Minimally Invasive Procedures for Diagnosis of Traumatic Right Diaphragmatic Tears: A Method for Correct Diagnosis in Selected Patients

2007 ◽  
Vol 73 (4) ◽  
pp. 388-392 ◽  
Author(s):  
Yoav Mintz ◽  
David W. Easter ◽  
Uzi Izhar ◽  
Yair Edden ◽  
Mark A. Talamini ◽  
...  
Keyword(s):  
Diagnostic Laparoscopy ◽  
Motor Vehicle ◽  
Correct Diagnosis ◽  
Traumatic Rupture ◽  
Respiratory Compromise ◽  
Vehicle Accidents ◽  
Left Diaphragm ◽  
Key Factor ◽  
The Right ◽  
High Index Of Suspicion

Traumatic rupture of the diaphragm is no longer uncommon. Because of the increasing frequency of motor vehicle accidents, the rate of blunt trauma to the chest and abdomen, which are the most common causes of diaphragmatic rupture, is increased as well. However, the diagnosis is frequently missed or delayed because of the lack of sensitivity and specificity of imaging modalities. Diagnostic laparoscopy is considered a standard tool for penetrating injuries to the left diaphragm and is widely practiced in selected cases. Right diaphragmatic tears, however, are more difficult to diagnose because of the sealing effect of the liver. Blunt abdominal trauma can cause large right diaphragmatic tears, causing liver incarcerations and respiratory compromise, therefore demanding the need for a comparable diagnostic tool. A high index of suspicion, together with knowledge of the mechanism of trauma, is the key factor for the correct diagnosis. Once the diagnosis has been considered, diagnostic laparoscopy and/or diagnostic thoracoscopy should be performed to confirm or rule out this injury. Factors suggestive of a right diaphragmatic tear include newly or progressive elevation of the right diaphragm and respiratory distress without underlining lung injury. The timing of the procedure should be in accordance with the hemodynamic and respiratory status of the patient. This procedure should be performed semielectively if there are no other indications for surgical intervention.

scholarly journals Acute Pseudohepatitis in a Chronic Substance Abuser Secondary to Occult Seat Belt Injury

1999 ◽  
Vol 13 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Eric CS Lam ◽  
Rhonda M Janzen ◽  
R Mark Meloche ◽  
Paul J Trepanier ◽  
Eric M Yoshida
Keyword(s):  
Liver Dysfunction ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Seat Belt ◽  
Traumatic Injury ◽  
Surgical Trauma ◽  
Vehicle Accidents ◽  
Serum Aminotransferases ◽  
The Right ◽  
High Index Of Suspicion

Causes of a massive elevation in serum aminotransferases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in the substance-abusing patient include viral hepatitis and drug hepatotoxicity. A patient chronically addicted to injection heroin and cocaine presented to the emergency room in a confused state and was admitted to a medical ward with an AST of 4120 U/L, ALT 3820 U/L and right upper quadrant discomfort. Investigations for viral and hepatotoxic causes for the liver dysfunction revealed only hepatitis C seropositivity. A computed tomogram of the abdomen, however, revealed a significant contusion to the right lobe of the liver consistent with traumatic injury. A motor vehicle accident, in which the patient was wearing a seat belt, and which had occurred a few days before admission and had been thought to be minor, was the cause of the liver dysfunction. Significant blunt abdominal traumatic injuries are usually managed exclusively by surgical trauma units. This case underlines the need for medical specialists to be aware of hepatic contusion injuries and to have a high index of suspicion when investigating unexplained hepatocellular dysfunction in chronic substance abusers who have been in motor vehicle accidents.

scholarly journals Traumatic Aortic Injury in a 3-Year-Old Child - A Case Report and Literature Review

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Aljohani M ◽  
◽  
Alanazi S ◽  
Keyword(s):  
Case Report ◽  
Significant Contribution ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Aortic Injury ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Pseudo Aneurysm ◽  
High Index Of Suspicion ◽  
Tomography Scan

This case report describes a case of aortic injury with pseudo-aneurysm in a 3-year-old Saudi boy following a motor vehicle accident. The diagnosis was suspected on computed tomography scan, and emergency surgery was performed. A Dacron graft was inserted to repair the injured aorta. Postoperatively, absent femoral, and distal pulses were noted, and thromboembolectomy was performed with good outcome. We believe that our study makes a significant contribution to the literature because it raises awareness of aortic injury and rupture in pediatric patients with multi-organ trauma following motor vehicle accidents. A high index of suspicion and early intervention are essential in improving outcomes.

An uncommon potentially lethal injury: Traumatic pericardial rupture with herniation of the heart

Trauma ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 139-141
Author(s):  
TA Yuvaraj Davidson ◽  
Parma Nand
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Fatal Outcome ◽  
Traumatic Rupture ◽  
Trauma Patients ◽  
Vehicle Accident ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Treatable Condition ◽  
Insight Into

Traumatic rupture of the pericardium with herniation of the heart can be a potentially lethal injury that can be easily overlooked. Prompt diagnosis and repair can be lifesaving. We report such a case with successful repair of this injury in a 45-year-old male who sustained multiple injuries following a motor vehicle accident. CT scan revealed rupture of the pericardium with herniation of the heart. The pericardial tear was promptly repaired by primary closure. This report gives an insight into this life threatening, yet promptly treatable condition, which can be easily missed resulting in a fatal outcome. Having a high index of suspicion while treating thoracic trauma patients can prevent fatalities. Immediate referral to a cardiothoracic service or closure of the tear through a thoracotomy, if the expertise is available, can be lifesaving.

scholarly journals Sacral Tuberculosis: An Atypical Manifestation

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Faisal Amir Si Mirah ◽  
Ahmad Faizal Roslan ◽  
Ed Simor Khan Mor Japar Khan ◽  
Rajandra Kumar Karupiah ◽  
Zamzuri Zakaria @ Mohamad
Keyword(s):  
Correct Diagnosis ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Ct Guided ◽  
Walking Aids ◽  
Grade 5 ◽  
History Of ◽  
Prolapsed Intervertebral Disc ◽  
The Right ◽  
High Index Of Suspicion

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.

Probability Analysis of Motor Vehicle Accidents

2002 ◽  
Author(s):  
Scott Kimbrough
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Probability Analysis ◽  
Maximum Information ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Stop Sign ◽  
Oncoming Vehicle ◽  
Probability Methods ◽  
The Right

Probability analysis is the key to extracting the maximum information from the evidence surrounding a motor vehicle accident. Moreover, it gives essential perspective to the answers drawn from the evidence, by conveying the uncertainty about the answers. In this paper, probability methods are used to analyze a typical intersection type collision between two vehicles. It is a situation in which one of the vehicles pulls out from a stop sign into the path of the other vehicle, which had the right of way. The vehicle that pulls out into the path of the oncoming vehicle precipitates the accident, but the driver of the oncoming vehicle may have contributed to the accident by traveling at excessive speed and or by being inattentive.

scholarly journals Taking Measure of the Charter’s Equality Guarantee: A Comment on the Court of Appeal’s Ruling in Morrow v. Zhang

2009 ◽  
pp. 229-252
Author(s):  
Barbara Billingsley
Keyword(s):  
Soft Tissue ◽  
Motor Vehicle ◽  
Soft Tissue Injuries ◽  
Motor Vehicle Accidents ◽  
Vehicle Accidents ◽  
Appeal Court ◽  
Automobile Accident ◽  
Minor Injury ◽  
The Right ◽  
Court Of Appeal

On 12 June 2009, the Alberta Court of Appeal released its decision in Morrow. The central issue in the case was whether Alberta’s minor injury cap unjustifiably violates the right to equality guaranteed by s. 15(1) of the Canadian Charter of Rights and Freedoms. Overturning the trial judgment of Neil Wittman A.C.J., the Court of Appeal concluded that the minor injury cap does not violate the Charter’s equality guarantee. The appeal Court held that, when looked at in the context of the province’s overall regulatory scheme of automobile accident insurance, the minor injury cap does not perpetuate a negative stereotype of individuals who suffer minor soft tissue injuries in motor vehicle accidents.

How Do We Know When a Screening Test is Clinically Useful?

2009 ◽  
Author(s):  
Alex J. Mitchell
Keyword(s):  
Screening Test ◽  
Correct Diagnosis ◽  
Clinical Skill ◽  
Screening Tools ◽  
Added Value ◽  
Clinical Interviews ◽  
Primary Care Patients ◽  
The Right ◽  
High Index Of Suspicion ◽  
Low Prevalence

There is no shortage of suggested methods to screen for depression, including clinical interviews. Assuming these are applied to a group containing patients with depression and patients without depression, how do we decide which are the optimal methods? In addition, how can tests be compared and how can tests be combined? This chapter discusses the methods used to compared scales and tools. The terms diagnosis and screening both refer to the application of an agreed method to confirm those with a condition and to exclude those without the condition (for discussion see Chapter 2). When attempting to separate depressed versus non-depressed individuals there is always an overlap of symptoms (or biological markers) (see Chapter 1, Fig. 1); therefore, a perfect test based on current tests is unobtainable. Testing may be focused on those at high risk of the condition (such as screening for depression after myocardial infarction) or applied to a wider population (screening for depression in all primary care patients). The former is a high-prevalence setting, which favors the ability to confirm a condition, whereas the latter is a low-prevalence setting, which favors the ability to refute a condition. It is often forgotten that the clinical process of making a diagnosis is a form of screening itself. Here the tool is the clinician’s clinical skill and the sample is all patients seen by the clinician. If a clinician is attuned to the concept of depression, has a high index of suspicion, and asks the right questions, then it is likely he or she will have high personal diagnostic accuracy. If the clinician is unconfident, inexperienced, and untrained, it is less likely that he or she will be able to make a correct diagnosis (see Table 5.1 and Chapter 3). Some literature suggests that the added value of screening tools for depression is apparent only in the latter situation. A diagnostic test for depression is designed to help the clinician elicit and weigh symptoms and signs to make a diagnosis. How, then, is this achieved, and how does a screening test work in scientific terms?

scholarly journals Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Muge Coban-Karatas ◽  
Rana Altan-Yaycioglu
Keyword(s):  
Head Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Anterior Segment ◽  
Peripheral Retina ◽  
Traumatic Rupture ◽  
Vehicle Accident ◽  
Ischemic Retinopathy ◽  
The Right ◽  
Fundoscopic Examination

We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma.

scholarly journals Catheter-Induced Thrombosis of the Superior Vena Cava

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Elio Venturini ◽  
Lucia Becuzzi ◽  
Lucia Magni
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Correct Diagnosis ◽  
Vena Cava ◽  
Venous Drainage ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
High Index Of Suspicion

There has been an increase in the use of central venous catheters (CVCs) in clinical practice. One of the most dangerous complications associated with their use is symptomatic or asymptomatic thrombosis (T), sometimes associated with superior vena cava (SVC) syndrome, resulting from impaired venous drainage. The right heart clots can induce an increased risk of mortality due the potential pulmonary embolism (PE). We report a case of asymptomatic 83-year-old woman in whom the thrombosis was detected after an echocardiogram. Echocardiography demonstrated a cardiac mass, and the T was confirmed by (magnetic resonance imaging) MRI. The clinical scenario, a high index of suspicion and routine use of echocardiogram in patients with CVC, can lead to a correct diagnosis, preventing dangerous complications.

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