scholarly journals Tension Viscerothorax in a Patient with Missed Traumatic Diaphragmatic Hernia. A Case Report.

Author(s):  
Herbert Butana ◽  
Ntawunga Laurance ◽  
Desire Rubanguka ◽  
Isaie Sibomana

Background: Diaphragmatic hernias occurring post trauma are a challenge to diagnose early especially when they follow blunt trauma. Many of those diagnosed early occur in penetrating thoraco-abdominal trauma which necessitates emergency exploration where the diagnosis is picked. Rarity of traumatic diaphragmatic hernia coupled with poor sensitivity of easily available imaging modalities makes it a big challenge to pick up this potentially fatal pathology. Case presentation: We present a rare case of tension viscerothorax in a young man who had presented to the emergency department at a provincial hospital of Rwanda three days before the second consultation where the chest x-ray was interpreted as normal and later as a pneumothorax before the diagnosis and treatment of tension viscerothorax could be made. Conclusion: Viscerothorax is an elusive diagnosis which when missed can complicate to strangulation of hernia contents or tension viscerothorax which carry a high mortality.

2021 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
D.A. Morozov ◽  
◽  
D.V. Khaspekov ◽  
E.A. Okulov ◽  
V.G. Masevkin ◽  
...  

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia


2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.


2013 ◽  
Vol 24 (1) ◽  
pp. 52-54
Author(s):  
SM Kamal ◽  
Md Abu Bakar ◽  
MA Ahad

A 65 years old farmer was admitted in Medicine ward with the complaints of progressive exertional breathlessness, non-productive cough and recurrent episodes of fever. The patient had clubbing and chest examination revealed end inspiratory crackles. Chest x-ray, CT scan of chest and spirometry revealed the features of interstitial lung disease (ILD). So we diagnosed the case as idiopathic pulmonary fibrosis variety of ILD. We reported this rare case for developing awareness among the clinicians. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14118 Medicine TODAY Vol.24(1) 2012 pp.52-54


2021 ◽  
Author(s):  
Duncan Mwangangi Matheka ◽  
Edwin Walong ◽  
Christine Yuko Jowi

Abstract BackgroundAngiofibromas are benign but locally aggressive vascular tumours that commonly occur in the nasopharynx, neck and face. Angiofibromas located in sites other than head and neck regions are rare. We report a massive interventricular tumour in a 5-month-old who died suddenly.Case presentationWe present a 5-month-old who died suddenly due to a massive rare cardiac tumour. A post mortem carried out diagnosed it as angiofibroma on histopathology. At three months of age, he had a persisting cough for a week, with associated occasional wheezing and dyspnea that stopped after symptomatic treatment. A chest x-ray revealed a mild cardiomegaly. Serial echocardiograms showed a well circumscribed, homogenous, highly vascularized mass filling the left ventricle. Surgical intervention was planned.Conclusions: Cardiac angiofibromas are rare pediatric neoplasms and as seen in this report, invariably fatal. More insights into their pathogenesis, prevention and treatment are required.


2021 ◽  
pp. 51-52
Author(s):  
Priyadarshan Konar ◽  
Subhendu Mahapatra ◽  
Jayita Chakrabarti ◽  
Gautam Sengupta

Introduction: Pectus Excavatum usually recognized during infancy and become worse with growing ages. Case presentation: We presented a 6 months old male child to our departmental OPD with complaints of indrawing of anterior chest wall. On physical examination revealed a signicant Pectus Excavatum deformity. There was no other abnormality except the chest wall deformity. An abnormal chest X-ray and CT scan demonstrated leftward displacement of heart and great vessels. Conclusion: Surgery for Pectus Excavatum is specialized and can be done in early childhood with better outcome.


2020 ◽  
Vol 56 (4) ◽  
pp. 320
Author(s):  
Anastasia Tjan ◽  
I Made Dwija Putra Ayusta ◽  
Dewa Gde Mahiswara

Herniation of bulla across mediastinum is rare, while transmediastinal giant bulla herniation accompanied with hydropneumothorax is even rarer. We report a case of an 18 years old male with dyspnea came to emergency department with trans-mediastinal giant bulla herniation, which appears as semilunar sign on chest x-ray, and right hydropneumothoraks. It appeared that the giant bulla also infected by the presence of air fluid level within. Semilunar sign was seen on the contralateral left mediastinum as the hallmark finding for trans-mediastinal herniation of bulla. Chest CT further confirms the diagnosis. Subsequently chest tube insertion and symptomatic relives were given, however the patient end up dead after 2 days of observation. Heart and lung compression by the lesions were the cause of this patient poor outcome. Bullous lung disease should be evaluated thoroughly and not underestimated since it could cause severe disease progression. 


2021 ◽  
Vol 1 (2) ◽  
Author(s):  
A. Mohamed ◽  
Shankar S ◽  
Abid Qazi

Background: Anterolateral defect of diaphragm is unusual and has been reported less than 5 times in literature. Case Presentation: We are reporting a case with typical initial presentation of a congenital diaphragmatic hernia. A chest x-ray raised suspicion of a cystic lesion or diaphragmatic eventration which was excluded by chest ultrasound. At operation he was found to have a localised and large anterolateral defect with a very thick sac which was plicated to bridge the diaphragmatic defect. Conclusion: A rare variant and should be differentiated from other variants using imaging.


2008 ◽  
Vol 50 (6) ◽  
pp. 347-350 ◽  
Author(s):  
Ebrahim Razi ◽  
Elaheh Malekanrad

A 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.


2018 ◽  
Vol 32 (2) ◽  
pp. 236-239 ◽  
Author(s):  
Jared L. Ostroff ◽  
Jessica N. LeClair (Barnet) ◽  
Marissa L. Ostroff ◽  
Corey S. Laskey

Background: Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate. Case Presentation: We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored. The chest pain improved when the topiramate was held. No identifiable causes of chest pain were apparent, other than the topiramate. Discussion: The Naranjo probability scale was utilized to determine the causality of topiramate. The resulting score of 3 indicates that it is possible that the chest pain was due to the topiramate. Conclusion: This report demonstrates an example of a patient who experienced chest pain possibly caused by the initiation of topiramate. The objective of this case report is to increase the awareness of chest pain as an adverse effect of topiramate.


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