Benzocaine-related methaemoglobinemia after transoesophageal echocardiography: a rare, life-threatening complication

2021 ◽  
Vol 14 (4) ◽  
pp. e241887
Author(s):  
John Wagner ◽  
Nicole Cornet ◽  
Alan Goldberg
Keyword(s):  
Transoesophageal Echocardiography ◽  
Supplemental Oxygen ◽  
Sudden Onset ◽  
Arterial Blood Gas ◽  
X Ray ◽  
Arterial Blood ◽  
Life Threatening ◽  
Chest X Ray ◽  
Life Threatening Complication ◽  
Methaemoglobin Level

Methaemoglobinemia is an uncommon but potentially life-threatening complication of topical benzocaine use that requires prompt identification in patients who undergo transoesophageal echocardiography (TEE). In this case, a 21-year-old patient who had sustained a stroke with residual right-sided weakness a few days prior to presentation underwent TEE to evaluate for intracardiac shunt. She required intubation as part of her poststroke care with some instrumentation to the posterior oropharynx. Shortly after TEE, the patient experienced sudden onset respiratory distress and hypoxia that did not improve with supplemental oxygen. Chest X-ray did not reveal any acute cardiopulmonary process. Arterial blood gas co-oximetry panel with methaemoglobin level confirmed the diagnosis of methaemoglobinemia. The patient promptly received methylene blue, recovered quickly and did not have any additional episodes of hypoxia.

scholarly journals A dangerous pleural effusion

2010 ◽  
Vol 92 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay K Shukla
Keyword(s):  
Rare Complication ◽  
Sudden Onset ◽  
Biliary Surgery ◽  
Biliary Leak ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
Chest X Ray

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be life-threatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.

scholarly journals Pneumothorax in the cases of silicosis in southern part of Rajasthan

2017 ◽  
Vol 4 (6) ◽  
pp. 1547 ◽  
Author(s):  
Rishi K. Sharma ◽  
Atul Luhadia ◽  
Shanti K. Luhadia ◽  
Yash Mathur ◽  
Harshil Pandya ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Rare Event ◽  
Silica Particles ◽  
Sudden Onset ◽  
Bilateral Pneumothorax ◽  
X Ray ◽  
Occupational Lung Disease ◽  
Secondary Spontaneous Pneumothorax ◽  
Life Threatening ◽  
Chest X Ray

Background: Silicosis is an occupational lung disease caused by inhalation of dust containing crystalline silica particles of size 0.5-5 microns in diameter. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work and ceramics. Pneumothorax is one of the complications of silicosis. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The incidence of secondary spontaneous pneumothorax (SSP) in silicosis as such is not known. This study aims to report the cases of secondary spontaneous pneumothorax in patients of silicosis in Southern part of Rajasthan.Methods: 50 patients of silicosis established by historical, clinical evaluation and radiological evidence with increased dyspnoea were included in the study. In all patients Chest X ray was done immediately.Results: Among 50 patients of silicosis with increased dyspnoea, Chest X ray showed pneumothorax in 20 patients of which 4 had bilateral pneumothorax, 7 had right pneumothorax and 9 had left pneumothorax. The mean duration of exposure to silica particles was 10 years (5 to 15 years). All the patients had various degrees of dyspnoea and chest pain. Tube thoracostomy was performed in 15 patients while 5 patients were managed conservatively with oxygen and bronchodilators.Conclusions: Our study showed an increased incidence of secondary pneumothorax in silicosis patients. The occurrence of pneumothorax, though rare in silicosis is a potentially life-threatening complication and may cause serious morbidity and mortality. The patients of silicosis who develop sudden onset of dyspnoea should be promptly investigated for this complication.

Computerized Ventilation

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 315-316
Author(s):  
RAN D. ANBAR
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Trials ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
X Ray ◽  
Arterial Blood ◽  
Chest X Ray

To the Editor.— Carlo et al1 report an "expert system" based on an algorithm for mechanical ventilation of infants with respiratory distress syndrome which would have corrected arterial blood gas derangements in 89% of 106 clinical trials. This algorithm was applied to additional trials using an independently designed computer-generated ventilation simulation program (VSP). Written in BASIC, VSP expects its user to manage a randomly "created" infant with respiratory distress syndrome by monitoring arterial blood gas values, physical examination findings, and chest x-ray film findings.2

scholarly journals The Role of Thoracic Ultrasound in Diagnosing Pneumothorax

2019 ◽  
Vol 38 (4) ◽  
pp. 239-43
Author(s):  
Mia Elhidsi ◽  
Budhi Antariksa ◽  
Dianiati Kusumo Sutoyo
Keyword(s):  
Gold Standard ◽  
Thoracic Ultrasound ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
Life Threatening Complication ◽  
B Lines ◽  
Lung Sliding ◽  
Lung Point

Diagnosis of a pneumothorax in some cases the can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. In this situation, thoracic sonography for pneumothorax can be especially helpful, allowing a method of quickly ruling out this potentially life-threatening complication. Its sensitivity dan specificity of ultrasound is higher than conventional chest x-ray. The four sonograms useful to diagnose pneumothorax and their usefulness in ruling in and ruling out the condition are lung sliding, lung pulse, B-lines and lung point. (J Respir Indo. 2018; 38: 239-43)

scholarly journals Dyspnea: when the preliminary imaging is unconvincing

2015 ◽  
Vol 9 (2) ◽  
pp. 163
Author(s):  
Angelica Moretti ◽  
Francesca Croci ◽  
Franco Carmassi
Keyword(s):  
Pleural Effusion ◽  
Decision Making Process ◽  
Blood Gas ◽  
Cytological Examination ◽  
Arterial Blood Gas ◽  
X Ray ◽  
Arterial Blood ◽  
Lung Consolidation ◽  
Left Pleural Effusion ◽  
Chest X Ray

A 73-year-old man was admitted to the Emergency Room (ER) for dyspnea and cough from several months. In ER were performed blood sampling, chest X-ray, electrocardiogram, echocardiogram and arterial blood gas. A thoracic ultrasound (US) revealed in the left side an abundant pleural effusion and a lung consolidation area of about 5 cm without air bronchogram. A thoracentesis showed the presence of hemorrhagic effusion. Chest computed tomography (CT) revealed micro-pulmonary embolism, abundant left pleural effusion with atelectasis of the lower ipsilateral lobe. Meanwhile the chest CT revised by the pulmonologist appeared suspicious for the presence of cancer, the cytological examination of pleural fluid revealed the presence of an adenocarcinoma. While the patient was waiting for the bronchoscopy he had a stroke and died in a few days. In conclusion, we believe that thoracic US has to be considered an extension of the physical examination, it is a bedside tool and it represents a valid diagnostic and therapeutic method. Therefore thoracic US, if closely linked to the physician’s activity, can directly affect the decision-making process and management of the patient with dyspnea.

scholarly journals Risk of vasopressin use: a case of acute pulmonary oedema, post intramyometrial infiltration of vasopressin in laparoscopic myomectomy

2019 ◽  
Vol 12 (12) ◽  
pp. e231331 ◽  
Author(s):  
Jennifer Frances Barcroft ◽  
Asmaa Al-Kufaishi ◽  
Justine Lowe ◽  
Stephen Quinn
Keyword(s):  
Pulmonary Oedema ◽  
Laparoscopic Myomectomy ◽  
Acute Pulmonary Oedema ◽  
Blood Gas ◽  
Positive End Expiratory Pressure ◽  
Arterial Blood Gas ◽  
X Ray ◽  
Arterial Blood ◽  
Chest X Ray

A 34-year-old patient underwent a laparoscopic myomectomy, complicated by a profound episode of bradycardia and hypotension following intramyometrial infiltration of vasopressin (20 IU), promptly corrected with intravenous ephedrine (6 mg) and glycopyrrolate (200 µg). At extubation, pink frothy fluid was noted in the endotracheal tube; she was visibly distressed, desaturated to 89% in air and was coughing up pink stained fluid. Acute pulmonary oedema secondary to vasopressin was suspected. A tight-fitting oxygen mask (100%) with positive end expiratory pressure was applied and intravenous furosemide (20 mg) and diamorphine (4 mg, 1 mg increments) were administered to facilitate diuresis and oxygenation. Chest X-ray confirmed acute pulmonary oedema. Arterial blood gas demonstrated type 2 respiratory failure. Over 12 hours, the oxygen was weaned to 1 L/min. She demonstrated excellent diuresis. Troponin and brain-natriuretic peptide were elevated, but echocardiogram was normal. The cardiology diagnosis was vasopressin-induced coronary vasospasm, precipitating acute pulmonary oedema. She was discharged home on day 5.

scholarly journals Methaemoglobinemia Induced by MDMA?

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
L. L. W. Verhaert
Keyword(s):  
Clinical Presentation ◽  
Good Condition ◽  
Blood Gas Analysis ◽  
Supplemental Oxygen ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Brown Colour ◽  
Arterial Blood Gas Analysis ◽  
Life Threatening

Case. A 45-year-old man with a blank medical history presented at the emergency room with dizziness and cyanosis. Physical examination showed cyanosis with a peripheral saturation (SpO2) of 85%, he did not respond to supplemental oxygen. Arterial blood gas analysis showed a striking chocolate brown colour. Based on these data, we determined the arterial methaemoglobin concentration. This was 32%. We gave 100% oxygen and observed the patient in a medium care unit. The next day, patient could be discharged in good condition. Further inquiry about exhibitions and extensive history revealed that the patient used MDMA (3,4- methylenedioxymethamphetamine, the active ingredient of ecstasy).Conclusion. Acquired methaemoglobinemia is a condition that occurs infrequently, but is potentially life threatening. Different nutrients, medications, and chemicals can induce methaemoglobinemia by oxidation of haemoglobin. The clinical presentation of a patient with methaemoglobinemia is due to the impossibility of O2binding and transport, resulting in tissue hypoxia. Important is to think about methaemoglobin in a patient who presents with cyanosis, a peripheral saturation of 85% that fails to respond properly to the administration of O2. Because methaemoglobin can be reduced physiologically, it is usually sufficient to remove the causative agent, to give O2, and to observe the patient.

scholarly journals Diagnosing gastric volvulus in chest X-ray: report of three cases

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Narendra Pandit ◽  
Abhijeet Kumar ◽  
Tek Narayan Yadav ◽  
Qamar Alam Irfan ◽  
Sujan Gautam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Abdomen ◽  
Gastric Volvulus ◽  
X Ray ◽  
Pain Abdomen ◽  
Life Threatening ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Specific Symptoms ◽  
Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

Life-threatening presentation of a parahiatal hernia after esophagectomy: a case report and review of the literature

2021 ◽  
Vol 14 (6) ◽  
pp. e242158
Author(s):  
Camille Plourde ◽  
Émilie Comeau
Keyword(s):  
Small Bowel ◽  
Transverse Colon ◽  
Acute Abdominal Pain ◽  
Haemodynamic Instability ◽  
Acute Setting ◽  
X Ray ◽  
Left Diaphragm ◽  
Life Threatening ◽  
Chest X Ray ◽  
Obstructive Shock

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.

scholarly journals Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
A. Corrado ◽  
T. Renda ◽  
S. Bertini
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Future Research ◽  
Chronic Obstructive ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Oxygen Therapy

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO255%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55<PaO2<65 mmHg), and in those with decreased oxygen saturation (SO2<90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when arterial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

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