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At least 1,585 records · Page 88Linked to original sources
PubMed1988

Reliability of physical examination in penetrating chest injuries.

The decision to insert an intercostal drain in chest injury must occasionally be made without a chest radiograph. A prospective analysis of the reliability of physical examination in penetrating pleural injuries was undertaken. A total of 51 consecutive patients were examined before obtaining a chest radiograph. The presumptive diagnosis and decision to institute intercostal drainage were compared with the radiological diagnosis and the actual decision in each patient. A policy of selective drainage of large pleural collections was employed. The series consisted mainly of stab injuries in young men. Physical examination accurately diagnosed 13 of the 14 large pneumo- or haemothoraces. This reliability combined with the selective drainage policy showed that physical examination accurately predicted the need for tube thoracostomy with a sensitivity of 96 per cent and a specificity of 93 per cent. This study suggests that experienced clinicians should not hesitate to institute immediate life-saving intercostal drainage when needed, before a chest radiograph is obtained.

Adolescent↗
PubMed1991

Subpulmonary haemothorax: 387 cases.

The diagnostic features of subpulmonary haemothorax (SH) are often overlooked. A retrospective review of 399 consecutive patients discharged with diagnoses of post-traumatic haemo- or haemopneumothorax yielded 51 (12.8 per cent) instances of SH on the initial radiographs. In 24 (47.1 per cent) of these initial diagnosis of SH had been missed. A concerted teach-in followed in order to reduce the rate of error. In a subsequent prospective study of 1773 consecutive patients with haemothorax (510) or haemopneumothorax (1263), mostly due to penetrating injuries, and who had undergone pre-interventional erect chest radiography, 336 (19.0 per cent) had the blood confined to the subpulmonary position; 156 (12.4 per cent) of the haemopneumothoraces and 180 (35.3 per cent) of the pure haemothoraces presented in this way. Confirmatory lateral decubitus radiography was necessary in 141 (42.0 per cent) of the SHs but initial diagnostic errors were confined to six cases (1.8 per cent). Comparison of the 336 SH patients and the 1437 presenting with more florid radiological signs showed only one significant difference in management and outcome: emergency thoracotomy rates of, respectively, 0.9 per cent and 9.2 per cent (P less than 0.0005). We conclude that SH is a common and normal presentation of less than massive haemothorax and we stress the diagnostic radiological features.

Diagnostic Errors↗
PubMed1993

Use of Autosuture Surgiport for pleural drain insertion.

The insertion of pleural drains (tube thoracostomy) is associated with serious complications in up to 10 per cent of cases. A safe and efficient technique of tube thoracostomy using the Autosuture Surgiport is described.

Chest Tubes↗
PubMed1993

Initial axial computerized tomography examination in chest injuries.

A total of 41 injured patients examined by both chest radiography and axial computerized tomography (CT) of the chest within the first 24 h after the accident were reviewed. In all, 10 patients died, eight from cerebral or cervical injuries, two from haemorrhage. Of the 27 cases with a haemothorax, 13 were seen on a chest radiograph. In only one case was a haemothorax seen on CT large enough to warrant intervention. CT revealed one minor pneumothorax. Nine patients already treated with a chest drain had some residual air demonstrated by CT, two being significant pneumothoraces. CT showed 28 cases of lung contusion as opposed to 23 on a chest radiograph. Of five cases with a mediastinal haematoma, three were seen on a chest radiograph, including the only patient with aortic rupture. Clinically important pathology was revealed in ordinary chest radiographs. Contusions, small pneumothoraces and minor effusions were sometimes overlooked. CT scan of the chest alone is rarely warranted in the injured patient, given a liberal indication for chest drainage and ready access to arch aortography.

Adolescent↗
PubMed1988

Computed tomography evaluation of pathologic processes in the potential spaces of the mediastinum.

The potential spaces of the mediastinum can be involved in a variety of disease processes and become evident by computed tomography study. The potential spaces may be distended with air, blood, inflammatory exudate, excessive fat, or tumor which separates and displaces the normal mediastinal structures. Seven cases with various pathologic processes are selected to demonstrate the computed tomography characteristics of such lesions. We emphasize the importance of computed tomography in evaluating and understanding various disease processes involving the potential spaces in an often widened mediastinum.

Adult↗
PubMed1995

Intrathoracic and subconjunctival petechiae in sudden infant death syndrome (SIDS).

The frequency and density of intrathoracic and subconjunctival petechiae was studied in 250 cases of SIDS and 69 controls. The control group included 37 infants with natural and 32 infants with traumatic causes of death. Intrathoracic petechiae were found significantly more frequently in the SIDS group (91.2% SIDS; 42% controls; p < 0.001) and were present at a higher density (p < 0.001). Subepicardial and thymic petechiae were detected at high density in older SIDS infants. Subconjunctival petechiae were low in density and found only in 2.4% of the SIDS group but they were detected in 8.1% of the natural death group and 21.9% (p < 0.05) of the lethal trauma group. Subconjunctival petechiae were found at highest density in strangulation. Intrathoracic petechiae are commonly found in SIDS but are not specific for SIDS. Subconjunctival petechiae are typical but not specific for strangulation. In SIDS, subconjunctival petechiae are rare and appear at low density.

Age Factors↗
PubMed1996

Chest trauma.

Trauma is a major cause of morbidity and mortality worldwide. Despite the advent of specialised trauma centres the outcome of patients who sustain major trauma remains disappointing. Plain radiography and more advanced imaging techniques such as ultrasound, computerised tomography (CT) and angiography, have a major role to play in the early decision making and subsequent management of patients who sustain polytrauma. This article discusses the choice of emergency imaging techniques available in chest trauma for clinicians and radiologists; their evaluation and some of the common pitfalls that may lead to errors of interpretation.

Aorta↗
PubMed1984

Pulmonary and aortic punctures--complications of an attempt at internal jugular venipuncture.

A case of pulmonary and aortic punctures occurred during an attempted internal jugular venipuncture in a patient with a dilated aortic arch. Procedural errors contributing to the complications included an inexperienced operator, inappropriate medial and caudal angulation of the needle, and failure to use a "finder" needle or Seldinger technique. Use of proper procedural technique will reduce the risk of complications in performing this procedure.

Adult↗
PubMed1985

Thoracentesis in the emergency department.

Presented is a review of thoracentesis, a procedure with which the emergency physician should be familiar. The pathophysiology of pleural effusions is described and is followed by a review of the clinical presentation and diagnosis. Special attention is given to technique and interpretation of results.

Biopsy, Needle↗
PubMedDate not supplied

CT appearance of primary pleural lymphoma.

We report a case of primary pleural lymphoma. The CT appearance was of hemorrhagic pleural effusion with thickened membranes. The CT evaluation of pleural disease is discussed.

Adult↗
PubMed1995

Spontaneous haemothorax as a complication of anti-coagulation following coronary angioplasty.

Haemorrhagic complications are well recognized when heparin is used during percutaneous transluminal coronary angioplasty (PTCA). We present a 74-year-old female who developed a large acute spontaneous haemothorax 20 h after coronary angioplasty. Spontaneous haemothorax has rarely been described and is predominantly associated with pulmonary embolism. In the absence of a pulmonary embolus, a spontaneous haemothorax during anti-coagulation has only been described twice in the world literature since 1862 (1). This is the first description of this complication following the use of heparin during PTCA.

Aged↗
PubMed2005

Chest and abdominal CT during extracorporeal membrane oxygenation: Clinical benefits in diagnosis and treatment.

RATIONALE AND OBJECTIVE: This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure. MATERIALS AND METHODS: Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records. RESULTS: CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived. CONCLUSION: Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.

Adolescent↗
PubMed2006

[Abbreviated laparotomy in severe abdominal trauma].

On critically injured patient the decision to perform a damage control laparotomy is based on the volume of transfusion and shock. The aim of the surgery which is to obtain as fast as possible the best hemostasis to limit the peritoneal thermal loss and to perform as soon as possible physiologic restoration in the Intensive Care Unit.

Abdominal Injuries↗