽

X Rays ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray ◽

Low Probability ◽

Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

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Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department

CJEM ◽

10.1017/s1481803500015293 ◽

2007 ◽

Vol 9 (05) ◽

pp. 347-351 ◽

Cited By ~ 6

Author(s):

Valérie Homier ◽

Colette Bellavance ◽

Marianne Xhignesse

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Chest Radiograph ◽

Chest Radiography ◽

Acute Abdominal Pain ◽

Tertiary Care ◽

Abdominal Radiograph ◽

Upper Respiratory Tract ◽

Abdominal Radiography ◽

X Ray

ABSTRACT Objective: Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context. Methods: We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit. Results: Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%). Conclusion: Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.

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The association of abnormal chest X-ray findings with mortality in patients requiring mechanical ventilation in mulago hospital general intensive care unit

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a674 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

HDG Ssemmanda ◽

J Ejoku ◽

TS Luggya ◽

C Lubulwa

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

General Intensive Care Unit ◽

Mulago Hospital ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray ◽

Hospital General

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Early clinical predictors of severe acute respiratory syndrome in the emergency department

CJEM ◽

10.1017/s148180350000885x ◽

2004 ◽

Vol 6 (01) ◽

pp. 12-21 ◽

Cited By ~ 2

Author(s):

W.N. Wong ◽

Antonio C.H. Sek ◽

Rick F.L. Lau ◽

K.M. Li ◽

Joe K.S. Leung ◽

...

Keyword(s):

Emergency Department ◽

Severe Acute Respiratory Syndrome ◽

Lymphocyte Count ◽

Case Definition ◽

World Health ◽

Clinical Predictors ◽

X Ray ◽

Abnormal Chest ◽

Contact Exposure ◽

Chest X Ray

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

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‘My Doctor Said I Had an Abnormal Chest X-Ray...’

Respiration ◽

10.1159/000070075 ◽

2003 ◽

Vol 70 (2) ◽

pp. 224-228

Author(s):

Hector E. Mateo ◽

Alpha A. Fowler

Keyword(s):

X Ray ◽

Abnormal Chest ◽

Chest X Ray

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Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000646 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000646 ◽

Cited By ~ 2

Author(s):

Bruce Kirenga ◽

Winters Muttamba ◽

Alex Kayongo ◽

Christopher Nsereko ◽

Trishul Siddharthan ◽

...

Keyword(s):

Statistical Significance ◽

Sub Saharan Africa ◽

Detailed Data ◽

X Ray ◽

Mild Disease ◽

Clinical Recovery ◽

Abnormal Chest ◽

Chest X Ray ◽

Sub Saharan ◽

Muscle Ache

RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited.ObjectiveWe determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda.MeasurementsAs of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation.Main resultsThe median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance.ConclusionMost of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.

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