Acute atraumatic peri-arrest tension gastrothorax presenting to the emergency department

2021 ◽  
Vol 14 (4) ◽  
pp. e240478
Author(s):  
James Phelan ◽  
Rengarajan Subramanian ◽  
Adeep Krishnan Kutty Menon
Keyword(s):  
Emergency Department ◽  
Sudden Onset ◽  
Haemodynamic Instability ◽  
Management Options ◽  
Rare Presentation ◽  
Shopping Centre ◽  
Mediastinal Shift ◽  
Portable Chest ◽  
Life Threatening ◽  
Tension Gastrothorax

A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Successful needle decompression followed by tube thoracostomy improved patient condition with no further complications. Surgical repair was performed but was delayed by COVID-19. This case provides a rare presentation of an acute life-threatening tension gastrothorax with difficult management considerations. A review of the management options is undertaken.

scholarly journals Transient binocular blindness: A rare presentation of aortic dissection

2018 ◽  
Vol 27 (4) ◽  
pp. 236-240
Author(s):  
Abdul Hafiz Shaharudin ◽  
Muhamad Hafiq Ab Hamid ◽  
Rosliza Yahaya ◽  
Nik Ahmad Shaiffudin Nik Him ◽  
Nik Arif Nik Mohamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Sudden Onset ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences. Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta. Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain. Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.

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 An Unusual Case of Acute Dyspnoea: Acute Intrathoracic Gastric Volvulus with Probable Tension Gastrothorax

2021 ◽  
Author(s):  
Jean Bosco Masabarakiza ◽  
Lingna Zhu ◽  
Yilmaz Gorur ◽  
Benoît Cardos ◽  
Noel Lorenzo-Villalba ◽  
...  
Keyword(s):  
Unusual Case ◽  
Rare Complication ◽  
Gastric Volvulus ◽  
Longitudinal Axis ◽  
Gastric Distension ◽  
Haemodynamic Instability ◽  
Acute Dyspnoea ◽  
Mediastinal Shift ◽  
Acute Gastric Volvulus ◽  
Tension Gastrothorax

Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. Intrathoracic gastric volvulus can lead to tension gastrothorax, which is defined as the presence of a massive gastric distension in the chest cavity causing a mediastinal shift with haemodynamic instability and a risk of cardiorespiratory arrest. We report a case of intrathoracic gastric volvulus with probable tension gastrothorax. Early diagnosis of gastrothorax with computed tomography and immediate insertion of a nasogastric tube resulted in rapid clinical improvement. Surgical intervention is the treatment of choice.

Late-Presenting Congenital Diaphragmatic Hernia: A Potentially Life Threatening Case

2009 ◽  
Vol 16 (2) ◽  
pp. 102-105 ◽  
Author(s):  
HY Chan ◽  
CC Wong ◽  
F Ng
Keyword(s):  
Respiratory Distress ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Sudden Onset ◽  
Mediastinal Shift ◽  
Wide Range ◽  
Urgent Operation ◽  
Life Threatening

Congenital diaphragmatic hernia (CDH) generally presents with respiratory distress in the neonatal period. Late onset CDH is less common and is associated with a wide range of clinical symptoms. We report a case of a 4-year-old child presenting with sudden onset of dizziness, abdominal pain and vomiting after swimming. Radiological investigations showed a left CDH with mediastinal shift. She gradually developed respiratory distress after admission. Urgent operation showed that the contents of the hernia included stomach, spleen, small and large bowels. This case highlights the importance of suspicion of CDH, proper clinical examination and investigation of children with acute non-specific gastrointestinal complaints.

scholarly journals Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients

2018 ◽  
Vol 9 (7) ◽  
pp. 199-208 ◽  
Author(s):  
Mabrouk Bahloul ◽  
Olfa Turki ◽  
Anis Chaari ◽  
Mounir Bouaziz
Keyword(s):  
Emergency Department ◽  
Pulmonary Oedema ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Haemodynamic Instability ◽  
Scorpion Envenomation ◽  
Icu Length Of Stay ◽  
Life Threatening ◽  
Initiation Of Therapy ◽  
Scorpion Stings

Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpion-envenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department. The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion’s species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).

Pickering syndrome: a rare presentation in emergency department

2021 ◽  
Vol 14 (2) ◽  
pp. e239421
Author(s):  
Prawal Shrimal ◽  
Ankit Kumar Sahu ◽  
Roshan Mathew ◽  
Abhinav Bansal
Keyword(s):  
Emergency Department ◽  
Renal Artery ◽  
Pulmonary Edema ◽  
Young Patient ◽  
Renal Artery Stenosis ◽  
Early Recognition ◽  
Hypertensive Emergency ◽  
Acute Pulmonary Edema ◽  
Rare Presentation ◽  
Life Threatening

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.

scholarly journals Cyanide intoxication by apricot kernels: A case report and literature review

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Faruk Ekinci ◽  
Dincer Yildizdas ◽  
Alper Ates ◽  
Naime Gökay
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Literature Review ◽  
Sudden Onset ◽  
Toxic Effects ◽  
Cyanide Poisoning ◽  
Life Threatening ◽  
Apricot Kernels ◽  
Cyanide Intoxication

Acute cyanide intoxication is a serious healthcare problem due to its potentially life threatening and fatal toxic effects. Ingestion of cyanide containing foods is an important source of cyanide poisoning and apricot kernels contain significant amounts of such cyanogenic compounds. Herein we report a previously healthy 4- year-old boy admitted to our emergency department with complaints of vomiting and sudden onset of unconsciousness after ingestion of apricot kernels. He was diagnosed as acute cyanide poisoning and treated with a specific antidote; hydroxocobalamin. Our report concludes with previous cases of cyanide poisoning after ingestion of apricot kernels and a quick look at sources, manifestations and treatment of acute cyanide poisoning.

scholarly journals A case of secondary tension pneumothorax in COVID-19 pneumonia in a patient with no prior history of lung disease

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096750
Author(s):  
Kwesi Amoah ◽  
Kulothungan Gunasekaran ◽  
Mandeep Singh Rahi ◽  
Michael G Buscher
Keyword(s):  
Lung Disease ◽  
Tension Pneumothorax ◽  
Kidney Injury ◽  
Sudden Onset ◽  
Prior History ◽  
Unusual Complication ◽  
Mediastinal Shift ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray

Complications that arise in patients with severe COVID-19 pneumonia are acute respiratory distress syndrome, often leading to mechanical ventilation, shock requiring vasopressors, acute kidney injury, stroke, thromboembolic phenomena, and myocardial injury. To date, there are four cases of tension pneumothorax in patients with COVID-19, published in literature. We present a 33-year-old man with no prior history of lung disease who was admitted to our hospital on account of hypoxic respiratory failure secondary to COVID-19 pneumonia. During his hospitalization, he developed sudden onset of chest pain which worsened with coughing. A chest X-ray showed a right-sided pneumothorax with left-sided mediastinal shift. He required placement of chest tubes with eventual resolution of the pneumothorax several days later. This case highlights the need for clinical recognition, consideration of differential diagnoses, prompt evaluation, appropriate imaging, and management of this severe life-threatening unusual complication of COVID-19 pneumonia.

scholarly journals A Patient with speechlessness and rhabdomyolysis: a rare presentation of severe hypocalcaemia

2020 ◽  
Vol 13 (12) ◽  
pp. e238072
Author(s):  
Florine Helene Jiwa ◽  
Kim van den Hoek ◽  
Clementine Jaantje Joanna van Zeijl ◽  
Albertus Jozef Kooter
Keyword(s):  
Emergency Department ◽  
Cold Water ◽  
Case Reports ◽  
Atypical Presentation ◽  
Rare Presentation ◽  
Calcium Supplements ◽  
Blood Tests ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Severe Hypocalcaemia

A 29-year-old man with no medical history presented to our emergency department with episodes of sudden speechlessness, hoarseness, vomiting after drinking cold water and spasms of his hands. Chvostek’s and Trousseau’s signs were both seen at presentation. Blood tests revealed severe hypocalcaemia (1.03 mmol/L) and rhabdomyolysis (creatine kinase (CK) of 2962 IU/L). The patient was treated immediately with calcium intravenously with an almost immediate improvement of his voice and quick normalisation of his CK. Additional investigation showed primary hypoparathyroidism in the presence of a vitamin D deficiency, requiring lifelong treatment with calcium supplements and alphacalcidol. Severe hypocalcaemia can be life threatening and prompt treatment is essential. This case reports the unusual first presentation of hypocalcaemia via speechlessness and vomiting together with rhabdomyolysis. Identifying an atypical presentation of hypocalcaemia is critical, for it can be lifesaving.

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.

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