Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

2020 ◽  
Vol 13 (9) ◽  
pp. e235281
Author(s):  
Sanjan Asanaru Kunju ◽  
Prithvishree Ravindra ◽  
Ramya Kumar Madabushi Vijay ◽  
Priya Pattath Sankaran
Keyword(s):  
Tension Pneumothorax ◽  
Emergency Laparotomy ◽  
Severe Respiratory Distress ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right ◽  
Tension Gastrothorax ◽  
Obstructive Shock ◽  
Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

scholarly journals Unexpected Tension Pneumothorax-Hemothorax during Induction of General Anaesthesia

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Ekaterini Amaniti ◽  
Chrysoula Provitsaki ◽  
Panagiota Papakonstantinou ◽  
George Tagarakis ◽  
Konstantinos Sapalidis ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Systemic Disease ◽  
Good Condition ◽  
Tension Pneumothorax ◽  
Positive Pressure ◽  
Aged Woman ◽  
Breath Sounds ◽  
Middle Aged Woman ◽  
Chest X Ray ◽  
The Right

Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.

scholarly journals Case Report: Bilateral Pneumothoraces Due To Targeted Tumor Therapy With Regorafenib in a Young Woman With Metastatic Colorectal Cancer

2021 ◽  
Author(s):  
Tobias Rachow ◽  
Tim Sandhaus ◽  
Thomas Ernst ◽  
Helmut Schiffl ◽  
Susanne M. Lang
Keyword(s):  
Colorectal Cancer ◽  
Chest Pain ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Tumor Therapy ◽  
Tension Pneumothorax ◽  
Cancer Case ◽  
Pretreated Patient ◽  
Breath Sounds ◽  
The Right

Abstract Background: Colorectal cancer is one of the most common cancer types, frequently metastasizing into the lungs. Treatment options have been vastly improved over the last years. With the increasing use of targeted therapies novel and rare adverse effects can be seen. In this report, we present the case of recurrent spontaneous bilateral pneumothorax due to fulminant tumor necrosis during the administration of regorafenib in a heavily pretreated patient with multiple lung metastases from colorectal cancer. Case presentation: A 43-year-old woman presented in our oncology department with chest pain and dyspnea. The patient was diagnosed with colorectal cancer seven years earlier and had received chemoradiation, surgery and multiple chemotherapies, before she was started on regorafenib because of progressive pulmonary metastases. Clinical examination revealed no breath sounds in the right hemithorax. The patient was tachycardic and orthopneic. Computed tomography scans demonstrated cavitation of former nodular bilateral pulmonary metastases. After drainage and resolution of the right-sided pneumothorax the patient returned eleven days later with recurrent dyspnea, chest pain and subcutaneous emphysema. Bilateral pneumothoraces were treated with chest tubes. Due to left-sided tension pneumothorax video-assisted thoracoscopy and bilateral pleurodeses were performed. Persistent air leaks with severe pain and pulmonary infiltrates led to the death of the patient. Conclusions: Our case illustrates the effectiveness of regorafenib in a highly pretreated patient. However, in our patient the ensuing cavitation of the multiple nodes led to recurrent pneumothoraces and associated infectious complications. Therefore, special surveillance should be implemented to detect potential transformation of solid pulmonary metastases during treatment with this multi-kinase inhibitor.

scholarly journals Non-traumatic Tension Gastrothorax: A Potential Mimicker of Tension Pneumothorax

2021 ◽  
Vol 15 (8) ◽  
pp. 1-7
Author(s):  
Jonathan D. Pierce ◽  
Neal R. Shah ◽  
Ata A. Rahnemai-Azar ◽  
Amit Gupta
Keyword(s):  
Clinical Presentation ◽  
Tension Pneumothorax ◽  
Accurate Diagnosis ◽  
Imaging Features ◽  
Elderly Female ◽  
Hemodynamic Compromise ◽  
Mediastinal Shift ◽  
Increased Risk ◽  
Life Threatening ◽  
Tension Gastrothorax

Tension gastrothorax is a rare, life-threatening clinical condition caused by intrathoracic herniation of the stomach through a diaphragmatic defect which becomes increasingly distended over time. If not recognized promptly, this can rapidly progress to respiratory distress, mediastinal shift, and hemodynamic compromise. Initial clinical presentation and imaging findings closely mirror those of tension pneumothorax, confounding diagnosis and potentially leading to unnecessary interventions with increased risk of morbidity and mortality. Here, we present a case of an elderly female who presented with a non-traumatic tension gastrothorax and a review of key imaging features and strategies to aid in recognition and accurate diagnosis of this emergent clinical entity.

scholarly journals Lifelong Idiopathic Unilateral Diaphragmatic Paralysis With Recurrent Pneumonia: A Case Report

2020 ◽  
Vol 10 (1) ◽  
pp. 26743
Author(s):  
Khosrow Agin ◽  
Akram Sabkara ◽  
Farzaneh Sadat Mirsafai Rizi ‎ ◽  
Bita Dadpour ◽  
Maryam Vahabzadeh ◽  
...  
Keyword(s):  
Primary Diagnosis ◽  
Diaphragmatic Paralysis ◽  
Recurrent Pneumonia ◽  
Emergency Center ◽  
Diabetes Mellitus Type Ii ◽  
X Ray ◽  
Breath Sounds ◽  
History Of ◽  
Chest X Ray ◽  
The Right

A 50-year-old woman was admitted to the emergency center with dyspnea, cough, and fever symptoms. She had a medical history of diabetes mellitus type II, rheumatoid arthritis, as well as several admission records due to aspiration pneumonia. The primary diagnosis was diabetic ketoacidosis and pneumonia. Normal breath sounds were reduced on the lower posterior right side of the thorax. A standard chest x-ray and lung Computed Tomography (CT) scan revealed collapse consolidation in the Right Lower Lobes (RLL) and Right Middle Lobes (RML). We here presented a case of unilateral diaphragmatic paralysis with a history of recurrent pneumonia.

scholarly journals Rapidly Progressive Pulmonary Apical Fibrosis and Parenchymal Destruction in a Patient with Ankylosing Spondylitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hasan Ulusoy ◽  
Nazmiye Tibel Tuna ◽  
Aslı Tanrivermis Sayit
Keyword(s):  
Computed Tomography ◽  
Ankylosing Spondylitis ◽  
Rare Complication ◽  
Granulomatous Inflammation ◽  
Pulmonary Involvement ◽  
High Resolution Computed Tomography ◽  
Thoracic Computed Tomography ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right

Pulmonary apical fibrosis is a rare complication of ankylosing spondylitis (AS). The essential characteristics of this lesion are its very slow progression and frequently asymptomatic nature. Herein, we are presenting a patient with AS who rapidly developed pulmonary apical fibrosis in a 3-year period despite decreased musculoskeletal pains. The 60-year-old male applied with complaints of progressively increasing cough in the recent two years, dyspnea, and fatigue. He had no chronic disease except AS. He had no continuous medication except nonsteroid anti-inflammatory drugs for 2-3 days monthly since his musculoskeletal pains decreased in the recent years. His physical examination revealed reduced breath sounds in the upper zones of the right lung. Chest X-ray revealed increased diffuse opacity in the upper zones of the right lung. Thoracic high-resolution computed tomography showed a consolidation accompanied with traction bronchiectases compatible with chronic fibrosis in the upper lobe of the right lung. However, thoracic computed tomography of the patient performed 3 years ago did not reveal pulmonary apical fibrosis and parenchymal destruction. Biopsy revealed no finding of malignancy, granulomatous inflammation, or vasculitis. The results of cultures were negative. So, the patient was diagnosed as pulmonary involvement of AS, which developed in a 3-year period. This case has shown that extra-articular complications may continue to develop in patients with AS even if their musculoskeletal complaints have subsided. So, patients with AS should be followed up regularly with systemic examinations.

scholarly journals Iatrogenic pneumothorax in a 4-week-old girl: new diagnosis of congenital lobar emphysema

2020 ◽  
Vol 13 (2) ◽  
pp. e233302
Author(s):  
Ashley Reed ◽  
Sandra Fernandes Lucas ◽  
Agnieszka Nowacka ◽  
Chukwubuike Eze
Keyword(s):  
Clinical Improvement ◽  
Tension Pneumothorax ◽  
Chest Drain ◽  
Severe Respiratory Distress ◽  
Congenital Lobar Emphysema ◽  
Tertiary Centre ◽  
Lobar Emphysema ◽  
Apex Beat ◽  
The Right ◽  
New Diagnosis

A 4-week-old female patient presented with severe respiratory distress, hypoxia and apnoeic episodes on a background of a few-day history of coryza and cough. There was significantly reduced air entry on the left side and a displacement of the apex beat to the right of the chest. The examination findings with oxygen desaturations and a right-sided mediastinal shift on chest X-ray led to a diagnosis of tension pneumothorax following which a needle thoracentesis was undertaken. This appeared to worsen the patient’s clinical condition; hence, a chest drain was inserted with unsatisfactory clinical improvement. In view of the presentation and lack of clinical improvement after chest drain insertion, the case was transferred to the paediatric respiratory team in a tertiary centre where the diagnosis was revised to congenital lobar emphysema based on chest computer tomography findings. She subsequently benefited from a left upper lobectomy and lingulectomy and was discharged home 4 days after surgery.

scholarly journals Perplexing case of lung mass perfectly mimicking a malignancy

2019 ◽  
Vol 12 (7) ◽  
pp. e229273
Author(s):  
Eid Humaid Alqurashi ◽  
Ahmed Sayeed ◽  
Hasheema Hasheem Alsulami ◽  
Hadeel Mashhour Al-Qurashi
Keyword(s):  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Wedge Resection ◽  
Biopsy Result ◽  
X Ray ◽  
Breath Sounds ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Histopathology Examination

A 35-year-old man, a known asthmatic and with a history of smoking presented with a history of recurrent episodes of mild haemoptysis. On examination, there was decreased intensity of breath sounds on the right infraclavicular area. The chest X-ray and CT chest showed a mass in right upper lobe with nodules in the other lobe. The VAT showed large heavily vascularised mass with surface laden with multiple nodules. The wedge resection of the mass was taken and sent for histopathology examination. The biopsy result showed picture suggestive of connective tissue disease associated follicular bronchiolitis. The patient did not have any signs or symptoms of connective tissue disease. However he was positive for Rheumatoid factor, ANA, anti-RO, anti-CCP antibodies. He was started on steroids and azathioprine. After 6 months of treatment, the size of the mass and nodules reduced by 50% and ESR was reduced to 5 from 75.

scholarly journals 571 Case of A Rare Presentation of Solitary Fibrous Tumour of the Pleura (SFTP)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Ishak ◽  
N Kostoulas
Keyword(s):  
Recurrence Risk ◽  
Tumour Mass ◽  
Rare Presentation ◽  
Ki 67 ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Pet Ct ◽  
Chest X Ray ◽  
Double Space ◽  
Mitotic Figures

Abstract Presentation A 69-year-old male presented with rapidly worsening symptoms of breathlessness, productive cough, and weight loss. Examination revealed a deviated trachea, and no breath sounds on auscultation of the left side of the chest. Investigations Chest X-ray revealed a giant mass associated with a large pleural effusion, subtotal lung collapse and mediastinal shift. FEV1 was 39% predicted and DLCO 62% predicted. Management Due to the severity of presentation, urgent pleural inspection, drainage, and biopsy were carried out. Compression of the heart resulting in tamponade with increased heartrate and breathlessness was suspected Further investigations and management Pleural biopsies and pleural fluid cytology were negative for malignancy. PET-CT showed mild avidity. Definitive management was tumour mass resection via left double space open thoracotomy. Macroscopy/Microscopy/Immunohistopathology Intra-operatively, the tumour was giant, occupying three quarters of the chest cavity. It measured 21 × 14×8 cm. The whole lung was attached to the chest wall with adhesions. Microscopy revealed patternless architecture, high vascularity, hypercellularity, necrosis, elongated nuclei, pale cytoplasms and mitotic activity of 2-3 mitotic figures per 10-highpower-fields. Immunohistochemistry stained positive with CD34, BCL2, CD99, Ki-67 and STAT6. Diagnosis of SFT was suspected; malignant potential could not be predicted. Follow-up was with repeat CT scans for five years. Recurrence risk was given as 20%. Learning points

scholarly journals Explosive Pleuritis

2001 ◽  
Vol 12 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Jasdeep K Sharma ◽  
Thomas J Marrie
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Respiratory Distress ◽  
Pleural Fluid ◽  
Case Definition ◽  
Pulmonary Tissue ◽  
X Ray ◽  
Mediastinal Shift ◽  
Chest X Ray ◽  
The Right

The objective of the present paper is to describe the clinical and computed tomography features of 'explosive pleuritis', an entity first named by Braman and Donat in 1986, and to propose a case definition. A case report of a previously healthy, 45-year-old man admitted to hospital with acute onset pleuritic chest pain is presented. The patient arrived at the emergency room at 15:00 in mild respiratory distress; the initial chest x-ray revealed a small right lower lobe effusion. The subsequent clinical course in hospital was dramatic. Within 18 h of admission, he developed severe respiratory distress with oxygen desaturation to 83% on room air and dullness of the right lung field. A repeat chest x-ray, taken the morning after admission, revealed complete opacification of the right hemithorax. A computed tomography scan of the thorax demonstrated a massive pleural effusion with compression of pulmonary tissue and mediastinal shift. Pleural fluid biochemical analysis revealed the following concentrations: glucose 3.5 mmol/L, lactate dehydrogenase 1550 U/L, protein 56.98 g/L, amylase 68 U/L and white blood cell count 600 cells/mL. The pleural fluid cultures demonstrated light growth of coagulase-negative staphylococcus and viridans streptococcus, and very light growth ofCandida albicans. Cytology was negative for malignant cells. Thoracotomy was performed, which demonstrated a loculated parapneumonic effusion that required decortication. The patient responded favourably to the empirical administration of intravenous levofloxacin and ceftriaxone, and conservative surgical methods in the management of the empyema. This report also discusses the patient's rapidly progressing pleural effusion and offers a potential case definition for explosive pleuritis. Explosive pleuritis is a medical emergency defined by the rapid development of a pleural effusion involving more than 90% of the hemithorax over 24 h, which causes compression of pulmonary tissue and mediastinal shift to the contralateral side.

scholarly journals Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Leire Zarain Obrador ◽  
Yusef Mohamed Al-Lal ◽  
Jorge de Tomás Palacios ◽  
Iñaki Amunategui Prats ◽  
Fernando Turégano Fuentes
Keyword(s):  
Gunshot Wound ◽  
Median Sternotomy ◽  
Uneventful Recovery ◽  
Hemodynamic Stability ◽  
Group Iii ◽  
Entrance Wound ◽  
Group I ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right

Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP>100 mmHg; group II, with SBP 60–100 mmHg; and group III, with SBP<60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

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