December 2021 Medical Image of the Month: Aspirated Dental Implant

No abstract available. Article truncated after first 150 words. A 76-year-old woman with a past medical history significant for left-sided breast cancer status post lumpectomy recently underwent an extensive dental procedure about 1 month prior to presentation. The dental procedure was prolonged, and the patient reported falling asleep during the procedure several times. She presented with fatigue, right pleuritic chest pain, low-grade fevers, and drenching sweats. She underwent chest radiography at an outside institution which disclosed pneumonia, for which she was treated with cefdinir and doxycycline without improvement. Thoracostomy tube drainage of the pleural effusion was performed and showed empyema. Imaging showed an airway foreign body which was retrieved bronchoscopically. The patient made an uneventful recovery. Aspiration during dental procedures is rare but reported (1). Dental items have been reported as the second most commonly ingested/aspirated foreign objects in adults. If the airway is not compromised, assessment for any lost or missing instrument and its component should be done …

Gallbladder perforation with cholecystopleural fistula: a case report

The cholelithiasis is a common pathology, however, if left untreated may cause a gallbladder perforation (GBP). This complication can include local or generalized biliary spillage, or a fistulous communication to an adjacent organ. We report a case of a patient with cholecystopleural fistula in a 71-year-old male. Complicated cholelithiasis presented fistulous GBP into the right pleura cavity, progressing into an empyema. The diagnosis was made preoperatively with computed tomography, and the patient was treated with a laparoscopic cholecystectomy, thoracostomy tube, and a biliopleural fistulectomy. The postsurgical outcome was satisfactory, with uneventful follow-up 3 weeks after.

Subcutaneous Emphysema Complicating Convalescent Stage of Measles in a Malnourished Indigent Child: A Case Report from North-western Nigeria.

Background: Measles is a highly infectious vaccine preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Among the complications of measles, pneumonia accounts for most measles-associated morbidity and mortality. However, subcutaneous emphysema is a rare complication of measles that can be challenging to manage and may portend poor outcome if untreated. Case presentation: We present a case of a 2yr old un-immunized rural dweller with massive subcutaneous emphysema comorbid with malnutrition complicating convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47days on admission during which the treatment was supported by faith-based organization and social welfare unit of the hospital.ConclusionSubcutaneous emphysema is a rare complication of measles infection that can be challenging to manage especially when comorbid with malnutrition in an indigent child. Multi-disciplinary team approach and the use of CTTD with NPWT is an effective management measure which can shorten the duration of hospital stay.

Thoracic Surgery Consultations in COVID-19 Critically Ill Patients: Beyond Conservative Approach

Introduction. Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons’ consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons. Methods and Materials. A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. We included all COVID-19 cases admitted to ICU in the period between March 15, 2020, and August 15, 2020, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded. Results. Of 122 patients who were admitted to ICU with COVID-19, 18 patients (14.75%) required thoracic surgery consultation and management. We discovered a significant association between the outcomes and reintubation rates and the rate of pneumothorax occurrence. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. On the other hand, there was a significant difference between the COVID ICU group who had thoracic complication and those who did not regarding the length of hospital stay. Conclusion. Noniatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.

Traumatic retained hemothorax: is it time for video assisted thoracoscopic surgery

Thoracic trauma is a significant cause of morbidity and mortality, if not treated promptly. 80% to 85% of chest injuries can be treated with chest tube insertion alone. However, in about four to 20% of population, there is incomplete clearance of hemothorax following tube insertion and can lead to a condition called retained hemothorax. The purpose of this review is to establish the role and effectiveness of Video assisted thoracoscopic surgery (VATS) in successful evacuation of retained hemothorax following blunt thoracic trauma. Relevant articles from databases like Pubmed, Google scholar, Medline and Cochrane library were included. A retained hemothorax is defined as the persistence of residual clots in the pleural cavity, which is radiologically evident, 72 hours following initial tube thoracostomy. The various options to manage this condition include observation, insertion of second thoracostomy tube, intrapleural fibrinolytic, VATS or thoracotomy. Based on review of existing studies, VATS evacuation was found to have shorter hospital stay, lesser costs and shorter duration of tube drainage. There was also lesser rate of conversion to thoracotomy as compared to other methods and fewer complications like fibrothorax and empyema. In hemodynamically unstable patients, which is a contraindication to VATS, use of intrapleural fibrinolytics like streptokinase may be considered as an alternative option to provide clearance of the retained hemothorax. Retained hemothorax, when encountered following thoracic trauma, can be effectively managed by VATS. The decision to use VATS for hemothorax evacuation should be made promptly for maximum results, especially within three to seven days following trauma.