Surgical Neck Emphysema Post Elective Tonsillectomy: Case Report and Literature Review

Neck emphysema after tonsillectomy surgery is very rare. We present a case documenting the conservative management of a post-tonsillectomy neck swelling, accompanied by crepitus. Computed tomography revealed a large air density at the region of the right masticator space and the masseter muscle, proximal to other deep neck spaces and muscles. Further investigations of her associated symptoms resulted in an additional diagnosis of systemic lupus erythematosus. We have also explored the signs and symptoms associated with such cases, along with a discussion of the literature published on surgical emphysema post-tonsillectomy.

Pre-registration UK diagnostic radiography student ability and confidence in interpretation of chest X-rays

Introduction Chest X-rays are the most frequently requested X-ray imaging in English hospitals. This study aimed to assess final year UK radiography student’s confidence and ability in image interpretation of chest X-rays. Methods Thirty-three diagnostic radiography students were invited to assess their confidence and ability in interpreting chest x-rays from a bank of n=10 cases using multiple choice answers. Data analysis included 2x2 contingency tables, Kappa for inter-rater reliability, a Likert scale of confidence for each case, and questions to assess individual interpretation skills and ways to increase the learning of the subject. Results Twenty-three students participated in the study. The pooled accuracy achieved was 61% (95% CI 38.4-77.7; k=0.22). The degree of confidence and ability varied depending upon the student and the conditions observed. High confidence was noted with COVID-19 (n=12/23; 52%), lung metastasis (n=14/23; 61%), and pneumothorax (n=13/23; 57%). Low confidence was noted with conditions of consolidation (n=8/23; 35%), haemothorax (n=8/23; 35%), and surgical emphysema (n=8/23; 35%). From the sample n=11 (48%), participants stated they felt they had the knowledge to interpret chest X-rays required for a newly qualified radiographer. Conclusion The results demonstrated final year radiography student’s confidence and ability in image interpretation of chest X-rays. Student feedback indicated a preference for learning support through university lectures, online study resources, and time spent with reporting radiographers on clinical practice to improve ability and confidence in interpreting chest X-rays.

EP.WE.577Chest air-leak complications in critically ill COVID-19 Patients: a retrospective single-centre cohort study

Introduction COVID-19 has caused a global pandemic with a proportion of patients admitted to intensive care with viral pneumonia and respiratory failure. Spontaneous air leaks have been reported in patients with COVID-19. We report on a phenomenon of significant chest air-leak manifestations on a cohort of critically unwell intubated COVID-19 patients in our single centre. Methods All patients admitted to our single-centre intensive care unit during the initial outbreak of COVID-19 in the UK were identified. Individual electronic notes and imaging were screened to look for complications of: surgical emphysema, pneumomediastinum and/or pneumothorax. Results 158 patients were admitted to our intensive care and eleven (7.0%) of patients were found to have suffered air leak complications unrelated to line insertion. Five suffered surgical emphysema only, one surgical emphysema with pneumomediastinum and two with the full triad of surgical emphysema, pneumomediastinum & pneumothorax. Two patients had unilateral pneumothoraces and one patient experienced a tension pneumothorax. Four patients were managed conservatively and seven had chest drains inserted. Overall outcomes were: one patient was discharged home, one discharged to ward, two transferred to an outside hospital and seven died. Conclusion Air-leak complications in COVID-19 patients, both spontaneous and ventilation associated are an under-recognised phenomenon. In the critically ill population literature suggests there is a > 5% incidence and risk reduction strategies should be considered. We advocate for early diagnosis and decompressive therapy with chest drains to avoid tamponade in intubated patients. Virus spread from air-leak should also be considered and health-care professionals adequately protected.

Our comprehensive experience with tracheostomy in tertiary multi-speciality hospital over four years

<p class="abstract"><strong>Background:</strong> Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.</p><p class="abstract"><strong>Methods:</strong> It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established. </p><p class="abstract"><strong>Results:</strong> A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complications relating to tracheostomy were documented in 40 patients (16%) intra-operatively and/or post-operatively which included bleeding, surgical emphysema, granulations along the stomal site and rarely shock. The mean time to decannulation was 13.48 days.</p><p class="abstract"><strong>Conclusions:</strong> Our study takes into account and discusses the findings of all the 246 tracheostomies which were performed during the study period of 4 years. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies.</p><p class="Default"> </p>

Comparative study between bedside chest ultrasound and chest CT scan in the diagnosis of traumatic pneumothorax

Background Traumatic pneumothorax (PTx) is common in chest trauma. Its incidence ranges between 10 and 28%. Chest X-ray (CXR) is the traditional imaging for the potential traumatic PTx, while CT chest is considered the gold standard diagnostic tool. However, it requires that the patient to be transferred from the Emergency Department (ED) with its resuscitative facilities. Chest US (E-FAST) has emerged as a sensitive tool that can be used on bedside basis with much higher sensitivity than CXR. The objective of this study was to compare between accuracy and usefulness of the bedside US chest and CT chest in the diagnosis of traumatic PTx, as well as its ability to quantify its size. This was a prospective clinical study that included two hundred patients who have been admitted to the ED. The inclusion criteria included any patient with chest trauma. Exclusion criteria included patients with clinical surgical emphysema, patients with life threatening PTx, and patients who did not undergo CT chest. Results Forty-seven hemithoraces were proved positive for PTx by CT chest, while forty-five hemithoraces out of those 47 were confirmed by bedside chest US. The sensitivity for chest US is 95.74% in detection of traumatic PTx. No false-positive cases were diagnosed. All of the forty-five hemithoraces diagnosed by chest US have been confirmed by CT scan making a specificity of 100%. Conclusions Chest US is a useful rapid diagnostic tool in the diagnosis and quantification of the traumatic PTx at ED. It avoids the delay in transportation of the critically ill patients to perform CT chest.