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.

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 THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

scholarly journals THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

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 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-recurrent inferior laryngeal nerve: a case report

2020 ◽  
Vol 7 (10) ◽  
pp. 3469
Author(s):  
Shah Urvin Manish ◽  
Boopathi Subbarayan ◽  
Saravanakumar Subbaraj ◽  
Tirou Aroul Tirougnanassambandamourty ◽  
S. Robinson Smile
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nodular Goiter ◽  
Anatomical Variations ◽  
Laryngeal Nerve ◽  
Anatomical Landmarks ◽  
Inferior Laryngeal Nerve ◽  
Nonrecurrent Inferior Laryngeal Nerve ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
The Right

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

AN ABDOMINAL INFECTION SIMULATING MALIGNANCY : A CASE REPORT

2021 ◽  
pp. 29-30
Author(s):  
Varsha Konyala ◽  
Poornima M
Keyword(s):  
Histopathological Examination ◽  
The Road ◽  
Aged Woman ◽  
Loss Of Weight ◽  
Middle Aged Woman ◽  
Chest X Ray ◽  
Extra Pulmonary ◽  
On The Road ◽  
Anti Tubercular Therapy ◽  
Spread Of Infection

Tuberculosis is notorious for its afiction to the lungs.However, one mustn't forget the case burden that extra pulmonary TB imposes.Here we present a case of a middle aged woman who came with non specic complaints per abdomen.Her abdominal pain, discomfort, loss of weight and appetite along with clinical examination and investigations pointed towards malignancy. On surgical exploration and histopathological examination, the case was conrmed as that of abdominal TB.Tuberculosis of the abdomen is one of the extra pulmonary sites where tubercular bacilli can reside. In such cases, apart from treating tuberculosis medically with anti tubercular therapy, one must also order a chest X-ray to identify any pulmonary foci of tuberculosis. This is to curb any potential spread of infection. Further, one must look acutely at cases with non specic ndings and consider TB in the differential diagnosis, particularly if the patient hails from a TB endemic region.With a keen eye for tuberculosis along with corroborative and relevant investigations, one can diagnose this chronic illness and put patients well on the road to recovery.

scholarly journals A hairy intruder into colon

2014 ◽  
Vol 05 (04) ◽  
pp. 159-161 ◽  
Author(s):  
Umesh Jalihal ◽  
Prithvipriyadarshini Shivalingaiah ◽  
Dheena Shurane ◽  
Kiran Reddyvari
Keyword(s):  
Dermoid Cyst ◽  
Germ Cells ◽  
Neural Tissue ◽  
Benign Tumors ◽  
Aged Woman ◽  
Adnexal Tumor ◽  
Middle Aged Woman ◽  
Bleeding Per Rectum ◽  
The Right ◽  
Ovarian Dermoid Cyst

AbstractOvarian dermoid cysts are benign tumors, which develop from totipotent germ cells and grow into mature tissue types consisting of hair, teeth, fat and neural tissue. Ovarian dermoid cyst fistulizing to the sigmoid is rare and presenting with bleeding per rectum is extremely rare. We present a case of middle-aged woman with bleeding per rectum who had the right adnexal tumor fistulating to sigmoid.

scholarly journals Primary Hepatic Leiomyoma in a Healthy Middle-Aged Woman: Literature Review and Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Mihajlo Djokic ◽  
Benjamin Hadzialjevic ◽  
Bostjan Luzar ◽  
Blaz Trotovsek
Keyword(s):  
Surgical Resection ◽  
Preoperative Diagnosis ◽  
Liver Tumors ◽  
Good Condition ◽  
Middle Aged ◽  
Aged Woman ◽  
Immunosuppressed Patients ◽  
Middle Aged Woman ◽  
History Of ◽  
Trucut Biopsy

Introduction: Primary hepatic leiomyoma (PHL) is a rare benign hepatic tumor with unclear pathogenesis. It more commonly occurs in immunosuppressed patients, while only 24 cases have been described among immunocompetent individuals. To date, only one successful preoperative diagnosis of PHL has been achieved.Case Presentation: Here we report a case of PHL in a middle-aged woman with no history of immunosuppression. Preoperative diagnosis of PHL was established using ultrasound-guided fine needle trucut biopsy (FNTB). Nevertheless, due to the growing nature of tumor and patient's symptoms, we proceeded with surgical resection, which confirmed the diagnosis of PHL. At 6-month follow up, the patient is in good condition with no evidence of tumor recurrence.Conclusions: PHL is an uncommon tumor that should be considered in the differential diagnosis of rare liver tumors. Image guided FNTB appears to be effective in achieving preoperative diagnosis of PHL. Surgical resection, however, remains both diagnostic and curative in the management of PHL.

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.

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