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Blunt trauma resulting in pneumothorax with progression to pneumoperitoneum: a unique diagnosis with predicament in management.

Curfman KR, Robitsek RJ, Sammett D, Schubl SD - J Surg Case Rep (2015)

Bottom Line: The patient is an 82-year-old male who was brought into the emergency department after being found at the bottom of a flight of stairs with a bleeding scalp laceration.Upon presentation, the patient underwent emergent intubation followed by tube thoracostomy placement, had necessary imaging and was transferred to the surgical intensive care unit (SICU).He was taken to the operating room for suspected viscus perforation, though none was found after extensively searching during an exploratory laparotomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ross University School of Medicine, Dominica, West Indies.

No MeSH data available.


Related in: MedlinePlus

CXR performed after thoracostomy and chest tube placement displaying areas of subcutaneous emphysema (white arrows).
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RJV147F1: CXR performed after thoracostomy and chest tube placement displaying areas of subcutaneous emphysema (white arrows).

Mentions: An 82-year-old male with past medical history of diabetes mellitus and alcohol abuse arrived by ambulance after being found unresponsive at the bottom of a flight of stairs with a scalp laceration. While en route to the hospital, two unsuccessful intubation attempts were made for a Glasgow coma scale (GCS) of 8. Upon arrival in the emergency department (ED), his GCS was determined to be 3 and was intubated with use of the Glidescope. Physical examination revealed decreased breath sounds on the left and crepitus over the left chest wall, suggestive of subcutaneous emphysema, and an immediate tube thoracostomy was performed prior to chest X-ray (CXR) to reduce the suspected pneumothorax. CXR post chest tube placement demonstrated large amounts of subcutaneous emphysema (Fig. 1 ), which was also visible on computed tomography (CT) scan along with evidence of pneumomediastinum and pneumoperitoneum (Fig. 2), with pneumoretroperitoneum and pneumoperitoneum present on abdominal CT scan (Fig. 3). As a result of the fall, he also sustained a fracture of the right frontal bone, fractures of the C2 and C3 vertebrae, and mild subarachnoid and subdural hemorrhage without shift. There were no intra-abdominal injuries found. He was admitted to the surgical intensive care unit (SICU) and maintained on mechanical ventilation, remaining hypotensive, hypothermic and mildly tachypneic, becoming increasingly unstable over the next 8 h. Due to the known pneumomediastinum, pneumoperitoneum and worsening instability, he was taken to the operating room for suspected viscus perforation and peritonitis. An exploratory laparotomy was performed, which revealed air within the lesser sac, but no evidence of bleeding or perforation. When closing the operative site, crepitus was also noted over the right chest wall, and a chest tube was placed into the right pleural space.Figure 1:


Blunt trauma resulting in pneumothorax with progression to pneumoperitoneum: a unique diagnosis with predicament in management.

Curfman KR, Robitsek RJ, Sammett D, Schubl SD - J Surg Case Rep (2015)

CXR performed after thoracostomy and chest tube placement displaying areas of subcutaneous emphysema (white arrows).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664951&req=5

RJV147F1: CXR performed after thoracostomy and chest tube placement displaying areas of subcutaneous emphysema (white arrows).
Mentions: An 82-year-old male with past medical history of diabetes mellitus and alcohol abuse arrived by ambulance after being found unresponsive at the bottom of a flight of stairs with a scalp laceration. While en route to the hospital, two unsuccessful intubation attempts were made for a Glasgow coma scale (GCS) of 8. Upon arrival in the emergency department (ED), his GCS was determined to be 3 and was intubated with use of the Glidescope. Physical examination revealed decreased breath sounds on the left and crepitus over the left chest wall, suggestive of subcutaneous emphysema, and an immediate tube thoracostomy was performed prior to chest X-ray (CXR) to reduce the suspected pneumothorax. CXR post chest tube placement demonstrated large amounts of subcutaneous emphysema (Fig. 1 ), which was also visible on computed tomography (CT) scan along with evidence of pneumomediastinum and pneumoperitoneum (Fig. 2), with pneumoretroperitoneum and pneumoperitoneum present on abdominal CT scan (Fig. 3). As a result of the fall, he also sustained a fracture of the right frontal bone, fractures of the C2 and C3 vertebrae, and mild subarachnoid and subdural hemorrhage without shift. There were no intra-abdominal injuries found. He was admitted to the surgical intensive care unit (SICU) and maintained on mechanical ventilation, remaining hypotensive, hypothermic and mildly tachypneic, becoming increasingly unstable over the next 8 h. Due to the known pneumomediastinum, pneumoperitoneum and worsening instability, he was taken to the operating room for suspected viscus perforation and peritonitis. An exploratory laparotomy was performed, which revealed air within the lesser sac, but no evidence of bleeding or perforation. When closing the operative site, crepitus was also noted over the right chest wall, and a chest tube was placed into the right pleural space.Figure 1:

Bottom Line: The patient is an 82-year-old male who was brought into the emergency department after being found at the bottom of a flight of stairs with a bleeding scalp laceration.Upon presentation, the patient underwent emergent intubation followed by tube thoracostomy placement, had necessary imaging and was transferred to the surgical intensive care unit (SICU).He was taken to the operating room for suspected viscus perforation, though none was found after extensively searching during an exploratory laparotomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ross University School of Medicine, Dominica, West Indies.

No MeSH data available.


Related in: MedlinePlus