scholarly journals Ruptured liver abscess mimicking perforated viscus

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Noushad Thayyil ◽  
Zohaer S Khan ◽  
Shaheed Mullaveettil ◽  
Maria Jennifer Cordero
Keyword(s):  
Emergency Department ◽  
Liver Abscess ◽  
Spontaneous Rupture ◽  
Free Fluid ◽  
Klebsiella Pneumonia ◽  
Point Of Care Ultrasound ◽  
Hollow Viscus ◽  
X Ray ◽  
Liver Abscesses ◽  
Chest X Ray

Background: Liver abscesses are common in the Emergency Department. A cross-sectional study conducted in Qatar showed pyogenic liver abscesses were more common than amebic abscesses. Spontaneous rupture of pyogenic liver abscess is a rare entity with serious complications. A rupture resulting in peritonitis requires urgent surgical intervention whereas localized abscesses are managed with surgical or image-guided percutaneous drainage in addition to appropriate antibiotics. We report a case of spontaneous rupture of liver abscess presented to our Emergency Department that mimicked perforated hollow viscus. Methods/Case presentation: A 58-year-old male patient presented with fever, generalized weakness, anorexia, and abdominal discomfort for 2 weeks. The patient had a history of Type 2 diabetes mellitus and taking oral hypoglycemics. His initial vital signs revealed a temperature of 38.2°C, heart rate of 104 beats per minute, blood pressure of 150/74 mmHg, respiratory rate of 26 breaths per minute, oxygen saturation of 96% on room air. He appeared sick and dehydrated. Pertinent findings on abdominal examination were epigastric and right upper quadrant tenderness. The laboratory report showed leucocytosis and elevated transaminase. A chest X-ray was ordered and revealed air under the diaphragm . Point of care ultrasound showed a right liver lobe hypoechoic lesion with internal echoes and surrounding free fluid. A computed tomography of the abdomen showed a large hepatic lesion (11.5 x 8.5 x 9 cm), subcapsular in location, containing gas with dependent fluid, suggesting a gas-forming hepatic abscess, with the possibility of rupture and pneumoperitoneum. Results/Findings/Recommendations: The patient was admitted and underwent ultrasound guided drainage of the abscess. His blood and pus culture showed Klebsiella pneumonia and he received Ceftriaxone and Metronidazole intravenously (IV) for 14 days. He was discharged after 15 days with a favorable outcome. Conclusion: To the best of our knowledge, spontaneous liver abscess rupture resulting in pneumoperitoneum is rare. Chest X-ray findings may mimic perforated hollow viscus.

scholarly journals Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

CJEM ◽  
2015 ◽  
Vol 18 (5) ◽  
pp. 391-394
Author(s):  
Michael Romano ◽  
Tomislav Jelic ◽  
Jordan Chenkin
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Fluid Collection ◽  
Chest Ct ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Level Of Consciousness ◽  
Chest X Ray ◽  
Ultrasound Assessment ◽  
Higher Sensitivity

AbstractThere is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-year-old woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient’s lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.

scholarly journals Correction to: Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Cristian Giuseppe Monaco ◽  
Federico Zaottini ◽  
Simone Schiaffino ◽  
Alessandro Villa ◽  
Gianmarco Della Pepa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severity Score ◽  
X Ray ◽  
Emergency Department Admission ◽  
Centre Study ◽  
Chest X Ray

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Protocol for DRAUP: a deimplementation programme to decrease routine chest radiographs after central venous catheter insertion

2021 ◽  
Vol 10 (4) ◽  
pp. e001222
Author(s):  
Enyo A Ablordeppey ◽  
Byron Powell ◽  
Virginia McKay ◽  
Shannon Keating ◽  
Aimee James ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Acute Care ◽  
Imaging Modality ◽  
Phase 1 ◽  
Venous Catheter ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
X Ray ◽  
Chest X Ray ◽  
Routine Chest

IntroductionAvoiding low value medical practices is an important focus in current healthcare utilisation. Despite advantages of point-of-care ultrasound (POCUS) over chest X-ray including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation has slow rate of adoption. This demonstrates a gap that is ripe for the development of an intervention.MethodsThe intervention is a deimplementation programme called DRAUP (deimplementation of routine chest radiographs after adoption of ultrasound-guided insertion and confirmation of central venous catheter protocol) that will be created to address one unnecessary imaging modality in the acute care environment. We propose a three-phase approach to changing low-value practices. In phase 1, we will be guided by the Consolidated Framework for Implementation Research framework to explore barriers and facilitators of POCUS for CVC confirmation in a single centre, large tertiary, academic hospital via focus groups. The qualitative methods will inform the development and adaptation of strategies that address identified determinants of change. In phase 2, the multifaceted strategies will be conceptualised using Morgan’s framework for understanding and reducing medical overuse. In phase 3, we will locally implement these strategies and assess them using Proctor’s outcomes (adoption, deadoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on the programme. Secondary outcomes will include POCUS-guided CVC confirmation efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS confirmation after CVC insertion.With limited data available to inform interventions that use concurrent implementation and deimplementation strategies to substitute chest X-ray for POCUS using the DRAUP programme, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that will expand the knowledge of implementation approaches to replacing low value or unnecessary care in acute care environments.Ethics and disseminationApproval of the study by the Human Research Protection Office has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.Trial registration numberClinicalTrials.gov Identifier, NCT04324762, registered on 27 March 2020.

scholarly journals Giant criptogenic pyogenic gas containing left liver abscess

2008 ◽  
Vol 136 (5-6) ◽  
pp. 292-294
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Vladimir Radak
Keyword(s):  
Escherichia Coli ◽  
Liver Abscess ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diabetic Patients ◽  
Surgical Drainage ◽  
X Ray ◽  
Left Liver ◽  
Liver Abscesses ◽  
The Right

INTRODUCTION Pyogenic gas containing liver abscesses are rare. Less than 50 cases seem to have been described so far. Most of them were localised within the right liver. The majority of those abscesses appear in diabetic patients. CASE OUTLINE The authors present a 64-year old diabetic male patient in whom the investigation (US, CT, plain X-ray) performed for fever of unknown origin confirmed a giant liver gas containing abscess that destroyed almost the entire left liver. Escherichia coli sensitive to several antibiotics was isolated from the abscess. The patient was cured by surgical drainage, limited debridement, lavage, drainage and antibiotics. CONCLUSION Pyogenic gas containing liver abscesses are easy to diagnose nowadays. The type of surgical drainage has to be adapted to a particular patient.

scholarly journals The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Anneloes NJ Huijgens ◽  
Laurens J van Baardewijk ◽  
Carolina JPW Keijsers
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Lateral View ◽  
X Ray ◽  
Hospital Patients ◽  
Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

Chest X-ray Utilization in Febrile Infants 60 Days or Less in the Emergency Department

2021 ◽  
Author(s):  
Erin Bell ◽  
Kristen Manto ◽  
Giang Ha ◽  
Nabeal Aljabban ◽  
Lilia Reyes
Keyword(s):  
Emergency Department ◽  
X Ray ◽  
Chest X Ray

scholarly journals Early clinical predictors of severe acute respiratory syndrome in the emergency department

CJEM ◽  
2004 ◽  
Vol 6 (01) ◽  
pp. 12-21 ◽  
Author(s):  
W.N. Wong ◽  
Antonio C.H. Sek ◽  
Rick F.L. Lau ◽  
K.M. Li ◽  
Joe K.S. Leung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Acute Respiratory Syndrome ◽  
Lymphocyte Count ◽  
Case Definition ◽  
World Health ◽  
Clinical Predictors ◽  
X Ray ◽  
Abnormal Chest ◽  
Contact Exposure ◽  
Chest X Ray

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature &gt;38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count &lt;1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

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.

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