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Sample records for chest trauma diagnosis

  1. Cardiac injuries in blunt chest trauma

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    Tobon-Gomez Catalina

    2009-09-01

    Full Text Available Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  2. Cardiac injuries in blunt chest trauma

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    Tobon-Gomez Catalina; Huguet Marina; Bijnens Bart H; Frangi Alejandro F; Petit Marius

    2009-01-01

    Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  3. Imaging of blunt chest trauma

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    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A. [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland). Dept. of Radiology

    2000-10-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  4. Treatment of 336 cases of chest trauma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; CHU Xiang-yang; LIU Yi; WANG Yun-xi

    2012-01-01

    Objective: To summarize the clinical features,diagnosis and treatment of chest trauma.Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011.Results:Out of all cases,325 were cured,accounting for 96.7%; 11 died,accounting for 3.3%.Among the dead cases,one died of hemorrhagic shock,three of acute respiratory distress syndrome,three of multiple organ failure,and four of severe multiple traumas.Conclusions:(1) For patients with severe chest trauma,early emergency treatment is crucial to save life.(2) Open thoracic surgery is needed for acute cardiac tamponade,intrapulmonary vascular injuries,progressive intrathoracic bleeding,lung laceration,tracheal breakage,and diaphragmatic injury.In addition,operative timing and method should be well chosen.(3) Pulmonary contusion is one of common complications in chest trauma,for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.

  5. Chest wall, lung, and pleural space trauma.

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    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  6. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

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    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  7. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  8. Chest Traumas due to Fall in Childhood

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    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim: Falls are the most common reason for childhood traumas. The aim of this study is to investigate the causes, types, monthly frequencies and results f injuries due to fall of children in our region and to recommend somep recautions for preventing these injuries. Material and Methods: A retrospective evaluation was performed in 47 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2009 with a diagnosis of chest trauma due to fall. For every patient, a pediatric trauma score (PTS was calculated. Descriptive statistics were performed for PTS and the duration of hospital stay. Results: The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas. Similarly, the length of hospital stay was also much longer in the cases with associated system injuries.Conclusions: Injuries occur mostly in summer season. It may be due to the fact that the children do not go to the school and usually spend their times outside in this period. The children and their parents should be educated about the prevention of these accidents. Additionally, the accident and injury rates may also be reduced by constructing safer games and sports grounds with robust infrastructure.

  9. Chest trauma in children: A local experience

    International Nuclear Information System (INIS)

    Chest trauma in childhood is relatively uncommon in clinical practice andhas been the subject of few reports in literature. This study was undertakento examine our experience in dealing with chest trauma in children. This wasa retrospective study of 74 children who sustained chest trauma and werereferred to King Fahd Hospital in Medina over a two-year period. The age,cause of injury, severity of injury, associated extrathoracic injuries,treatment and outcome were analyzed. The median age of patients was nineyears. Fifty-nine of them (80%) sustained blunt trauma in 62% of thechildren, gun shot wounds were seen in five and stab wounds in 10 children.Head injury was the most common injury associated with thoracic trauma andwas seen in 14 patients (19%) and associated intra-abdominal injuries wereseen in nine patients. Chest x-ray of the blunt trauma patients revealedfractured ribs in 24 children, pneumothorax in six, hemothorax in four,hemoneumothorax in three, and pulmonary contusions in 22 patients. Fifty onepercent of children were managed conservatively, 37% required tubethoracostomy, 8% were mechanically ventilated and 4% underwent thoractomy.The prevalence of chest trauma in children due to road traffic accidents ishigh in Saudi Arabia. Head injury is thought to be the most common associatedextrathoracic injuries, however, most of these patients can be managedconservatively. (author)

  10. Chest trauma in childhood. Radiological findings

    International Nuclear Information System (INIS)

    Blunt thoracic trauma is frequently associated with further injuries (head and/or blunt abdominal trauma). The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries. (orig./MG)

  11. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

  12. Cardiogenic shock following blunt chest trauma

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    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  13. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

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    Mojtaba Chardoli; Toktam Hasan-Ghaliaee; Hesam Akbari; Vafa Rahimi-Movaghar

    2013-01-01

    Objective:Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray (CXR) is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT) in hemodynamically stable patients with blunt chest trauma.Methods:Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results:Two hundreds patients (84% male and 16% female) were included with a mean age of(37.9±13.7) years.Rib fracture was the most common finding of CXR (12.5%) and CT scan (25.5%).The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion:Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

  14. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.)

  15. Chest Traumas due to Bicycle accident in Childhood

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    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim:Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Trauma is the second most common cause of mortality in children aged 1-4 years and leading cause of death in children older than 4 years. Thoracic injury is the second most leading cause of death in traumatized children. Multisystemic injury is found in more than 50% of children with thoracic injuries most of which are secondary to blunt traumas. We planned this study to evaluate thorax trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers.Material and Methods:  A retrospective evaluation was performed in 17 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2010 with a diagnosis of chest trauma due to bicycle driving. For every patient, a pediatric trauma score (PTS was calculated. Descriptive statistics were performed for PTS. Results; Eleven (64.70% cases were injured due to the tricycle accidents and six cases 6 (35.29% were injured due to the two-wheeled bicycle accidents. The most frequent thoracic pathologies included pulmonary contusion (41.2% and chest wall contusion (29.41%. Extrathoracic injuries were seen in 35.29%, the extremities (17.64% and abdomino pelvic (11.76% being the most commonly involved. Treatment consisted of symptomatic treatment in 12 patients (70.58%, tube thoracostomy in 2 patients (11.76%, and thoracotomy in 1 patient (5.9%. The morbidity was seen in 3 patients (17.64%. The mortality rate was 5.9% (n:1. The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas Conclusions: The pediatric thorax has a greater cartilage content and incomplete ossification of the ribs. Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic injury may exist in the

  16. Chest trauma in children: current imaging guidelines and techniques.

    LENUS (Irish Health Repository)

    Moore, Michael A

    2011-09-01

    Given the heterogeneous nature of pediatric chest trauma, the optimal imaging approach is tailored to the specific patient. Chest radiography remains the most important imaging modality for initial triage. The decision to perform a chest computed tomography scan should be based on the nature of the trauma, the child\\'s clinical condition, and the initial radiographic findings, taking the age-related pretest probabilities of serious injury into account. The principles of as low as reasonably achievable and Image Gently should be followed. The epidemiology and pathophysiology, imaging techniques, characteristic findings, and evidence-based algorithms for pediatric chest trauma are discussed.

  17. Severe Pulmonary Valve Regurgitation 40 Years After Blunt Chest Trauma.

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    Fuglsang, Simon; Heiberg, Johan; Hjortdal, Vibeke Elisabeth

    2015-10-01

    Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a blunt chest trauma. In this case report, we present a patient with pulmonary regurgitation originating from a chest trauma 40 years ago. Possible mechanisms are osseous pinch of the pulmonary valve between the anterior chest wall and the vertebral column, and retrograde blowout from severe compression of the lungs. PMID:26434447

  18. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

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    Omar, Hesham R.; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-01-01

    Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult ...

  19. The molecular fingerprint of lung inflammation after blunt chest trauma

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    Ehrnthaller, Christian; Flierl, Michael; Perl, Mario; Denk, Stephanie; Unnewehr, Heike; Ward, Peter A.; Radermacher, Peter; Ignatius, Anita; Gebhard, Florian; Chinnaiyan, Arul; Huber-Lang, Markus

    2015-01-01

    Background After severe blunt chest trauma, the development of an acute lung injury (ALI) is often associated with severe or even lethal complications. Especially in multiple injured patients after blunt chest trauma ALI/ARDS [acute respiratory distress syndrome (ARDS)] is frequent. However, in the initial posttraumatic phase, inflammatory clinical signs are often not apparent and underlying changes in gene-expression profile are unknown. Methods Therefore, inflammation in lung tissue followi...

  20. Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report

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    Fagkrezos Dimitris

    2012-10-01

    Full Text Available Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.

  1. Chest trauma: A case for single lung ventilation

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    Nagaraj Pandharikar

    2016-01-01

    Full Text Available Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

  2. Pectus excavatum in blunt chest trauma: a case report

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    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  3. [Diagnostic value of the procalcitonine test in purulent-septic complications of chest traumas].

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    Vadachkoriia, V K; Gogishvili, Sh G; Shapatava, K K

    2007-04-01

    The aim of the present work was to assess the value of the semi-quantitative procalcitonine test (PCT) in diagnosis of purulent-septic complications of chest traumas, efficacy of the therapy carried out, and outcome prognosis. For this, 71 patients with chest traumas were enrolled in the study. Concentrations of PCT were assessed in dynamics using an immunochromatographic, semi-quantitative quick test. Semi-quantitative quick PCT test is highly sensitive diagnostic marker that can be used for the assessment of a chest trauma, infectious-septic complication severity, and efficiency of the therapy indicated. Thus, it can be successfully used for monitoring trauma therapy. PCT sensitivity during first 12 hrs of infectious-septic complication development is 2-3-times higher than that of routine methods for laboratory diagnostics, and even more sensitive that IL-6 and CRT, when we are dealing with combined chest traumas. PCT concentration increase is 4-times more frequent in gram-positive bacterial processes than in gram-negative ones. This has to be taken into account, when appropriate antibacterial treatment is selected for restricted infectious-septic complications. PMID:17525495

  4. Imaging of blunt chest trauma; Bildgebung des stumpfen Thoraxtraumas

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    Prosch, H. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Negrin, L. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Unfallchirurgie, Wien (Austria)

    2014-09-15

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [German] Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditaet und Mortalitaet einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden koennen. Zur Abklaerung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenroentgen und die Computertomographie bewaehrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklaert werden, ob bei dem Patienten ein therapiebeduerftiger Pneumothorax, Haematoperikard oder Haematothorax vorliegen. Auch das Lungenroentgen wird zur Diagnose eines Pneumothorax oder Haematothorax eingesetzt, wenngleich seine Sensitivitaet deutlich eingeschraenkt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaeren. (orig.)

  5. Prevalence of Radiologic Findings in Patients with Blunt Chest Trauma in Isfahan

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    M. Haghighi

    2008-01-01

    Full Text Available Background/Objective: Chest trauma due to its vital organs can be very dangerous and lethal. Our country has the first grade of accidents in the word, so rapid diagnosis and treatment in patients with chest trauma is necessary. One cost benefit and available imaging modality in each Region of our country is X-ray."nCXR interpretation needs to knowledge about prevalence of abnormal Radiologic findings and their accuracy. Therefore, it is necessary to perform a study about the rate of CXR abnormal findings in patients with blunt chest trauma."nPatients and Methods: In this descriptive and prospective study, CXR of patients with blunt chest trauma that admitted in Alzahra and Kashani hospitals studied and percent of vital radiologic findings prevalence determined."nResults: The final results were as below:"n1- Rib FX (18.5% (143, 2- Hemothorax (13.6% (105, 3- Pneumothorax (11.8% (91, 4- Sub cutaneous emphysema (10.2% (79, 5- Lung laceration (8.1% (63, 6- Mediastinal winding (6.4% (50, 7- Clavicular and sternal FX (5.8% (44, 8- Pneumo mediastinum (4.1% (32, 9- spinal FX (3.5% (27, 10- Great vessels injury signs (1.4% (11."nConclusion: According to above results, accurate investigation of CXR, helps physician and radiologist to find any threatened finding, so determination of next step as clinical follow up or spiral CT, angiography or surgery; accordingly.

  6. Acute aortic and mitral valve regurgitation following blunt chest trauma.

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    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  7. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

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    Yusuke Yamaoka

    2014-01-01

    Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

  8. [The use of a method of sequential mathematical analysis for the differential diagnosis of trauma from a fall from a height and of trauma due to the collision of a moving automobile with a pedestrian by the chest injuries].

    Science.gov (United States)

    Solokhin, A A; Gaĭvoronskaia, V I; Baranov, Iu I

    1997-01-01

    Fifty cadavers of subjects dead after falling from height and 50 cadavers of subjects dead as a result of collisions between moving cars and pedestrians were examined. Under study were injuries to soft tissues of the chest, thoracic bones and viscera, and combinations thereof. Mathematical probability successive analysis after Gubler (1978) helped distinguish 64 highly informative injuries-signs which permit determining the type of injury. Diagnostic coefficients and informative value of these signs are presented in the differential diagnostic table.

  9. Profile of chest trauma in Zaria Nigeria: A prelminary report

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    S A Edaigbini

    2011-01-01

    Materials and Methods A prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department. Results A total of 4784 patients (3143 men and 1641 women were admitted during this period for trauma. There were a total of 628(13.13% deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3% were males and 7(16.7% were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s (23.8%, hemopneumothorax (14.3%, hemothorax (7.1%, pneumothorax (4.8%, combinations of chest injuries (7.1%, chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%. Associated injuries included head injury (63.6%, orthopaedic injury (27.3% and combinations (abdominal, head, orthopaedic (9.1%. The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had pre-hospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4% required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general

  10. Emergency department evaluation and management of blunt chest and lung trauma (Trauma CME).

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    Morley, Eric J; Johnson, Scott; Leibner, Evan; Shahid, Jawad

    2016-06-01

    The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung. Utilization of decision rules for chest x-ray and computed tomography are discussed, along with the emerging role of bedside lung ultrasonography. Management controversies presented include the limitations of needle thoracostomy us¬ing standard needle, chest tube placement, and chest tube size. Finally, a discussion is provided related to airway and ventilation management to assist in the timing and type of interventions needed to maintain oxygenation. PMID:27177417

  11. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

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    Fogarassy Peter; Maunz Martin; Beck Torsten; Baccouche Hannibal; Beyer Martin

    2009-01-01

    Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior i...

  12. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    International Nuclear Information System (INIS)

    A 31/2-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  13. Pediatric chest CT after trauma: impact on surgical and clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rina P. [Vanderbilt University School of Medicine, Nashville, TN (United States); Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Vanderbilt Children' s Hospital, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States); Ray, Jackie [Vanderbilt University, Department of Pediatric Surgery, Vanderbilt Children' s Hospital, Nashville, TN (United States)

    2010-07-15

    Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

  14. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study

    International Nuclear Information System (INIS)

    Blunt thoracic injuries detected by computed tomography of the chest infrequently require immediate therapy. If immediate therapy is needed, findings will be visible on plain roentgenograms or on clinical exam. Routine Computed Tomography of the chest in blunt trauma is not recommended but may be helpful in selected cases. (N.C.)

  15. [Isolated left ventricular--right atrial shunt after blunt chest trauma (author's transl)].

    Science.gov (United States)

    Kreuzer, E; Beyer, J

    1978-12-01

    A case of left-ventricular-right-atrial septal defect secundary to blunt chest trauma is described. The etiology of this type of septal defect, e. g. congenital, following aortic and mitral valve replacement, endocarditis and trauma, is discussed. Early defect closure is recommended in the presence of significant shunt volume. PMID:751280

  16. Effect of seawater immersion on plasma osmotic pressure and electrolyte balance following open chest trauma

    Institute of Scientific and Technical Information of China (English)

    李辉; 鹿尔驯; 虞积耀; 王大鹏; 马聪

    2002-01-01

    To explore the effect of seawater immersion on serum osmotic pressure and electrolytes balance following chest trauma in dogs. Methods: Twenty-five healthy adult dogs were used in the experiment. A canine model of right open pneumothorax was established by chest puncturing on all animals. Animals were divided into three groups: a control group (n = 10) with chest trauma without any immersion;a seawater group ( n = 10) immersed in seawater after chest trauma and a normal saline group ( n = 5 ) immersed in normal saline solution following chest trauma. Blood samples were taken at different time intervals to determine plasma osmotic pressure and electrolytes. The hemodynamic changes were also recorded. Results: Mortality in the seawater group was much higher than that of the control group and the normal saline group. The mean survival time in the seawater group lasted only 45 minutes, while in the control group and the normal saline group the average survival time was more than 4 hours (P < 0.01 ). One of the most important causes of death was hypernatremia and high osmolality. Severe electrolytes imbalance was observed in seawater group.Hypernatremia and high osmolality were the most significant factors of high mortality in the seawater group. Conclusions: Seawater immersion after chest trauma appears to be associated with severe electrolyte imbalance as well as high osmotic pressure, These may be the risk factors leading to fatal outcome.

  17. Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

    OpenAIRE

    Battle, Ceri Elisabeth; Hutchings, Hayley; Lovett, Simon; Bouamra, Omar; Jones, Sally; Sen, Aruni; Gagg, James; Robinson, David; Hartford-Beynon, Jake; Williams, Jeremy; Evans, Adrian

    2014-01-01

    Introduction Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods There were two distinct phases to the overall study; the development and the v...

  18. Imaging manifestations and the related clinical characteristics of chest trauma during the Yushu Earthquake

    Institute of Scientific and Technical Information of China (English)

    Zhang Zhijin; Tang Guibo; He Xiaofen; Zhang Ming; Wu Dangjie; Geng Gasongbao

    2013-01-01

    The purpose of this study was focused on the imaging features of the chest trauma and its relation to clinical characteristics.All the injured patients were from the Yushu Earthquake areas on days April 14-23,2010.After an initial treatment,the injurers were rapidly transported from Yushu at an altitude of 4000 m via air to Xining at 2260 m within 6~8 h,and promptly admitted to Qinghai Provincial People' s Hospital.A total of 130 wounded injurers who had high suspicion of chest injuries all had examinations of Chest X-ray and computed tomography (CT) images.Of them 63 injurers presented at least one of the features of the chest trauma in imaging with a positive rate of 48.5 %.Of these,37 cases (28.5 %) were multi-system with multiple injuries,33 cases (25.4 %) were chest trauma with multi-injury types,which included thoracic fractures in 54 cases (85.7 %),pleural injury in 56 cases (88.9 %),lung injury in 54 cases (85.7 %),lungs complications in 37 cases (58.7 %),and extrapulmonary complications of 35 cases (55.6 %).The radiological data were analyzed retrospectively.The features of chest trauma in Yushu Earthquake,the complications of chest injuries,and the relation between imaging findings and clinical manifestations,as well as the differences of chest trauma between Yushu Earthquake and Wenchuan Earthquake were discussed in detail.

  19. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    Science.gov (United States)

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

  20. Diagnosis and treatment of pancreatic trauma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Sen-huang; WANG San-ming; LI Jian-wen

    2005-01-01

    Objective: To improve diagnosis and therapeutic efficacy for pancreatic trauma. Methods: We retrospectively analyzed 71 cases of pancreatic injuries received in our department from 1987 to 2004. Different surgical procedures were performed according to different patterns of pancreatic injuries. Among them, 31 cases were defined as Grade I or II injury according to the pancreatic organ injury score developed by American Association for the Surgery of Trauma and were performed pancreas debridement and drainage; 26 cases belonged to Grade III injury and were performed distal pancreatectomy plus external drainage; 10 cases of Grade IV injury in whom 8 were performed distal Roux-en-Y pancreaticojejunostomy and 2 were performed Whipple operation; 4 cases of Grade V injury in whom 1 was performed restoration of duodenal damage, suture of proximal pancreatic laceration and distal Roux-en-Y pancreaticojejunostomy, and 3 were performed Whipple operation. Results: Sixty-six cases were cured, of whom 14 had postoperative complications, and 5 cases died. The causes of death were of pancreatic fistula in 2 cases, upper gastrointestinal bleeding in 1 case, ARDS in 1 case, and serious abdominal infection in 1 case. Conclusions: Preoperative diagnosis for pancreatic trauma is rather challenging. Prompt explorative laparotomy is still a reliable diagnostic method for pancreatic trauma. In order to improve curative rate, different surgical procedures should be undertaken according to different sites and grades of pancreatic traumas.

  1. Developing risk factors for post traumatic empyema in patients with chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mara del Pilar Quiroga; Jos Daniel Charry; Nicols Becerra; Juan Camilo Garcia; Eliana Karina Muoz; Rodrigo Lara

    2015-01-01

    Objective:To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68%(17) and 84%coagulated hemothorax trauma. Empyema management thoracoscopy was in 100%of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

  2. Clinical rescue of severe craniocerebral trauma with severe chest trauma%重型颅脑损伤合并严重胸损伤的临床救治

    Institute of Scientific and Technical Information of China (English)

    朱志清; 张武容; 茆仁胜; 徐胜宏; 蒋国荣

    2009-01-01

    目的 探讨重型颅脑损伤合并严重胸损伤的诊断和治疗.方法 对32例重型颅脑损伤合并严重胸损伤的临床资料进行分析.结果 GOS预后评分:恢复良好14例,中残9例,重残3例,植物生存2例,死亡4例.结论 重型颅脑损伤合并严重胸损伤其伤情复杂而严重,伤残率和病死率较高.全面详细的检查、正确的诊断和及时有效的治疗和处理,弄清颅脑损伤和胸部损伤的关系,积极防治成人呼吸窘迫综合征(ARDS)及肺部感染等并发症,是提高抢救成功率的关键.%Objective To investigate the diagnosis and treatment of severe craniocerebral trauma with severe chest trauma. Methods The clinical data of 32 cases of severe craniocerebral trauma with severe chest trauma were analysed.Results According to GOS :good recovery 14 cases;residues 9 cases;severely disabled 3 cases;plant survival 2 cases;death 4 cases.Conclusion The severe craniocerebral trauma with severe chest trauma is a complex and serious injury and the disability and mortality rates is high. Making a full review in the diagnosis and treatment, correctly handling the relationship of craniocerebral trauma and chest trauma, controling ARDS and complications such as pulmonary infection was required in the process and the success rate of rescue could be improved.

  3. Chest radiograph usefulness in the diagnosis of acute aortic dissection

    Institute of Scientific and Technical Information of China (English)

    Nancy Welch; Chat Dang; Carlton Allen; Robert Cook

    2005-01-01

    Objective To assess the diagnostic value of chest radiographs in patients presenting to a busy inner-city Emergency Department with subsequently proven acute aortic dissection. Methods A retrospective review of initial chest radiographs and charts of patients with the confirmed diagnosis of acute aortic dissection was done for a period of 5 years from 1998 to 2003. A comparison was made between the initial readings of chest radiographs prior to confirmation of the aortic dissection, and a retrospective review of the same radiographs by two board-certified radiologists with special attention to the classic findings of acute aortic dissection identifiable on plain films. Results The charts of nine patients (four men, five women) with proven acute aortic dissection were reviewed. All nine patients were suspected of having acute aortic dissection based on presenting history and symptoms of chest pain (66% ), migratory pain (89% ), back pain (89% ), and the abruptness of onset of pain (89% ). Initial plain portable chest X-rays were obtained in the Emergency Department in all nine patients. Six of nine (67%) radiographs were read as normal, while three (33%) demonstrated a widened mediastinum (> 8.0cm), two (22%) showed an abnormal aortic contour, with one ( 11% ) displaying an apical cap. Confirmation of the diagnosis was obtained with either a spiral CT angiogram or transesophageal echocardiography (TEE). All nine plain radiographs were retrospectively reviewed by two board-certified radiologists aware of the diagnosis of acute dissection without a change in the readings. Conclusions Plain portable chest radiographs are of limited usefulness for the screening of acute aortic dissection. Further radiologic evaluation should be dictated by the clinical presentation and an awareness of the low sensitivity of portable chest X- rays.

  4. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients

    OpenAIRE

    Becker Brian; Ney Arthur L; Palmer Cassandra A; Anderson Casandra A; Schaffel Steven D; Quickel Robert R

    2008-01-01

    Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequent...

  5. Psychological trauma of funnel chest in adolescents and the appropriate age for minimally invasive surgery repair

    Institute of Scientific and Technical Information of China (English)

    ZHAO Jing; LUO Li; XIAO Li-jun; GU Ling-yun; SUN Tian-sheng

    2013-01-01

    Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior.This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health.We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery.Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest.The funnel chest index,the Symptom Checklist-90,and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients.A sample of 234adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing.Age groups were adopted as an independent variable,and other factors in funnel chest patients were dependent variables.Results There was a significant difference in the relapse rate for funnel chest in the different age groups (x2=11.883,P=0.008).There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old.There was a significant difference in the SCL-90 total score in the different age groups (F=12.538,P=0.0001),the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90.There was a significant difference in the standard score of E (introversion/extraversion) in the different age groups (F=10.06,P=0.0001).There was also a significance in the funnel chest index before surgery in the different psychological scales (P<0.01),with a higher funnel chest index score associated with more obvious psychological trauma.Age and the number of variables,including the relapse rate,SCL-90 score,standard score of E,and standard score of N in the EPQ were significantly

  6. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    Directory of Open Access Journals (Sweden)

    Fogarassy Peter

    2009-10-01

    Full Text Available Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.

  7. Computer-aided diagnosis in chest radiography: Beyond nodules

    Energy Technology Data Exchange (ETDEWEB)

    Ginneken, Bram van [University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)], E-mail: bram@isi.uu.nl; Hogeweg, Laurens; Prokop, Mathias [University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    2009-11-15

    Chest radiographs are the most common exam in radiology. They are essential for the management of various diseases associated with high mortality and morbidity and display a wide range of findings, many of them subtle. In this survey we identify a number of areas beyond pulmonary nodules that could benefit from computer-aided detection and diagnosis (CAD) in chest radiography. These include interstitial infiltrates, catheter tip detection, size measurements, detection of pneumothorax and detection and quantification of emphysema. Recent work in these areas is surveyed, but we conclude that the amount of research devoted to these topics is modest. Reasons for the slow pace of CAD development in chest radiography beyond nodules are discussed.

  8. [Blunt chest trauma with total rupture of the right main stem bronchus--a case report].

    Science.gov (United States)

    Moerer, O; Heuer, J; Benken, I; Roessler, M; Klockgether-Radke, A

    2004-01-01

    Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. Early surgical treatment is mandatory to prevent major pulmonary resection. This case shows that computer tomography might fail to provide the right diagnosis. Independent lung ventilation is an option to protect the bronchial anastomosis during the early postoperative period. Reported here is the case of a young man who sustained a total traumatic rupture of the right main stem bronchus after being thrown from the passenger seat through the windshield of a motor vehicle. When the emergency doctor arrived on the scene, he found the patient with dyspnoea and massive thoracic subcutaneous emphysema. Reduced breath sounds on the left and no breath sounds on the right side led to an immediate placement of two chest tubes and controlled mechanical ventilation. After primary care in a district hospital, the patient was transferred to our university hospital for further treatment of his head injury. On admission, the patient was making breath sounds on both sides and a CT scan showed no clear sign of a tracheo-bronchial lesion. After neurosurgical intervention, the diagnosis of a rupture of the right main stem bronchus was made with delay by fibre-optic bronchoscopy. The patient was intubated with a left-sided double lumen endotracheal tube followed by surgical end-to-end anastomosis of the lesion. The initial postoperative ventilator support consisted of BIPAP-mode ventilation of the left lung, while the right lung was kept open with positive airway pressure. Forty-eight hours later, synchronised independent lung ventilation with two ventilators was

  9. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  10. Diagnosis of chest pain with foregut symptoms in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    Bo Deng; Ru-Wen Wang; Yao-Guang Jiang; Qun-You Tan; Xiang-Li Liao; Jing-Hai Zhou; Yun-Ping Zhao; Tai-Qian Gong; Zheng Ma

    2009-01-01

    AIM: To evaluate the diagnosis of chest pain with foregut symptoms in Chinese patients. METHODS: Esophageal manomet r ic studies, 24-h introesophageal pH monitoring and 24-h electrocardiograms (Holter electrocardiography) were performed in 61 patients with chest pain. RESULTS: Thirty-nine patients were diagnosed with non-specific esophageal motility disorders (29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia). Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux (two patients had concomitant myocardial ischemia), and one patient was diagnosed with nutcracker esophagus. CONCLUSION: The esophageal manometric studies, 24-h intra-esophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain, particularly in patients with foregut symptoms. In cases of esophageal motility disorders, pathological gastroesophageal reflux may be a major cause of chest pain with non-specific esophageal motility disorders. Spasm of the esophageal smooth muscle might affect the heart-coronary smooth muscle, leading to myocardial ischemia.

  11. Most frequent causes, complications and differential diagnosis of neonatal respiratory distress in chest X-ray

    Energy Technology Data Exchange (ETDEWEB)

    Ponhold, W. (Vienna Univ. (Austria). Kinderklinik)

    1982-01-01

    The radiologic changes of the chest X-ray of 270 newborns with respiratory distress were analyzed. In cases of Hyaline Membranes the chest X-Ray showed finely granular evenly disseminated structures combined with signs of hypoventilation. Localized, patchy, streaky, homogenous and reticulonodular shadows were found in cases of pneumonia and hemorrhage. Hyperinflation were an additional sign for an inflammatory disease. This symptom was also demonstrated in pulmonary bleeding, but was less common. The bilateral interstitial augmentation of the pulmonary structure in combination with cardiomegaly was mainly a symptom for cardial insufficiency and transient tachypnea. The differentiation between fine granular and reticulo-nodular structures should create no problem if the chest X-ray is of good quality. Extrapulmonary air collections were found in a high percentage in the course of artificial ventilation as a consequence of the 'baro-trauma'. The radiologic diagnosis of BPD was no problem. The value of the chest X-ray lies in the demonstration of a pulmonary cause for the respiratory distress, in the demonstration of complications and in the radiological observation of the disease.

  12. Our Experiences with Chest Trauma Patients in Syrian Civil War

    Directory of Open Access Journals (Sweden)

    Samil Gunay

    2014-03-01

    Full Text Available Aim: Thoracic surgery is a branch, the efficiency of which is unquestionable for war. And during the civil war in Syria, thoracic surgery specialists have been feeling this efficiency so closely. So we want to share our experiences on patients sent from this region. Material and Method: The cases comprised of 41 patients in total, 33 men and 8 women, between the ages of 16-75, who were brought from Syria between the dates of August 2012 %u2013 November 2013. The files of the patients were received from archive. Results: Except 11 isolated thorax trauma patients, it was determined thorax and abdomen injuries at 9 patients (21.9%, thorax and extremity injuries at 8 patients (19.5%, thorax and vertebra injuries at 3 patients (7.3%, thorax, abdomen and cranium injuries at 5 patients (12.1%, thorax, abdomen and eye injuries at one patient (2.4%, thorax, abdomen and vertebra injuries at 3 patients (7.3%, thorax, abdomen and extremity injuries at one patient (2.4%. Discussion: Thoracic surgery is a lifesaving branch in case of fast and effectual medical intervention to injuries during war.

  13. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery.

    Science.gov (United States)

    Unsworth, Annalise; Curtis, Kate; Asha, Stephen Edward

    2015-01-01

    Blunt chest trauma is associated with a high risk of morbidity and mortality. Complications in blunt chest trauma develop secondary to rib fractures as a consequence of pain and inadequate ventilation. This literature review aimed to examine clinical interventions in rib fractures and their impact on patient and hospital outcomes. A systematic search strategy, using a structured clinical question and defined search terms, was performed in MEDLINE, EMBASE, CINAHL and the Cochrane Library. The search was limited to studies of adult humans from 1990-March 2014 and yielded 977 articles, which were screened against inclusion/exclusion criteria. A hand search was then performed of the articles that met the eligibility criteria, 40 articles were included in this review. Each article was assessed using a quantitative critiquing guideline. From these articles, interventions were categorised into four main groups: analgesia, surgical fixation, clinical protocols and other interventions. Surgical fixation was effective in patients with flail chest at improving patient outcomes. Epidural analgesia, compared to both patient controlled analgesia and intravenous narcotics in patients with three or more rib fractures improved both hospital and patient outcomes, including pain relief and pulmonary function. Clinical pathways improve outcomes in patients ≥ 65 with rib fractures. The majority of reviewed papers recommended a multi-disciplinary approach including allied health (chest physiotherapy and nutritionist input), nursing, medical (analgesic review) and surgical intervention (stabilisation of flail chest). However there was a paucity of evidence describing methods to implement and evaluate such multidisciplinary interventions. Isolated interventions can be effective in improving patient and health service outcomes for patients with blunt chest injuries, however the literature recommends implementing strategies such as clinical pathways to improve the care and outcomes of

  14. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100 % O2

    OpenAIRE

    Wagner, Katja; Gröger, Michael; McCook, Oscar; Scheuerle, Angelika; Asfar, Pierre; Stahl, Bettina; Huber-Lang, Markus; Ignatius, Anita; Jung, Birgit; Duechs, Matthias; Möller, Peter; Georgieff, Michael; Calzia, Enrico; Radermacher, Peter; Wagner, Florian

    2015-01-01

    Cigarette smoking (CS) aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1) CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2) hyperox...

  15. Chest Pain: The Need to Consider Less Frequent Diagnosis

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães

    2016-01-01

    Full Text Available Chest pain is one of the most frequent patient’s complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.

  16. Chest Pain: The Need to Consider Less Frequent Diagnosis

    Science.gov (United States)

    Morais, Anabela; Carvalho, Sofia; Cunha, Joana; Lima, Ana R.; Moreira, J. Ilídio; Faria, Trigo

    2016-01-01

    Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries. PMID:27034853

  17. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT.

    Directory of Open Access Journals (Sweden)

    Robert M Rodriguez

    2015-10-01

    Full Text Available Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs for selective chest computed tomography (CT in adult blunt trauma patients.From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity. In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1 abnormal chest X-ray, (2 rapid deceleration mechanism, (3 distracting injury, (4 chest wall tenderness, (5 sternal tenderness, (6 thoracic spine tenderness, and (7 scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%, a specificity of 20.8% (95% CI 19.2%-22.4%, and a negative predictive value (NPV of 99.8% (95% CI 98.9%-100% for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%, a specificity of 25.5% (95% CI 23.5%-27.5%, and a NPV of 93.9% (95% CI 91.5%-95.8% for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%, a specificity of

  18. Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma

    International Nuclear Information System (INIS)

    Detection of pulmonary contusion in patients with blunt chest trauma is very important so as to commence therapy immediately to avoid irreversible damage. The purpose of our study was to evaluate the efficacy of technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) aerosol inhalation lung scintigraphy in comparison with chest computed tomography (CT) in the diagnosis of pulmonary contusion at acute blunt chest trauma. Twenty-nine patients with isolated blunt chest trauma were referred to the emergency department of our hospital, and nine healthy people participated in this study. Sixteen patients who had pulmonary contusion on CT scans were referred to as group 1, and 13 patients who had normal CT scans as group 2. Nine healthy people comprised a control group. 99mTc-DTPA aerosol inhalation lung scintigraphy was performed on the first day in all patients. The mean half time (T1/2) and penetration index values of 99mTc-DTPA clearance were significantly lower in groups 1 and 2 compared with the control group. Among the three groups, there were no significant differences in arterial blood gas analysis except for PO2. The mean T1/2 value of 99mTc-DTPA clearance did correlate with PO2 values but not with pH, PCO2, or HCO3 values. 99mTc-DTPA radioaerosol inhalation lung imaging may serve as a useful adjunct and supportive method to chest CT scanning for detecting mild pulmonary contusion. (author)

  19. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO therapy in blunt thoracic trauma patients

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    Becker Brian

    2008-10-01

    Full Text Available Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN, was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN. The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit. Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

  20. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

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    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  1. Efficacy of aprotinin treatment on bilateral blunt chest trauma created in rabbits

    International Nuclear Information System (INIS)

    Objectives: To investigate the effects of aprotinin, on blood gasses, oxidant-antioxidant status, and lung histopathology in an experimental bilateral blunt chest trauma model. Methods: Conducted at the Experimental Animal Laboratory of Meram Medical School at Selcuk University, Konya, Turkey, the study comprised 21 New Zealand female albino rabbits who were divided into three groups. Trauma was applied on the sham and aprotinin groups, which was administered intravenous Aprotinin 20.000 U/kg. Arterial blood samples were obtained from all rabbits at hours 0, 3, 24, and 96. At hour 96 after trauma, all rabbits were sacrificed using the decapitation method, and then blood and lung tissue samples were obtained. Blood nitric oxide, malondialdehyde and blood gas measurements were made. Histopathological changes in the lung were examined with a light microscope. Results: While no positive effect of aprotinin was observed on nitric oxide malondialdehyde and partial pressure of carbon dioxide values, it was seen to have an increasing effect on partial oxygen pressure level. Aprotinin had a partial effect on lung histopathology. Conclusion: Aprotinin was determined to have a positive effect on PO/sub 2/ levels. We could not find any positive effects especially on alveolar haemorrhage. (author)

  2. Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility

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    G. Kaguthi

    2014-01-01

    Full Text Available The chest radiograph (CXR is considered a key diagnostic tool for pediatric tuberculosis (TB in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts, a medical officer (M.O, and four clinical officers (C.Os with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n=8. A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k=0.14 (95% CI: 0.10–0.18 and on lymphadenopathy moderate k=0.26 (95% CI: 0.18–0.36. M.O [75% (95% CI: 34.9%–96.8%] and C.Os [63% (95% CI: 24.5%–91.5%] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.

  3. CT evaluation of pulmonary parenchymal injury due to blunt chest trauma and its clinical significance

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    Niimi, Hiroshi (St. Marianna University School of Medicine, Kawasaki, Kanagawa (Japan))

    1990-10-01

    The CT findings of pulmonary parenchymal injury due to blunt chest trauma in 73 patients and their clinical significance were analyzed. CT was obtained within 6 hours after trauma. Findings were analyzed according to the number of injured segments and severity which was classified into three grades. A correlation was also made with arterial blood PaO{sub 2} and thoracic complications. Pulmonary parenchymal injury was identified in multisegmental portions bilaterally in most cases. It was most frequently observed in the posterior portion of the lung such as segment 6. More than 50% of lesions were classified as Grade 1. Pulmonary laceration, defined as patchy density with the cavitary lesion (Grade 3), was noted in 9.2%. There was a good correlation between extent of pulmonary injury and degree of hypoxia. The correlation of pneumothorax was also found with extensive lesion and frequency of Grade 3 lesion. Cases with pulmonary laceration tend to have extensive injury, and be related to the degree of hypoxia. In conclusion, CT evaluation of pulmonary parenchymal injury is valuable not only for morphological evaluation but also for estimation of hypoxia. (author).

  4. Splenic injury diagnosis & splenic salvage after trauma

    NARCIS (Netherlands)

    D.C. Olthof

    2014-01-01

    Non-operative management (NOM) has replaced surgery as the treatment of choice for hemodynamically stable patients with splenic injury after trauma. The growing use of NOM for blunt abdominal organ injury has been made possible by the progress in the quality and availability of the multidetector CT

  5. Evidence-based diagnosis of abdominal trauma; Evidenzbasierte Diagnostik des abdominellen Traumas

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    Schueller, G. [Medizinische Universitaet Wien, Univ.-Klinik fuer Radiodiagnostik, Wien (Austria)

    2008-05-15

    Abdominal trauma is a common cause of death particularly in patients up to 40 years of age. In order to reduce mortality a rapid radiologic diagnosis is essential. At present, sonography plays a role only in the evaluation of minor trauma and as a 'focused assessment with sonography for trauma' (FAST) to clarify free intraperitoneal fluid immediately on admittance in severely injured patients. However, computed tomography has proven to be a potent tool for the triage of patients with abdominal trauma, because, based on the results of the CT scan, patients can be referred for laparotomy or safely classified for 'wait and see' treatment. Therapeutic decisions are largely based on injury severity scores and the radiologist must be familiar with them as well as with the associated therapeutic consequences. (orig.) [German] Das Trauma des Abdomens ist insbesondere bei Patienten unter 40 Jahren eine haeufige Todesursache. Die rasche Erstellung aussagekraeftiger radiologischer Befunde ist unerlaesslich, um die Mortalitaet zu senken. Die Sonographie wird heute nur mehr bei Bagatelltraumen und als 'focused assessment with sonography for trauma' (FAST) zur Abklaerung freier intraperitonealer Fluessigkeit unmittelbar nach dem Eintreffen schwer verletzter Patienten verwendet. Hingegen hat die Radiologie mit der Multidetektorcomputertomographie (MDCT) ein geeignetes Instrument zur Verfuegung, um seine Rolle fuer die Triage zur operativen oder konservativen Behandlung von Patienten nach Trauma des Abdomens erfuellen zu koennen. Die therapeutischen Entscheidungen werden wesentlich von Verletzungsscores bestimmt, mit denen der Radiologe zusammen mit den sich daraus ergebenden Konsequenzen vertraut sein muss. (orig.)

  6. A blunt chest trauma causing left anterior descending artery dissection and acute myocardial infarction treated by deferred angioplasty

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    Rafid Fayadh Al-Aqeedi

    2011-01-01

    Full Text Available Traumatic coronary artery dissection is an uncommon cause of acute myocardial infarction (AMI. We report a case of blunt chest trauma resulting from a motorcycle collision causing ostial dissection of the left anterior descending (LAD artery in a 31-year-old previously healthy male. The patient also suffered from compound comminuted fractures of the humerus and ulna and severe liver laceration, which hampered both percutaneous and surgical acute revasularization. After a stormy hospital course, a bare metal stent was implanted to seal the LAD artery dissection. The patient was discharged in a stable condition and was followed-up for rehabilitation. This case report underscores the multidisciplinary approach in facing challenges encountered after rare sequelae of chest trauma.

  7. Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

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    Oshaug K

    2013-07-01

    Full Text Available Katja Oshaug, Peder A Halvorsen, Hasse Melbye General Practice Research Unit, University of Tromsø, Tromsø, Norway Background: Although proven to be associated with bronchial obstruction, chest signs are not listed among cues that should prompt spirometry in the early diagnosis of chronic obstructive pulmonary disease (COPD in established guidelines. Aims: We aimed to explore how chest findings add to respiratory symptoms and a history of smoking in the diagnosis of COPD. Methods: In a cross-sectional study, patients aged 40 years or older, previously diagnosed with either asthma or COPD in primary care, answered questionnaires and underwent physical chest examination and spirometry. Results: Among the 375 patients included, 39.7% had forced expiratory volume in 1 second/forced vital capacity <0.7. Hyperresonance to percussion was the strongest predictor of COPD, with a sensitivity of 20.8, a specificity of 97.8, and likelihood ratio of 9.5. In multivariate logistic regression, where pack-years, shortness of breath, and chest findings were among the explanatory variables, three physical chest findings were independent predictors of COPD. Hyperresonance to percussion yielded the highest odds ratio (OR = 6.7, followed by diminished breath sounds (OR = 5.0, and thirdly wheezes (OR = 2.3. These three chest signs also gave significant diagnostic information when added to shortness of breath and pack-years in receiver operating-characteristic curve analysis. Conclusion: We found that chest signs may add to respiratory symptoms and a history of smoking in the diagnosis of COPD, and we conclude that chest signs should be reinstated as cues to early diagnosis of COPD in patients 40 years or older. Keywords: diagnosis, COPD, physical chest examination, spirometry

  8. Detection of alveolar epithelial injury by 99mTc-DTPA radioaerosol inhalation lung scan following blunt chest trauma

    International Nuclear Information System (INIS)

    DTPA clearance rate is a reliable index of alveolar epithelial permeability, and is a highly sensitive marker of pulmonary epithelial damage, even of mild degree. In this study, 99mTc-DTPA aerosol inhalation scintigraphy was used to assess the pulmonary epithelial membrane permeability and to investigate the possible application of this permeability value as an indicator of early alveolar or interstitial changes in patients with blunt chest trauma. A total of 26 patients was chest trauma (4 female, 22 male, 31-80 yrs, mean age; 53±13 yrs) who were referred to the emergency department in our hospital participated in this study. Technetium-99m diethylene triamine pentaacetic acid (DTPA) aerosol inhalation scintigraphy was performed on the first and thirtieth days after trauma. Clearance half times (T1/2) were calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was calculated on the first-minute image. On the first day, mean T1/2 value of the whole lung was 63±19 minutes (min), and thirtieth day mean T1/2 value was 67±21 min. On the first day, mean PI values of the lung and 30th day mean PI value were 0.60±0.05, and 0.63 ±0.05, respectively. Significant changes were observed in radioaerosol clearance and penetration indices. Following chest trauma, clearance of 99mTc-DTPA increased owing to breakdown of the alveolar-capillary barrier. This increase in the epithelial permeability of the lung appears to be an early manifestation of lung disease that may lead to efficient therapy in the early phase. (author)

  9. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

    OpenAIRE

    Orkun Özkurtul; Andreas Höch; Andreas Reske; Carsten Hädrich; Christoph Josten; Jörg Böhme

    2015-01-01

    Introduction: Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment. Presentation of case: Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed...

  10. The diagnosis of pneumonia requires a chest radiograph (x-ray – yes, no or sometimes?

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    Dan Gower Wootton

    2014-06-01

    Full Text Available Community-acquired pneumonia (CAP remains a common condition associated with considerable morbidity and mortality. Outcome is improved by early recognition and rapid institution of empirical antibiotic therapy. A number of international guidelines recommend a chest radiograph (x-ray is obtained when pneumonia is suspected; the argument forwarded is that chest radiographs are relatively inexpensive and enable pneumonia (lung consolidation to be confirmed or excluded. But, radiographs are not available in the community setting and introduce a delay in diagnosis and treatment. For these reasons, in mild CAP treated by primary care, guidelines suggest criteria for clinical diagnosis. However, there is debate as to whether clinical features alone are sufficiently reliable to support a diagnosis of CAP with some suggesting diagnostic precision is improved by chest radiographs. Conversely, several studies have demonstrated a lack of agreement in the interpretation of chest radiographs bringing their role as the ultimate arbiter of diagnosis into question. Below we debate the diagnostic role of the humble chest radiograph in the context of suspected CAP.

  11. Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

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    Barbirato, Gustavo Borges; Azevedo, Jader Cunha de; Felix, Renata Christian Martins; Correa, Patricia Lavatori; Volschan, Andre; Viegas, Monica; Pimenta, Lucia; Dohmann, Hans Fernando Rocha; Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Centro de Estudos do Hospital Pro-Cardiaco (Procep), Rio de Janeiro, RJ (Brazil)

    2009-04-15

    Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. Objective: To evaluate the operating characteristics of {sup 99m}Tc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of cute myocardial infarction. Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and non diagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial infarction (MI) were not excluded (24 patients). Troponin I concentrations were determined at admission and 6 hours later. Nuclear physicians performed a blind analysis of the images, and myocardial infarction was confirmed whenever troponin I level increase was three times that of the control. Results: Resting perfusion image was abnormal in all 6 patients with MI. Only 1 patient had a normal image and increased troponin levels. Fifty-five patients had positive images without MI, and 46 patients had normal images and troponin levels. The prevalence of the disease was 6.5%. The sensitivity and specificity of the resting images during an episode of chest pain to diagnose MI was 85.7% and 45.5%, respectively. The negative predictive value was 97.7%. Conclusion: Patients undergoing chest pain protocol with SPECT showed an excellent negative predictive value to exclude diagnosis of myocardial infarction. These results suggest that resting perfusion image is an important tool at the chest pain unit. (author)

  12. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

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    Al-Koudmani Ibrahim

    2012-04-01

    Full Text Available Abstract Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41% followed by traffic accidents (33%. Pneumothorax (51%, Hemothorax (38%, rib fractures (34%, and lung contusion (15% were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%. A minority of the patients required thoracotomy (5.7%, and tube thoracostomy (56% was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%. Conclusions New traffic laws (including seat belt enforcement reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.

  13. Blunt Chest Trauma in Mice after Cigarette Smoke-Exposure: Effects of Mechanical Ventilation with 100% O2.

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    Katja Wagner

    Full Text Available Cigarette smoking (CS aggravates post-traumatic acute lung injury and increases ventilator-induced lung injury due to more severe tissue inflammation and apoptosis. Hyper-inflammation after chest trauma is due to the physical damage, the drop in alveolar PO2, and the consecutive hypoxemia and tissue hypoxia. Therefore, we tested the hypotheses that 1 CS exposure prior to blunt chest trauma causes more severe post-traumatic inflammation and thereby aggravates lung injury, and that 2 hyperoxia may attenuate this effect. Immediately after blast wave-induced blunt chest trauma, mice (n=32 with or without 3-4 weeks of CS exposure underwent 4 hours of pressure-controlled, thoraco-pulmonary compliance-titrated, lung-protective mechanical ventilation with air or 100% O2. Hemodynamics, lung mechanics, gas exchange, and acid-base status were measured together with blood and tissue cytokine and chemokine concentrations, heme oxygenase-1 (HO-1, activated caspase-3, and hypoxia-inducible factor 1-α (HIF-1α expression, nuclear factor-κB (NF-κB activation, nitrotyrosine formation, purinergic receptor 2X4 (P2XR4 and 2X7 (P2XR7 expression, and histological scoring. CS exposure prior to chest trauma lead to higher pulmonary compliance and lower PaO2 and Horovitz-index, associated with increased tissue IL-18 and blood MCP-1 concentrations, a 2-4-fold higher inflammatory cell infiltration, and more pronounced alveolar membrane thickening. This effect coincided with increased activated caspase-3, nitrotyrosine, P2XR4, and P2XR7 expression, NF-κB activation, and reduced HIF-1α expression. Hyperoxia did not further affect lung mechanics, gas exchange, pulmonary and systemic cytokine and chemokine concentrations, or histological scoring, except for some patchy alveolar edema in CS exposed mice. However, hyperoxia attenuated tissue HIF-1α, nitrotyrosine, P2XR7, and P2XR4 expression, while it increased HO-1 formation in CS exposed mice. Overall, CS exposure

  14. Computerized tomography of chest in emphysema and interstitial diseases diagnosis

    International Nuclear Information System (INIS)

    To study the effect of increasing the spatial resolution on thin section (1.5 mm) computed tomography (CT) of the chest, we compared images reconstructed with the standard algorithm (SA) to three other images obtained with 1) a high spatial frequency algorithm, 2) retrospective targeting to a small field of view (FOV) reconstructed with the high spatial frequency algorithm, and 3) the same high spatial frequency algorithm with images acquired with the small (0.6 mm) rather the large (0.9 mm) focal spot. Examinations were performed on a phantom, on normal subjects, and on patients with emphysema and other diffuse lung diseases. Modulation transfer function (MTF) calculations revealed that higher resolution was achieved on the small focal spot and high spatial frequency algorithm than on the standard algorithm. Evaluation of the four images from 25 normal subjects, 16 patients with emphysema and 9 with interstitial disease was performed by means of an ROC study. Results from the areas under the ROC curves, sensitivity and specificity have shown that images reconstructed with the high spatial frequency algorithm were preferred. We conclude that the use of a high spatial frequency algorithm increases spatial resolution and improves visibility of lung parenchyma. Although more evaluation is needed, the potential of increasing spatial resolution further by using a smaller focal spot is currently limited by the mas Available per slice and the associated increased level of quantum noise. (Author)

  15. STUDY OF CLINICAL PROFILE AND OUTCOME OF 216 VICTIMS OF CHEST TRAUMA IN TERTIARY CARE CENTRE OF CENTRAL INDIA

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    Sanjay

    2015-11-01

    Full Text Available This observational study of 216 victims of chest injuries was carried out at Sri Aurobindo Medical College and Postgraduate Institute of Indore (India. The study was conducted from 1st January 2010 to 30th June 2014 in the Department of Surgery at Sri Aurobindo Medical College and Postgraduate Institute, Indore. Polytrauma is recognized as the leading cause of death and disability in first four decades of life and the third most common cause of death. Chest is the central portion of body which contains vital organs of utmost importance. As chest is a large and exposed portion, it is vulnerable to impact injuries which are frequently life threatening. This study was carried out to quantify the problem of chest injuries in the population at large with special reference to various clinical presentations and outcome of management at our centre. Although blunt and penetrating injuries both were included in the study, but blunt injuries were commoner (82.4%. Road traffic accident was responsible for 57.4% cases. A total of 120 patients out of 216 (55.5% were between 21 to 40 years of age. More than eighty percent victims were males. Musculoskeletal injuries (Long bone fractures etc., were the most common associated injuries. Twenty six (22.23% out of 216 died due to their injuries or complications. Twenty five percent were managed conservatively and were discharged in a satisfactory condition. One hundred and fifty nine needed thoracostomy, the commonest operative intervention. Overall outcome of chest injuries largely depends on magnitude and location of concomitant injuries. Prompt diagnosis of problem and immediate surgical intervention are the most important factors in the efficient management of chest injuries.

  16. The Effect of Pre-Injury Anti-Platelet Therapy on the Development of Complications in Isolated Blunt Chest Wall Trauma: A Retrospective Study

    OpenAIRE

    Battle, Ceri; Hutchings, Hayley; Bouamra, Omar; Phillip A Evans

    2014-01-01

    Introduction The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the developmen...

  17. Elastofibroma dorsi – differential diagnosis in chest wall tumours

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    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  18. Chest x-ray quality in the diagnosis of pneumonia in children: From prescription to optimization

    International Nuclear Information System (INIS)

    Acute lower respiratory tract infection (ALRI), primarily pneumonia, is the leading cause of childhood death in developing countries. The increasing incidence of antimicrobial resistance and the high cost of vaccines lead to considering the first strategy to reduce pneumonia deaths the early detection of the disease. Case management begins with the clinical examination and may continue with the prescription of a chest x-ray. Consequently, the radiograph should meet quality standards, and radiologists and paediatricians must know how to interpret the images. Special attention should be paid on patient dose due to children radiosensitivity, high frequency and chest x rays rejection rate. This paper is a retrospective study of chest radiographs performed in 5731 children with clinical diagnosis of ALRI assisted in three Uruguayan hospitals during the three year investigation supported by the Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) that had the aim of estimating the burden of pneumonia (from 2001 to 2004). It is analyzed the prescription of radiographs during the diagnosis and in later controls (2220 children assisted in two of the three hospitals). Patient doses are estimated from technical parameters and equipment specifications. The investigation also analyzes patient doses that could have been avoided if paediatricians had managed the disease according to the established protocols. Results show that 82.4 % of chest x-rays diagnosed pneumonia and that some children underwent up to ten radiographs. Significant differences were found in patient dose in the three hospitals, concluding that education on image quality on chest radiographs of radiologists, paediatricians and radiological technologists is the first and best tool for the earlier diagnosis of pneumonia in children and for the application of Radiation Protection (RP) principles in medical exposures. (author)

  19. Chest X-ray quality in the diagnosis of pneumonia in children: from prescription to optimization

    International Nuclear Information System (INIS)

    Acute lower respiratory tract infection (ALRI), primarily pneumonia, is the leading cause of childhood death in developing countries. The increasing incidence of antimicrobial resistance and the high cost of vaccines lead to considering the first strategy to reduce pneumonia deaths the early detection of the disease. Case management begins with the clinical examination and may continue with the prescription of a chest x-ray. Consequently, the radiograph should meet quality standards, and radiologists and paediatricians must know how to interpret the images. Special attention should be paid on patient dose due to children radiosensitivity, high frequency and chest x rays rejection rate. This paper is a retrospective study of chest radiographs performed in 5731 children with clinical diagnosis of ALRI assisted in three Uruguayan hospitals during the three year investigation supported by the Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) that had the aim of estimating the burden of pneumonia (from 2001 to 2004). It is analyzed the prescription of radiographs during the diagnosis and in later controls (2220 children assisted in two of the three hospitals). Patient doses are estimated from technical parameters and equipment specifications. The investigation also analyzes patient doses that could have been avoided if paediatricians had managed the disease according to the established protocols. Results show that 82.4 % of chest X-rays diagnosed pneumonia and that some children underwent up to ten radiographs. Significant differences were found in patient dose in the three hospitals, concluding that education on image quality on chest radiographs of radiologists, paediatricians and radiological technologists is the first and best tool for the earlier diagnosis of pneumonia in children and for the application of Radiation Protection (RP) principles in medical exposures. (author)

  20. Traumatic asphyxia due to blunt chest trauma: a case report and literature review

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    Sertaridou Eleni

    2012-08-01

    Full Text Available Abstract Introduction Crush asphyxia is different from positional asphyxia, as respiratory compromise in the latter is caused by splinting of the chest and/or diaphragm, thus preventing normal chest expansion. There are only a few cases or small case series of crush asphyxia in the literature, reporting usually poor outcomes. Case presentation We present the case of a 44-year-old Caucasian man who developed traumatic asphyxia with severe thoracic injury and mild brain edema after being crushed under heavy auto vehicle mechanical parts. He remained unconscious for an unknown time. The treatment included oropharyngeal intubation and mechanical ventilation, bilateral chest tube thoracostomies, treatment of brain edema and other supportive measures. Our patient’s outcome was good. Traumatic asphyxia is generally under-reported and most authors apply supportive measures, while the final outcome seems to be dependent on the length of time of the chest compression and on the associated injuries. Conclusion Treatment for traumatic asphyxia is mainly supportive with special attention to the re-establishment of adequate oxygenation and perfusion; treatment of the concomitant injuries might also affect the final outcome.

  1. Automatic diagnosis of pneumoconiosis by texture analysis of chest X-ray images

    International Nuclear Information System (INIS)

    This paper presents a study on automatic diagnosis of pneumoconiosis by texture analysis of chest X-ray images. A pre-processing method for normalizing distribution of film density is proposed and its effectiveness is studied experimentally. Dominant causes of the deviations of texture features for evaluating the profusion of small opacities are excluded by the pre-processing. New texture features based on the distribution of gradient vectors are also proposed. Experiments to evaluate the proposed system are demonstrated

  2. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    old, and only 2.5% more than 60 years old. The most common trauma was a road traffic accident, and the LAD was the vessel most often affected. Angiography revealed 12 cases with completely normal vessels, which might be due to spasm or recanalisation; 31 cases showed occlusion but no atherosclerosis...

  3. Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner;

    2008-01-01

    of various treatments are lacking. METHODS/DESIGN: We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom......'s standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a) a self-report questionnaire; b) a semi-structured interview; c) a general health examination; and d) a specific manual examination of the muscles and joints of the neck, thoracic...

  4. Role of Complement C5 in Experimental Blunt Chest Trauma-Induced Septic Acute Lung Injury (ALI)

    Science.gov (United States)

    Karbach, Michael; Braumueller, Sonja; Kellermann, Philipp; Gebhard, Florian; Huber-Lang, Markus; Perl, Mario

    2016-01-01

    Background Severe blunt chest trauma is associated with high mortality. Sepsis represents a serious risk factor for mortality in acute respiratory distress syndrome (ARDS). In septic patients with ARDS complement activation products were found to be elevated in the plasma. In single models like LPS or trauma complement has been studied to some degree, however in clinically highly relevant double hit models such as the one used here little data is available. Here, we hypothesized that absence of C5 is correlated with a decreased inflammatory response in trauma induced septic acute lung injury. Methods 12 hrs after DH in mice the local and systemic cytokines and chemokines were quantified by multiplex bead array or ELISA, activated caspase-3 by western blot. Data were analyzed using one-way ANOVA followed by post-hoc Sidak’s multiple comparison test (significance, p≤ 0.05). Results In lung tissue interleukin (IL)-6, monocyte chemo attractant protein-1 (MCP-1) and granulocyte-colony stimulating factor (G-CSF) was elevated in both C5-/- mice and wildtype littermates (wt), whereas caspase-3 was reduced in lungs after DH in C5-/- mice. Systemically, reduced keratinocyte-derived chemokine (KC) levels were observed after DH in C5-/- compared to wt mice. Locally, lung myeloperoxidase (MPO), protein, IL-6, MCP-1 and G-CSF in brochoalveolar lavage fluid (BALF) were elevated after DH in C5-/- compared to wt. Conclusions In the complex but clinically relevant DH model the local and systemic inflammatory immune response features both, C5-dependent and C5-independent characteristics. Activation of caspase-3 in lung tissue after DH was C5-dependent whereas local inflammation in lung tissue was C5-independent. PMID:27437704

  5. Overview of Diagnosis and Treatment of Psychological Trauma in Children.

    Science.gov (United States)

    Munson, Carlton E.

    1995-01-01

    Provides comprehensive definition of psychological trauma and offers guidance to practitioners who are increasingly needed to treat traumatized children. Key therapy considerations are organized around the role of dissociation and repetition compulsion in trauma. Presents treatments in connection with aloneness of trauma experience, dream and…

  6. Survey of physicians concerning the use of chest radiography in the diagnosis of pneumonia in out-patients

    OpenAIRE

    Marrie, Thomas J

    1997-01-01

    OBJECTIVE: To determine how physicians use chest radiography in the diagnosis of pneumonia in ambulatory patients.STUDY POPULATION: A convenience sample of 176 Nova Scotia family physicians and internists selected to represent all geographic areas of the province proportional to population.STUDY INSTRUMENT: A 35-item questionnaire covering demographics, experience with out-patients with pneumonia, use of chest radiographs to make this diagnosis and factors that were considered important in th...

  7. Posteroanterior chest X-ray for the diagnosis of pneumothorax: methods, usage, and resolution

    Directory of Open Access Journals (Sweden)

    Denise Rossato Silva

    2010-08-01

    Full Text Available Denise Rossato Silva, Sandra Jungblut Schuh, Paulo de Tarso Roth DalcinUniversidade Federal do Rio Grande do Sul, Porto Alegre-RS, BrazilAbstract: Most pneumothoraces are demonstrated on fully inspired erect posteroanterior (PA chest X-ray (CXR. Expiratory films may have a role in the clinical management of patients with a small respiratory reserve in whom pneumothorax is suspected and not demonstrated on the inspiratory film. PA CXR can be used for the diagnosis of spontaneous and ­nonspontaneous pneumothoraces. When digital radiography is used, for most authors, a 2.5-lp/mm spatial ­resolution is satisfactory to detect a pneumothorax.Keywords: radiography, computed tomography, pneumothorax, posteroanterior chest X-ray

  8. Chest pain characteristics and gender in the early diagnosis of acute myocardial infarction.

    Science.gov (United States)

    Arora, Garima; Bittner, Vera

    2015-02-01

    Acute myocardial infarction is one of the leading causes of cardiovascular disease mortality in both men and women. Chest pain, which is often described as chest pressure, tightness, or a squeezing sensation, is the most frequent symptom in patients presenting with acute myocardial infarction. Although the diagnosis of acute myocardial infarction is often based on typical changes on a surface electrocardiogram and on changes in cardiac biomarkers, there is a need to better recognize and understand the impact of sex on symptoms among patients presenting with acute coronary syndrome or acute myocardial infarction. We briefly review the pathophysiology of ischemic symptoms, discuss potential mechanisms for variation in ischemic symptoms by sex, and summarize recent publications that have addressed sex differences in ischemic symptoms.

  9. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso

    Directory of Open Access Journals (Sweden)

    Wellingson Silva Paiva

    2007-12-01

    Full Text Available Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada.

  10. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    International Nuclear Information System (INIS)

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion

  11. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  12. Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

    International Nuclear Information System (INIS)

    Highlights: • (Lateral) chest X-ray's are often performed in older individuals for various reasons. • Vertebral fractures are visualized on lateral chest X-ray, but the diagnosis of vertebral fractures is until now only validated on (lateral) spine X-ray's. • This study shows that a (lateral) chest X-ray is sufficient for the diagnosis of vertebral fractures. • Older individuals with a vertebral fracture on a (lateral) chest X-ray do not need further radiography with thoracic spine X-ray or vertebral fracture assessment with DXA. - Abstract: Background: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. Methods: To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately, blinded and in different time periods. Agreement and Cohens’ kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. Results: 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95–98% for the two levels of fracturing, with a Cohen's kappa of 0.88–0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81–0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). Conclusion: The results show good agreement and intraobserver reliability on

  13. Diagnosis of Coronary Artery Disease in Patients with Chest Pain by Means of Magnetocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, H.; Kim, K.; Kim, J. M.; Lee, Y. H.; Kim, T. E.; Lim, H. K.; Park, Y. K. [Biomagnetism Research Center, Korea Research Institute of Standards and Science, Daejeon (Korea, Republic of); Ko, Y. G.; Chung, N. [Cardiovascular Center, College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    2006-10-15

    Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool for the detection of cardiac electrical abnormality associated with myocardial ischemia. In our previous study, we have proposed a new classification method of MCG parameters, based on the different populations of the parameters between coronary artery disease(CAD) patients, symptomatic patients and healthy volunteers. We used four parameters, representing the directional changes of the electrical activity in the period of an R-ST-T interval. In patients with chest pain and without ST-segment elevation, who were selected consecutively from all patients admitted to the hospital in 2004, the patients with CAD could be classified with a higher sensitivity than conventional methods, showing that the proposed method can be useful for the diagnosis of CAD with MCG. In this study, we examined the validity of the algorithm with the prior probability distribution in diagnosis of new patients admitted to the hospital in 2005. In the results, presence of CAD could be found with sensitivity and specificity of 81.3% and 71.4%, respectively, in patients with chest pain and non-diagnostic ECG findings.

  14. Renal trauma imaging: Diagnosis and management. A pictorial review

    International Nuclear Information System (INIS)

    The purpose of this review is to illustrate and discuss the spectrum of imaging findings, particularly computed tomography (CT), of blunt and penetrating renal trauma, based on our own materials, according to the American Association for Surgery of Trauma (AAST) renal injury grading scale. The article also indicates the conditions in which interventional radiology procedures can be applied for the management of renal trauma. Cases for this pictorial review were selected from the imaging material collected at the Radiology Department of Hamad Medical Corporation during a 14-year period from 1999 to 2012. The material includes 176 cases (164 males and 12 females) with confirmed blunt or penetrating renal trauma. Following abdominal trauma, all patients had a CT examination performed on admission to the hospital and/or during hospitalization. The most representative and illustrative cases of renal trauma were reviewed according to CT findings and were categorized according to the AAST grading system. The review describes a spectrum of imaging presentations with special emphasis on the 5 grades of renal injury on a CT according to the AAST scale. The most representative cases were illustrated and discussed with indications of possible interventional radiology treatment. Two groups of patients not included in the AAST grading system were presented separately: those with preexisting renal abnormalities and those with sustained iatrogenic renal injury. Proper application of renal trauma grading scale is essential for selecting the patients for conservative treatment, surgery or interventional radiology procedure

  15. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Directory of Open Access Journals (Sweden)

    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  16. The diagnostic value of X-ray and CT scan of the chest trauma%X线平片和CT扫描对胸部创伤的诊断价值

    Institute of Scientific and Technical Information of China (English)

    陈志勇; 陈俊

    2016-01-01

    Objective:To discuss the diagnostic value of X-ray and CT scan of the chest trauma.Methods:30 patients with chest trauma were selected,doing X-ray,CT examination. Results: 13 cases were pulmonary exudative change, in which X-ray showed normal in 2 cases, while CT lung found pale patchy and high-density shadow.6 cases were pneumothorax,in which it was difficult to see very little pneumothorax for X-ray, while CT scan was clear.In addition, X-ray and CT could clear diagnosis of pneumohemothorax in 6 cases,pulmonary hematoma in 5 cases,hemothorax in 8 cases,rib fracture in 9 cases, mediastinal and subcutaneous emphysema in 6 cases,pulmonary atelectasis in 1 case.Conclusion:X-ray and CT scan are important methods in diagnosis of chest trauma,and CT is superior to X-ray.%目的:探讨 X 线平片和 CT 扫描对胸部创伤的诊断价值。方法:收治胸部创伤患者30例,行 X 线、CT 检查。结果:肺部渗出性改变13例,平片显示正常2例,而CT检查则均发现肺部的浅淡斑片状、云絮状高密度影。气胸6例,极少量的气胸,用平片很难看到,而CT扫描却十分清晰。另外,血气胸6例,肺血肿5例,胸腔积血8例,肋骨骨折9例,纵隔及皮下气肿6例,肺不张1例,X线和CT均能明确诊断。结论:X线平片和CT扫描是诊断胸部创伤的重要方法,而CT扫描明显优于X线平片。

  17. Use of radionuclide imaging in diagnosis and management of the acute trauma patient

    International Nuclear Information System (INIS)

    Trauma, when defined as all accidental and intentional injury, is the leading cause of death for persons up to age 44 in the United States and Canada, and it accounts for more years of life lost before age 70 than cancer and heart disease combined. In 1982 in the United States there were 165,000 deaths from trauma and at least twice as many cases of permanent disability, with a total cost of approximately $50,000,000,000. This paper describes the use of radionuclide imaging in the diagnosis and management of trauma

  18. Computer-aided diagnosis workstation and network system for chest diagnosis based on multislice CT images

    Science.gov (United States)

    Satoh, Hitoshi; Niki, Noboru; Eguchi, Kenji; Moriyama, Noriyuki; Ohmatsu, Hironobu; Masuda, Hideo; Machida, Suguru

    2008-03-01

    Mass screening based on multi-helical CT images requires a considerable number of images to be read. It is this time-consuming step that makes the use of helical CT for mass screening impractical at present. To overcome this problem, we have provided diagnostic assistance methods to medical screening specialists by developing a lung cancer screening algorithm that automatically detects suspected lung cancers in helical CT images, a coronary artery calcification screening algorithm that automatically detects suspected coronary artery calcification and a vertebra body analysis algorithm for quantitative evaluation of osteoporosis likelihood by using helical CT scanner for the lung cancer mass screening. The function to observe suspicious shadow in detail are provided in computer-aided diagnosis workstation with these screening algorithms. We also have developed the telemedicine network by using Web medical image conference system with the security improvement of images transmission, Biometric fingerprint authentication system and Biometric face authentication system. Biometric face authentication used on site of telemedicine makes "Encryption of file" and Success in login" effective. As a result, patients' private information is protected. Based on these diagnostic assistance methods, we have developed a new computer-aided workstation and a new telemedicine network that can display suspected lesions three-dimensionally in a short time. The results of this study indicate that our radiological information system without film by using computer-aided diagnosis workstation and our telemedicine network system can increase diagnostic speed, diagnostic accuracy and security improvement of medical information.

  19. Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries.

    Science.gov (United States)

    Biffl, Walter L; Moore, Ernest E; Feliciano, David V; Albrecht, Roxie A; Croce, Martin; Karmy-Jones, Riyad; Namias, Nicholas; Rowell, Susan; Schreiber, Martin; Shatz, David V; Brasel, Karen

    2015-12-01

    This is a recommended management algorithm from the Western Trauma Association addressing the diagnostic evaluation and management of esophageal injuries in adult patients. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, the recommendations herein are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithms and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this guideline to formulate their own local protocols.The algorithm contains letters at decision points; the corresponding paragraphs in the text elaborate on the thought process and cite pertinent literature. The annotated algorithm is intended to (a) serve as a quick bedside reference for clinicians; (b) foster more detailed patient care protocols that will allow for prospective data collection and analysis to identify best practices; and (c) generate research projects to answer specific questions concerning decision making in the management of adults with esophageal injuries.

  20. The use of the biomarker “copeptin” for the diagnosis of acute chest pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Elisa Conti

    2011-09-01

    Full Text Available The aim of the study is to assess if copeptin, in combination with negative troponin, is able to accelerate the rule-out of AMI in patients with chest pain. The study was retrospectively conducted on three groups of patients selected according to their discharge diagnoses: patients with non-ST elevation myocardial infarction (NSTEMI, non-cardiac chest pain (NCCP, unstable angina (UA. Comparing the levels of copeptin, we found that the diagnosis of AMI is associated more often with copeptin positive values (> 14 pmol/l than the diagnosis of NCCP and UA. However, about a quarter of our patients in which the combination of copeptin and troponin in the first blood sample was negative, the final diagnosis was AMI. According to our results, the combination of the two negative markers does not allow a safe rule out of AMI at time zero.

  1. Diagnosis and management of colonic injuries following blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Yi-Xiong Zheng; Li Chen; Si-Feng Tao; Ping Song; Shao-Ming Xu

    2007-01-01

    AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma.METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods,associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed.RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injuryrelated abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02).CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

  2. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma

    International Nuclear Information System (INIS)

    Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination of plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows

  3. Tratamento das lesões de aorta nos traumatismos torácicos fechados Management of aortic lesions in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Boulanger Mioto Neto

    2005-09-01

    o Paulo, and treated by the Vascular Surgery Department from January 2001 to June 2004. Ten male patients were assessed: seven were treated by endovascular techniques and three by conventional operation. RESULTS: Concerning the location, there were eight injuries of the descending thoracic aorta proximal to the isthmus, one injury of the descending aorta at the thoracoabdominal transition, and one traumatic dissection of the aorta. Mean time for the surgical procedure was 10.62 ± 3.45 hours for patients submitted to endoluminal repair and 28 ± 32.39 hours for those submitted to conventional repair. The total hospitalization period varied from 9 to 180 days (mean of 23.33 ± 6.66 days for patients who received endoprosthesis and 42.55 ± 52.7 for those conventionally operated. Endoprostheses used were: one Excluder®, one Apolo®, and five Talent®. Of the operated patients, two used atrium femoral artery bypass. There were two deaths, one among the patients conventionally operated and one among those who received endoprosthesis. CONCLUSIONS: Aortic lesions in blunt chest trauma are rare and often associated to a great number of lesions. Early and accurate diagnosis is the key for the progress of patients. The endovascular repair in hemodynamically stable patients is an efficient alternative.

  4. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso

    OpenAIRE

    Wellingson Silva Paiva; Robson Luis Oliveira de Amorim; Wagner Malago Tavares; Eduardo Joaquim Lopes Alho; Brasil Ping Jeng; Eberval Gadelha Figueiredo

    2007-01-01

    Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid ...

  5. Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma%闭合性胸部外伤致心脏破裂16例

    Institute of Scientific and Technical Information of China (English)

    李晓峰; 马建欣; 刘建伟; 雷威

    2012-01-01

    Objective To retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.%目的 探讨闭合性胸部外伤致心脏破裂的手术抢救入路与方法.方法 2004年1月至2010年12月我院抢救闭合性胸部外伤致心脏破裂患者16例,均采用胸骨正中切口行心脏破裂修补术,分析其效果.结果 除1例在体外循环建立前出现心跳停止、手术修补后心肺复苏失败外,余15例全部救治成功.结论 闭合性胸部外伤致心脏破裂应及时果断进行抢救和急诊手术,心脏破裂修补术可以提高患者的存活率.

  6. Computer aided diagnosis in digital chest radiography: evaluation of pulmonary emphysema in COPD patients

    OpenAIRE

    Coppini, Giuseppe; Ferdeghini, Ezio Maria; Paterni, Marco; Tonelli, Lucia; Bauleo, Carolina; Monti, Simonetta; Miniati, Massimo

    2004-01-01

    Computer-aided quantitative analysis of chest radiographs is a useful tool in describing alterations in lung shape that occur in patients with emphysema. In the present study, the analysis was limited to the lateral chest radiograph, but we expect that the use of the postero-anterior view may further improve the rate of correct classification.

  7. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  8. Lesão da valva tricúspide por trauma torácico penetrante Lesión de la válvula tricúspide por trauma torácico penetrante Tricuspid valve lesion due to penetrating chest trauma

    Directory of Open Access Journals (Sweden)

    Renata de Carvalho Bicalho Carneiro

    2010-02-01

    Full Text Available As lesões da valva tricúspide decorrentes de trauma torácico penetrante são raras e frequentemente subdiagnosticadas. O objetivo deste relato é descrever um caso de insuficiência tricúspide grave secundária a acidente por arma branca com evolução insidiosa, diagnosticada 19 anos após o ocorrido. O caso enfatiza a importância do acompanhamento adequado dos pacientes vítimas de trauma torácico penetrante por longo período após a injúria, para detecção de possíveis complicações tardias do trauma.Las lesiones de la válvula tricúspide resultantes de trauma torácico penetrante son raras y frecuentemente subdiagnosticadas. El objetivo de este relato es describir un caso de insuficiencia tricúspide severa secundaria a accidente por arma blanca con evolución insidiosa, diagnosticada 19 años tras lo sucedido. El caso enfatiza la importancia del seguimiento adecuado de los pacientes víctimas de trauma torácico penetrante por largo período tras la injuria, para detección de posibles complicaciones tardías del trauma.Tricuspid valve lesions caused by penetrating chest trauma are rare and often underdiagnosed. The objective of this report is to describe a case of severe tricuspid insufficiency secondary to a knifing incident with an insidious evolution, diagnosed 19 years after the incident. The case emphasizes the importance of adequate follow-up of patients that are victims of penetrating chest trauma for a long period after the injury, to detect possible late complications of the trauma.

  9. Impact of d-Dimers on the Differential Diagnosis of Acute Chest Pain: Current Aspects Besides the Widely Known

    OpenAIRE

    Hahne, Kathrin; Lebiedz, Pia; Breuckmann, Frank

    2014-01-01

    d-dimers are cleavage products of fibrin that occur during plasmin-mediated fibrinolysis of blood clots. In the emergency department, d-dimer measurement represents a valuable and cost-effective tool in the differential diagnosis of acute chest pain including the main life-threatening entities: acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Whereas the diagnostic and prognostic values of d-dimer testing in acute coronary syndrome is of less priority, increases of d-di...

  10. THE EVOLUTION OF ISOLATED BILATERAL LUNG CONTUSION FROM BLUNT CHEST TRAUMA IN RATS: CELLULAR AND CYTOKINE RESPONSES

    OpenAIRE

    Raghavendran, Krishnan; Davidson, Bruce A.; Woytash, James A.; Helinski, Jadwiga D.; Marschke, Cristi J.; Manderscheid, Patricia A.; Notter, Robert H.; Paul R. Knight

    2005-01-01

    Lung contusion is the leading cause of death from blunt thoracic trauma in adults, but its mechanistic pathophysiology remains unclear. This study uses a recently developed rat model to investigate the evolution of inflammation and injury in isolated lung contusion. Bilateral lung contusion with minimal cardiac trauma was induced in 54 anesthetized rats by dropping a 0.3-kg hollow cylindrical weight onto a precordial shield (impact energy, 2.45 Joules). Arterial oxygenation, pressure-volume (...

  11. 心脏外伤的诊断与治疗%The diagnosis and treatment of cardiac trauma

    Institute of Scientific and Technical Information of China (English)

    王文璋; 高举; 王幼黎; 王志超; 李娅娜; 郑国强

    2011-01-01

    目的:探讨心脏外伤的诊断及治疗方法,提高心脏外伤的抢救成功率.方法:我科于1999年3月至2010年10月共收治10例心脏外伤患者,男性7例,女性3例,年龄18~51岁,平均(29.5±8.5)岁.其中刀刺伤5例,车祸伤3例,高处坠落伤2例.表现为出血性休克者3例,急性心包填塞者7例.损伤部位有:左心室4例,左心房2例,右心室3例,右心耳1例.结果:所有患者手术均取得成功,没有死亡病例.结论:早期快速诊断、紧急开胸手术治疗,及时有效补充血容量,采取自体血液回输,是成功抢救心脏外伤的关键.%Objective : To discuss the key points of diagnasis and treatment of cardiac trauma in order to increase the success rate of cardiac trauma rescue. Methods:From Mar. 1999 to Oct. 2010, 10 patients with cardiac trauma were treated in our hospital. There were 7 males and 3 females. The mean age was (29.5 ±8.5) years( 18-51 years) . 5 patients had history of stab wound in the chest, 3 patients had crush injury during traffic accidents, 2 of them had injury from fall. 3 patients manifested as serious hemorrhagic shock, 7 patients manifested as acute tamponade. lesion location : 4 cases with left ventricular wound, 2 cases with injury of cardiac left atrium, 3 cases with right ventricular wound, 1 case with right atrial appendage wound. Results : No operative death occurred, all patients recovered smoothly. Conclusion : Early diagnosis and emergent surgical treatment, prompt and effective volume replacement includs application of autotransfusion are important in saving the lives of patients with cardiac trauma.

  12. Diagnosis of IPA in HIV: The role of the chest X-ray and radiologist

    Energy Technology Data Exchange (ETDEWEB)

    Zaspel, Uta [Charite - Universitaetsmedizin Berlin, Institut fuer Radiologie, Berlin (Germany); Denning, David W. [The University of Manchester, Education and Research Centre, Wythenshawe Hospital, Manchester (United Kingdom); Lemke, Arne J.; Roettgen, Rainer; Bittner, Roland; Oestmann, Joerg W. [Charite - Universitaetsmedizin Berlin, Klinik fuer Strahlenheilkunde, Berlin (Germany); Greene, Reginald [Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Boston (United States); Schuermann, Dirk [Charite - Universitaetsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Infektiologie und Asthma-Poliklinik, Berlin (Germany); Maschmeyer, Georg [Charite - Universitaetsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Haematologie und Onkologie, Berlin (Germany); Ruhnke, Markus [Charite - Universitaetsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Onkologie und Haematologie, Berlin (Germany); Herbrecht, Raoul [Hopital de Hautepierre, Department d' Hematologie et d' Oncologie, Strasbourg (France); Ribaud, Patricia [Hopital Saint-Louis, Service d' Hematologie, Paris (France); Lortholary, Olivier [Universite Paris V, Centre National de Reference des Mycoses et des Antifongiques, Institut Pasteur, Service des Maladies Infectieuses et Tropicales, Hopital Necker, Paris (France); Zonderland, Harmien [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Rabe, Klaus F. [Leiden University Medical Centre, Department of Pulmology, Leiden (Netherlands); Neumann, Klaus [Krankenhaus und Herzzentrum Bernau, Bernau (Germany)

    2004-11-01

    The role of clinical information and chest film for the discrimination between invasive pulmonary aspergillosis (IPA) and its differential diagnoses in human immunodeficiency virus (HIV) infection was studied. The diagnostic performance of clinical information and chest film alone and in combination was studied for eight internists and eight radiologists with regular exposure to IPA patients. The multicenter case sample consisted of 25 patients with proven IPA and 25 with other pulmonary diseases typical for HIV. The cases were presented on a CD-ROM. Receiver operating characteristics (ROC) methodology was employed. With clinical information alone, internists achieved the highest diagnostic performance (area under curve/AUC=0.84). Viewing the chest films did not contribute to their performance (AUC=0.80, P=0.26). The radiologist's performance on the basis of viewing the chest film (AUC=0.75) increased significantly (P=0.012) when clinical information (AUC=0.83) was supplied. IPA cases with characteristic radiological appearance were correctly identified in 90% with chest film. For radiologists with regular exposure to HIV patients, chest films hold relevant information and contribute to the determination in cases with characteristic radiological appearance. Overall and especially in cases with less characteristic radiological appearance, they have significant profit from full access to the clinical data. For internists with regular exposure to HIV patients, chest films do not provide information essential for the verification or differentiation of potential IPA. (orig.)

  13. Analgesic effect of flurbiprofen axetil for chest trauma%氟比洛芬酯用于胸部创伤镇痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    刘武新

    2012-01-01

    Objective To investigate the analgesic affects and safety of intravenous infusion of flurbiprofen axetil in chest trauma patients. Methods 60 chest trauma patients with multiple rib fractures (three or more ) were randomly divided into groups A and B. The flurbiprofen axetil injection ( kaifen ) 50 mg were given by intravenous infusion in group A. The tramadol injection 100 mg were given by intramuscular injection in group B. VAS scales and the side effects were observed in the two groups during drug onset and duration, before treatment, and 2, 6, 24 hours after treatment. Result The difference in drug onset time and duration between the two groups was statistically significant ( P 0. 05 ). 3. 33% of group A experienced adverse reactions compared with 16. 67% from group B. Conclusion The use of glurbiprofen axetil for chest trauma patients is effective and adverse reactions are less.%目的 观察静脉滴注氟比洛芬酯对胸部创伤患者的镇痛效果及安全性.方法 60例以多发肋骨骨折(3根以上)为主的胸部创伤患者随机分为A、B两组,A组给予氟比洛芬酯注射液(凯纷)50 mg加入生理盐水50 ml静脉滴注,B组给予曲马多注射液100 mg肌肉注射.比较起效时间、维持时间及用药前、用药后2、6、24 h疼痛视觉模拟评分(VAS)值,以及副反应观察.结果 A组药物起效时间及持续时间与B组比较差异有统计学意义(P0.05);两组用药后不良反应:A组不良反应率为3.33%,B组不良反应发生率为16.67%.结论 氟比洛芬酯用于胸部创伤镇痛效果确切,且副作用少.

  14. Diaphragmatic rupture precipitated by intercostal chest tube drainage in a patient of blunt thoraco-abdominal trauma

    Science.gov (United States)

    Mehrotra, Ashok Kumar; Feroz, Asif; Dawar, Sachet; Kumar, Prem; Singh, Anupam; Khublani, Trilok Kumar

    2016-01-01

    Blunt thoraco-abdominal trauma in collision injuries in road traffic accident (RTA) occasionally results in diaphragmatic injury and rupture besides other serious multisystem injuries. These diaphragmatic injuries (DI) frequently go undetected specially when occur on the right side. DI associated with hemothorax need insertion of intercostal tube drainage (ICTD). ICTD has never been reported to precipitate diaphragmatic rupture and hernia. We are reporting such a rare case for the first time in medical literature. PMID:26933316

  15. Pediatric chest imaging. Chest imaging in infants and children. 2. rev. ed.

    International Nuclear Information System (INIS)

    Imaging of the pediatric chest continues to evolve rapidly. All chapters in this 2nd edition of Pediatric Chest Imaging have been extensively updated, with additional disease-specific information and numerous new illustrations. The book thus presents the state of the art in the diagnosis of pediatric chest disorders, highlighting the role played by advanced technology. As the conventional features of most of these disorders are extremely well known, special attention is devoted to the technical aspects of the modern imaging modalities, their indications, and the diagnostic information that they supply. Individual chapters focus on chest ultrasound, nuclear medicine imaging, high-resolution chest CT, helical CT, and pediatric cardiac CT and pediatric cardiacMRI. Others are directed towards specific disorders, including congenital malformations of the chest, chest tumors, pulmonary infection, trauma, the lung in systemic diseases, the pediatric airway, foreign bodies, the thymus, and the chest wall. Without exception, the authors of this book are internationally known specialists with great expertise in the field. This book will serve as a handy, superbly illustrated reference for all who routinely image children, as well as for those who need access to information on how best to image them. (orig.)

  16. Bone scanning a useful addition in the diagnosis of ankle joint trauma

    International Nuclear Information System (INIS)

    A retrospective study of the indication in 169 scintigraphic examinations of the ankle joint was made. Usually joints respond to trauma with a generalized increase of the concentration of the radiopharmaceutical. By using a highly performed technique the focal hot spot caused by the fracture can be seen in the bone scan. The focal accumulation of the radioactive material must not correspond to a bone fracture in any case. The ligamentous avulsion of a bone chip and/or the periosteum can yield the same image but it cannot be diagnosed by radiographic techniques. Initially the routine radiograph and even the tomograph often are interpreted as normal or equivocal. In these cases of ankle trauma bone scanning completes the clinical evaluation. Although bone scanning is very important in the diagnosis of any traumatic lesion of the ankle joints it cannot replace the conventional X-ray technique. (orig.)

  17. Pulmonary intimal sarcoma: a rare differential diagnosis for arterial filling defects on a chest CT

    International Nuclear Information System (INIS)

    We present a rare case of pulmonary intimal sarcoma mimicking pulmonary embolism in a 40-year-old woman. Although extremely rare, these tumors must be considered in patients who present inappropriate imaging findings that suggest embolism. Chest computed tomography is the modality of choice to determine the extent of the tumor. We present a female patient with suspected embolism that was in fact found to be an endothelial sarcoma of the pulmonary arteries

  18. Accuracy of the interpretation of chest radiographs for the diagnosis of paediatric pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohamed A Elemraid

    Full Text Available World Health Organization (WHO radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.There was significant disagreement (22% between the first and second reports (kappa = 0.70, P<0.001, notably in those aged <5 years (26%, kappa = 0.66, P<0.001. The most frequent sources of disagreement were the reporting of patchy and perihilar changes.This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

  19. Shell shock, trauma, and the First World War: the making of a diagnosis and its histories.

    Science.gov (United States)

    Loughran, Tracey

    2012-01-01

    During the First World War, thousands of soldiers were treated for "shell shock," a condition which encompassed a range of physical and psychological symptoms. Shell shock has most often been located within a "genealogy of trauma," and identified as an important marker in the gradual recognition of the psychological afflictions caused by combat. In recent years, shell shock has increasingly been viewed as a powerful emblem of the suffering of war. This article, which focuses on Britain, extends scholarly analyses which question characterizations of shell shock as an early form of post-traumatic stress disorder. It also considers some of the methodological problems raised by recasting shell shock as a wartime medical construction rather than an essentially timeless manifestation of trauma. It argues that shell shock must be analyzed as a diagnosis shaped by a specific set of contemporary concerns, knowledges, and practices. Such an analysis challenges accepted understandings of what shell shock "meant" in the First World War, and also offers new perspectives on the role of shell shock in shaping the emergence of psychology and psychiatry in the early part of the twentieth century. The article also considers what relation, if any, might exist between intellectual and other histories, literary approaches, and perceptions of trauma as timeless and unchanging.

  20. Abdominal aortic injury in a child: intravenous digital subtraction angiogram (IVDSA) for the diagnosis of pediatric vascular trauma

    International Nuclear Information System (INIS)

    Abdominal aortic injury due to trauma is a rare entity, especially in the pediatric population. We report a 6-year-old girl with partial transection of the abdominal aorta as a result of a motor vehicle accident. The diagnosis was made with IVDSA. The patient survived the injury. We discuss the imaging findings, mechanisms, and associated injuries of abdominal aortic trauma in children. (orig.)

  1. Traumatic Infra-renal Aortic Dissection After a High-energy Trauma: A Case Report of a Primary Missed Diagnosis

    OpenAIRE

    Holger Godry; Guido Rölleke; Achim Mumme; Thomas A. Schildhauer; Martin Gothner

    2014-01-01

    A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed...

  2. Feasibility study of the diagnosis and monitoring of cystic fibrosis in pediatric patients using stationary digital chest tomosynthesis

    Science.gov (United States)

    Potuzko, Marci; Shan, Jing; Pearce, Caleb; Lee, Yueh Z.; Lu, Jianping; Zhou, Otto

    2015-03-01

    Digital chest tomosynthesis (DCT) is a 3D imaging modality which has been shown to approach the diagnostic capability of CT, but uses only one-tenth the radiation dose of CT. One limitation of current commercial DCT is the mechanical motion of the x-ray source which prolongs image acquisition time and introduces motion blurring in images. By using a carbon nanotube (CNT) x-ray source array, we have developed a stationary digital chest tomosynthesis (s- DCT) system which can acquire tomosynthesis images without mechanical motion, thus enhancing the image quality. The low dose and high quality 3D image makes the s-DCT system a viable imaging tool for monitoring cystic fibrosis (CF) patients. The low dose is especially important in pediatric patients who are both more radiosensitive and have a longer lifespan for radiation symptoms to develop. The purpose of this research is to evaluate the feasibility of using s-DCT as a faster, lower dose means for diagnosis and monitoring of CF in pediatric patients. We have created an imaging phantom by injecting a gelatinous mucus substitute into porcine lungs and imaging the lungs from within an anthropomorphic hollow chest phantom in order to mimic the human conditions of a CF patient in the laboratory setting. We have found that our s-DCT images show evidence of mucus plugging in the lungs and provide a clear picture of the airways in the lung, allowing for the possibility of using s- DCT to supplement or replace CT as the imaging modality for CF patients.

  3. Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

    Directory of Open Access Journals (Sweden)

    Farès Moustafa

    2014-01-01

    Full Text Available Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.

  4. Computer-aided diagnosis for osteoporosis using chest 3D CT images

    Science.gov (United States)

    Yoneda, K.; Matsuhiro, M.; Suzuki, H.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.

    2016-03-01

    The patients of osteoporosis comprised of about 13 million people in Japan and it is one of the problems the aging society has. In order to prevent the osteoporosis, it is necessary to do early detection and treatment. Multi-slice CT technology has been improving the three dimensional (3-D) image analysis with higher body axis resolution and shorter scan time. The 3-D image analysis using multi-slice CT images of thoracic vertebra can be used as a support to diagnose osteoporosis and at the same time can be used for lung cancer diagnosis which may lead to early detection. We develop automatic extraction and partitioning algorithm for spinal column by analyzing vertebral body structure, and the analysis algorithm of the vertebral body using shape analysis and a bone density measurement for the diagnosis of osteoporosis. Osteoporosis diagnosis support system obtained high extraction rate of the thoracic vertebral in both normal and low doses.

  5. Criteria for applying imaging diagnosis and initial management for pediatric head trauma

    International Nuclear Information System (INIS)

    It may be difficult to perform CT for pediatric head trauma because of body movement and radiation exposure. Imaging application criteria were established, in which patients diagnosed as less likely to have an intracranial lesion meeting the criteria were not indicated for imaging and subjected to course observation at home, and this policy was explained to the parents. When consent was obtained, patients were followed up at home, and we checked on the condition by making a phone call 4-8 hours after injury. The patients were 103 infants aged 15 years or younger brought to the emergency medical care center of our hospital between May and August 2008. Imaging was basically indicated for cases of traffic accidents, falls from a high level, those brought in by ambulance, referred cases, and cases with disturbance of consciousness, neurologically abnormal findings, vomiting on examination, and trauma requiring X-ray examination in addition to that for the head. However, apart from these cases, imaging was not required. Imaging was not necessary for 94% of infant cases. The parents were convinced by the explanation and selected course observation at home in 94% of cases for which imaging was judged as unnecessary. None of the patients required re-examination based on the conditions reported in phone calls to homes. Imaging diagnosis for pediatric head trauma is not always necessary, and its application should be decided on after consultation. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on the child's condition by making a phone call several hours after injury is useful for both patients and physicians. (author)

  6. Computer-aided diagnosis of pneumoconiosis abnormalities extracted from chest radiographs scanned with a CCD scanner

    International Nuclear Information System (INIS)

    This paper presents a computer-aided diagnosis for pneumoconiosis radiographs obtained with a common charge-coupled devices (CCD) scanner. Since the current computer-aided diagnosis systems of pneumoconiosis are not practical for medical doctors due to high costs of usage for a special scanner, we propose a novel system which measures abnormalities of pneumoconiosis from lung images obtained with a common CCD scanner. Experimental results of discriminations between normal and abnormal cases for 56 right-lung images including 6 standard pneumoconiosis images have shown that the proposed abnormalities are well extracted according to the standards of pneumoconiosis categories. (author)

  7. Isolated Blunt Duodenal Trauma: Delayed Diagnosis and Favorable Outcome with "Quadruple Tube" Decompression

    Directory of Open Access Journals (Sweden)

    Stefano Crippa

    2007-09-01

    Full Text Available Context Isolated blunt duodenal injury is a rare finding associated with high morbidity and significant mortality. The early identification of a duodenal injury is usually difficult, considering the anatomical location of the duodenum and lack of peritoneal signs and diagnostic delay is part of the clinical picture in most cases. Case report A 43-year-old man was admitted to our hospital after a motor vehicle collision. At admission he underwent emergency surgery because of lower extremities fractures. Twelve hours later he started to complain an increasing abdominal pain; blood tests showed serum amylase up to 180 U/L and a CT scan demonstrated a perforation of the third duodenal portion. At laparotomy a Grade III injury of the duodenum was evident. The laceration was sutured and a “quadruple-tube” decompression was performed. The postoperative course was uneventful. One year after surgery he is well without any long-term complication. Conclusion A high degree of suspicion is necessary for early diagnosis of blunt duodenal trauma and CT scan should be performed in case of all significant epigastric trauma. In most cases primary direct repair of duodenal wounds can be safely achieved and duodenal decompression via triple or quadriple tube technique is required to decrease the risk of duodenal fistula.

  8. Value of the computerized axial tomography for early diagnosis of cranio cerebral trauma

    International Nuclear Information System (INIS)

    A descriptive and cross-sectional study was conducted in 62 patients with cranio cerebral trauma admitted to 'Saturnino Lora' Provincial Teaching Hospital of Santiago de Cuba, from January 2005 to May 2006, in whom computerized axial tomography indicated at the emergency room was performed with the purpose of evaluating the effectiveness of this radiographic technique for early diagnosis of the injury. In the case material there was neither association between the source and imaging results, nor between the age and sex. The main clinical manifestations were vomiting, headache and motor deficit as well as frontal location, intraparenchymatous hematoma (the latter as the most common image finding) and the hyperdense area as tomographic pattern. The survival was of 91,9%

  9. New scoring system for intra-abdominal injury diagnosis after blunt trauma

    Directory of Open Access Journals (Sweden)

    Shojaee Majid

    2014-02-01

    Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

  10. Computer-aided diagnosis workstation and telemedicine network system for chest diagnosis based on multislice CT images

    Science.gov (United States)

    Satoh, Hitoshi; Niki, Noboru; Eguchi, Kenji; Ohmatsu, Hironobu; Kakinuma, Ryutaru; Moriyama, Noriyuki

    2009-02-01

    Mass screening based on multi-helical CT images requires a considerable number of images to be read. It is this time-consuming step that makes the use of helical CT for mass screening impractical at present. Moreover, the doctor who diagnoses a medical image is insufficient in Japan. To overcome these problems, we have provided diagnostic assistance methods to medical screening specialists by developing a lung cancer screening algorithm that automatically detects suspected lung cancers in helical CT images, a coronary artery calcification screening algorithm that automatically detects suspected coronary artery calcification and a vertebra body analysis algorithm for quantitative evaluation of osteoporosis likelihood by using helical CT scanner for the lung cancer mass screening. The functions to observe suspicious shadow in detail are provided in computer-aided diagnosis workstation with these screening algorithms. We also have developed the telemedicine network by using Web medical image conference system with the security improvement of images transmission, Biometric fingerprint authentication system and Biometric face authentication system. Biometric face authentication used on site of telemedicine makes "Encryption of file" and "Success in login" effective. As a result, patients' private information is protected. We can share the screen of Web medical image conference system from two or more web conference terminals at the same time. An opinion can be exchanged mutually by using a camera and a microphone that are connected with workstation. Based on these diagnostic assistance methods, we have developed a new computer-aided workstation and a new telemedicine network that can display suspected lesions three-dimensionally in a short time. The results of this study indicate that our radiological information system without film by using computer-aided diagnosis workstation and our telemedicine network system can increase diagnostic speed, diagnostic accuracy and

  11. Optimising diagnosis and treatment of coagulopathy in severely injured trauma patients

    OpenAIRE

    Balvers, K

    2016-01-01

    Trauma has a profound impact on public health around the world. Yearly approximately 5 million people die due to traumatic injury, which is 1 out of every 3 severely injured patients. Therefore, improving survival after trauma is a major challenge in which timely therapy is of great importance. In trauma patients, massive haemorrhage is one of the leading causes of mortality. Exsanguination accounts for more than 30% of mortality in trauma patients. The main part of the treatment of massive h...

  12. Chest MRI

    Science.gov (United States)

    Nuclear magnetic resonance - chest; Magnetic resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI ... healthy enough to filter the contrast. During the MRI, the person who operates the machine will watch ...

  13. Intrathoracic lipoma masquerading as subclavian artery trauma.

    LENUS (Irish Health Repository)

    Munro, P T

    2012-02-03

    A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.

  14. Efficient radiologic diagnosis of pelvic and acetabular trauma; Rationelle bildgebende Diagnostik von Becken- und Azetabulumverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Mildenberger, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rommens, P.M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Unfallchirurgie

    2000-01-01

    In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.) [German] Bei der Klaerung einer Verletzung des Beckens oder des Azetabulums stellen konventionelle Uebersichtsaufnahmen weiterhin die Basis der bildgebenden Diagnostik dar. Art und Umfang werden bestimmt von lokalen Gegebenheiten (z.B. Verfuegbarkeit von CT-Geraeten) sowie vom klinischen Zustand des Patienten. Aufgrund der diagnostischen Ungenauigkeit der konventionellen Roentgendiagnostik gerade im Bereich des stabilitaetsbedeutsamen dorsalen Beckenringes und des Azetabulums schliesst sich beim klinisch stabilen

  15. Impact of d-Dimers on the Differential Diagnosis of Acute Chest Pain: Current Aspects Besides the Widely Known.

    Science.gov (United States)

    Hahne, Kathrin; Lebiedz, Pia; Breuckmann, Frank

    2014-01-01

    d-dimers are cleavage products of fibrin that occur during plasmin-mediated fibrinolysis of blood clots. In the emergency department, d-dimer measurement represents a valuable and cost-effective tool in the differential diagnosis of acute chest pain including the main life-threatening entities: acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Whereas the diagnostic and prognostic values of d-dimer testing in acute coronary syndrome is of less priority, increases of d-dimers are frequently found in venous thromboembolism and acute aortic syndromes, especially acute aortic dissection. As to the high negative predictive value of d-dimer in those disorders, patients with low to intermediate pretest probability may profit in terms of less necessity of further non-invasive or even invasive imaging, simultaneously reducing potential complications and healthcare-related costs. However, because of the low specificity of the different d-dimer tests in contrast to its frequent usage, adequate interpretation is required. Age-related adjustment of d-dimer levels may be used to increase its diagnostic power. PMID:25392700

  16. Chest X-Ray

    Medline Plus

    Full Text Available ... However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a tiny dose of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. ...

  17. Traumatic infra-renal aortic dissection after a high-energy trauma: a case report of a primary missed diagnosis

    Directory of Open Access Journals (Sweden)

    Holger Godry

    2014-01-01

    Full Text Available A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed injuries, but trauma computed tomography (CT scans in injured patients are still not standard. We report on a 54-year old Caucasian female patient who was involved in a car accident. The fellow passenger of the car was seriously injured. The patient had been previously treated at two different hospitals, and a dislocated acetabular fracture had been diagnosed. Because of this injury, the patient was transferred to our institution, a level 1 trauma-center where, according to the nature of the accident as a high-energy trauma, a complete polytrauma management was performed at the time of admission. During the body check, a moderate tension of the lower parts of the abdomen was detected. During the CT scan, an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery was observed. The patient required an operation on the day of admission. After 19 days post-trauma care the patient was able to leave our hospital in good general condition. Therefore, missed injuries in multiple injury patients could be fatal, and it is essential that the orthopedic surgeon leaves room for suspicion of injuries based on the nature of the trauma. Traumatic injuries of the abdominal aorta are rare. According to the ATLS® trauma schedule, all of the patients who have experienced high-energy trauma and associated fractures should undergo routine screening using a trauma CT scan with contrast agents to detect

  18. Attach importance to the early diagnosis and treatment of acute coagulation dysfunction after major war trauma

    OpenAIRE

    Li, Jie-Shou; Li, You-sheng

    2013-01-01

    Coagulation dysfunction after major war trauma is conventionally attributed to consumption and dilution of coagulation factors. However, recent studies have identified an acute coagulation dysfunction at the early stage after trauma. This coagulation dysfunction due to endogenous coagulation disturbance at the early stage after trauma is called acute traumatic coagulation dysfunction (ATCD), and the patients with ATCD would have an increased complication rate and mortality. Standard coagulati...

  19. Improved detection of pulmonary nodules on energy-subtracted chest radiographs with a commercial computer-aided diagnosis software: comparison with human observers

    International Nuclear Information System (INIS)

    To retrospectively analyze the performance of a commercial computer-aided diagnosis (CAD) software in the detection of pulmonary nodules in original and energy-subtracted (ES) chest radiographs. Original and ES chest radiographs of 58 patients with 105 pulmonary nodules measuring 5-30 mm and images of 25 control subjects with no nodules were randomized. Five blinded readers evaluated firstly the original postero-anterior images alone and then together with the subtracted radiographs. In a second phase, original and ES images were analyzed by a commercial CAD program. CT was used as reference standard. CAD results were compared to the readers' findings. True-positive (TP) and false-positive (FP) findings with CAD on subtracted and non-subtracted images were compared. Depending on the reader's experience, CAD detected between 11 and 21 nodules missed by readers. Human observers found three to 16 lesions missed by the CAD software. CAD used with ES images produced significantly fewer FPs than with non-subtracted images: 1.75 and 2.14 FPs per image, respectively (p=0.029). The difference for the TP nodules was not significant (40 nodules on ES images and 34 lesions in non-subtracted radiographs, p = 0.142). CAD can improve lesion detection both on energy subtracted and non-subtracted chest images, especially for less experienced readers. The CAD program marked less FPs on energy-subtracted images than on original chest radiographs. (orig.)

  20. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Xiong Ye

    Full Text Available Lung ultrasonography (LUS is being increasingly utilized in emergency and critical settings. We performed a systematic review of the current literature to compare the accuracy of LUS and chest radiography (CR for the diagnosis of adult community-acquired pneumonia (CAP. We searched in Pub Med, EMBASE dealing with both LUS and CR for diagnosis of adult CAP, and conducted a meta-analysis to evaluate the diagnostic accuracy of LUS in comparison with CR. The diagnostic standard that the index test compared was the hospital discharge diagnosis or the result of chest computed tomography scan as a "gold standard". We calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled diagnostic odds ratio using the DerSimonian-Laird method. Five articles met our inclusion criteria and were included in the final analysis. Using hospital discharge diagnosis as reference, LUS had a pooled sensitivity of 0.95 (0.93-0.97 and a specificity of 0.90 (0.86 to 0.94, CR had a pooled sensitivity of 0.77 (0.73 to 0.80 and a specificity of 0.91 (0.87 to 0.94. LUS and CR compared with computed tomography scan in 138 patients in total, the Z statistic of the two summary receiver operating characteristic was 3.093 (P = 0.002, the areas under the curve for LUS and CR were 0.901 and 0.590, respectively. Our study indicates that LUS can help to diagnosis adult CAP by clinicians and the accuracy was better compared with CR using chest computed tomography scan as the gold standard.

  1. CT of the chest in suspected child abuse using submillisievert radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, Thomas R.; Seibert, J.A.; Stein-Wexler, Rebecca [Medical Center Children' s Hospital, Division of Pediatric Radiology, University of California-Davis, Sacramento, CA (United States); Lee, Justin S. [University of California-Davis, Department of Radiology, Sacramento, CA (United States); Coulter, Kevin P. [Medical Center Children' s Hospital, Department of Pediatrics, University of California-Davis, Sacramento, CA (United States)

    2015-07-15

    The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. (orig.)

  2. CT of the chest in suspected child abuse using submillisievert radiation dose

    International Nuclear Information System (INIS)

    The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. (orig.)

  3. Influence of 'optical illusion' on the detectability of pneumothorax in diagnosis for chest CT images. Substantiation by visual psychological simulation images

    International Nuclear Information System (INIS)

    Some cases have been reported in which an optical illusion of lightness perception influences the detectability in diagnosis of low-density hematoma in head CT images in addition to the visual impression of the photographic density of the brain. Therefore, in this study, the author attempted to compare the detectability in diagnosis for chest images with pneumothorax using visual subjective evaluation, and investigated the influence of optical illusion on that detectability in diagnosis. Results indicated that in the window setting of lung, on such an occasion when the low-absorption free space with pneumothorax forms a crescent or the reduced lung borders on the chest-wall, an optical illusion in which the visual impression on the difference of the film contrast between the lung and the low-absorption free space with pneumothorax was psychologically emphasized when contrast was observed. In all cases the detectability in diagnosis for original images with the white thorax and mediastinum was superior to virtual images. Further, in case of the virtual double window setting of lung, thorax, and mediastinum, under the influence of the difference in the radiological anatomy of thorax and mediastinum as a result of the grouping theories of lightness computation, an optical illusion different from the original images was observed. (author)

  4. Radiation doses and image quality in pediatric chest X-ray for the diagnosis of pneumonia in selected Latin American countries

    International Nuclear Information System (INIS)

    Full text: Pneumonia and acute lower respiratory infections in general, is the leading cause of child death in developing countries. According to the World Health Organization (WHO), 4 millions of children die annually due to this disease. Despite the growing use of vaccination as an alternate approach to reduce mortality, the increasing antimicrobial resistance and the high costs of vaccines remain important obstacles in the global struggle against the disease. The usual treatment strategy begins with a clinical examination of the patient followed by the prescription of a chest X-ray. Radiography would appear as the best available method for diagnosing pneumonia only if radiologists (and other health professionals such as pediatricians) knew how to interpret the images showed in the radiographs, and these meeting the standards of quality (anatomic structures, image contrast and optical density, and patient dose among other factors). On the other hand, special attention should be paid on patient doses due to children's specific radiosensitivity, repeated and extended use of chest x-ray in all Radiology Departments, and high rejection rate due to both equipment malfunction and to human skills shortcomings. Patient doses of chest X-ray performed to children less than 5 years old in PAHO Sentinel Hospitals for surveillance of bacterial pneumonias in various Latin American countries were estimated using technical parameters and equipment specifications. Image quality was compared to WHO criteria for chest X-rays quality. Results showing differences in patient doses translates on one hand the impact of specific characteristics of the radiological equipment, including equipment limitations and performance of the radiographs and on the other various and divers levels of health professionals skills and training on image quality interpretation and dose optimization. The study concludes that professionals' training and education on chest radiographs image quality constitutes

  5. Significance of magnetic resonance imaging in the diagnosis of vertebral artery injury associated with blunt cervical spine trauma

    International Nuclear Information System (INIS)

    Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma. (author)

  6. Lymphomas presenting as chest wall tumors

    OpenAIRE

    Witte, Biruta; Hürtgen, Martin

    2006-01-01

    Four cases of thoracic lymphoma mimicking chest wall tumors are presented. As resection is not the treatment of first choice in lymphomas, pretherapeutical evaluation of chest wall tumors should include a thoroughly staging and a biopsy for histopathological diagnosis. Chest wall destruction due to an anterior mediastinal mass, or a chest wall tumor associated with mediastinal lymph node enlargement, could be suspicious of thoracic lymphoma. Lymphoma with chest wall involvement mostly turns o...

  7. Traumatic bilateral carotid artery dissection following severe blunt trauma: a case report on the difficulties in diagnosis and therapy of an often overlooked life-threatening injury

    OpenAIRE

    Crönlein, Moritz; Sandmann, Gunther H.; Beirer, Marc; Wunderlich, Silke; Biberthaler, Peter; Huber-Wagner, Stefan

    2015-01-01

    Background Traumatic carotid artery dissections are very rare, often overlooked and life-threatening injuries. Diagnosis and treatment are difficult especially in multiple injured patients. Case presentation We report on a 28-year-old female major trauma patient (injury severity score, ISS 50) who was involved in a motor vehicle accident. She was primarily transferred to a level II trauma center. After initial assessment and operative management, an anisocoria was diagnosed on the intensive c...

  8. [The diagnosis of the types of automobile-caused trauma by the nature of the injuries to the internal abdominal organs].

    Science.gov (United States)

    Solokhin, A A; Tkhakakhov, A A

    1996-01-01

    A total of 307 cases of fatal car injuries with traumas of the abdominal organs are analyzed. There were three types of injuries: those caused by collision of a pedestrian with a moving car (96 cases) injuries inflicted inside a car cabin (n = 157), and inflicted by a car wheel crossing the body (n = 54). Differences in the injuries inflicted in different types of car traumas are described. The authors demonstrate the possibility of differential diagnosis of these types of traumas in cases when the circumstances of the accident are unknown. They offer a differential diagnostic table for practical use, based on their findings.

  9. The imaging of paediatric thoracic trauma

    International Nuclear Information System (INIS)

    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  10. Computer-aided diagnosis for the detection of the pulmonary nodules on digital chest radiography in lung cancer screening

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of computer-aided detection (CAD) system for pulmonary nodule detection using digital chest radiography in lung cancer screening. Methods: One hundred consecutive digital chest radiographs from 6280 outpatients for lung cancer screening were independently reviewed by a thoracic radiologist and a computer-aided pulmonary nodule detection system. The radiographs were also reviewed by two experienced thoracic radiologists and the true nodules confirmed by two radiologists with reference to the CT images were marked and stored as a gold standard in the CAD system. The sensitivity and false positive of the radiologist and the CAD system for the detection of nodules on digital chest radiographs were compared. Results: Ninety-five and 304 nodules were identified by radiologist and the CAD system, respectively. Of 134 nodules marked as true nodules by experienced radiologists, 82 (61.2%) and 105 (78.4%) nodules were identified by the radiologist and the CAD, respectively. The radiologist missed 35 true nodules which were only detected by CAD. The CAD system missed 10 true nodules which were only detected by radiologist. One hundred and twelve (83.6%) nodules were identified by radiologist with the CAD system. One hundred and ninety-nine nodules identified by CAD were false-positive with a rate of 2.0 (199/100) per case. Conclusion: Combining review of digital radiographs by radiologist with CAD system can improve the detection of pulmonary nodules in lung cancer screening. (authors)

  11. Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high-kilovolt radiographs

    International Nuclear Information System (INIS)

    Tuberculosis (TB) remains the most common notifiable infectious disease in South Africa. The diagnosis of pulmonary TB in children is often very difficult because of the non-specific radiological signs and inter-observer variation in the interpretation of radiographs. The frontal high-kilovolt (kV) radiograph has been used to assess the effect of TB adenopathy on the tracheobronchial tree and to detect endobronchial lesions. The aims of the present study were to assess the specificity and sensitivity of chest radiographs in the diagnosis of pulmonary TB and to assess whether the addition of the high-kV radiograph affects these parameters. The study group consisted of paediatric patients suspected of having pulmonary TB over a 6-year period. These patients had clinical, bacteriological and radiographic examinations. Radiographs were examined by one experienced radiologist in two sittings separated by a 6-week interval. On the first sitting, only standard radiographs were examined and, on the second sitting, these were supplemented with high-kV radiographs. Differences in the detection of each recognized radiological feature of pulmonary TB before and after the addition of the high-kV film were analysed for statistical significance. The frequency of radiographic findings in our study compared favourably with other reports. No statistically significant differences for the detection of radiographic features consistent with pulmonary TB, or for the diagnosis of pulmonary TB, were demonstrated between the two sittings. Specificity increased from 74.4% to 86.6% with the addition of the high-kV view and sensitivity remained constant at 38.8%. The present study does not support the routine use of the frontal high-kV radiograph for the diagnosis of pulmonary TB. This paper also confirms the findings of others, that standard chest radiographs are a poor indicator of pulmonary TB in children Copyright (2004) Blackwell Publishing Asia Pty Ltd

  12. Radiology of trauma to kidney and lower urinary tract

    International Nuclear Information System (INIS)

    The contents are trauma to kidney, imaging of kidney trauma, management of renal trauma, delayed complications, trauma to the lower urinary tract, trauma to urinary bladder, radiologic diagnosis, ethiology of blunt bladder injury, urethal injury (6 refs.)

  13. INADEQUACY IN DIAGNOSIS OF BLUNT TRAUMA ABDOMEN - CAN ANAESTHESIOLOGIST BE BAFFLED BY CATASTROPHIC INTRAOPERATIVE FINDINGS?

    Directory of Open Access Journals (Sweden)

    Joyanta Kumar

    2015-08-01

    Full Text Available The magnitude of injury inflicted by Blunt trauma abdomen has varied manifestations ranging from minor single - system injury to devastating, multi - system injury .Blunt trauma abdomen alone or in association with polytrauma is a frequent presentation in the emergency department. High index of suspicion and clinical acumen is required during evaluation of blunt abdominal injuries because physical signs and symptoms indicating presence of visceral lesions may poorly correlate with clinical presentation. Diagnostic peritoneal tapping is considered safe initial option with high accuracy but carries possibility of significant false positive and false negative result. Ultrasonography (FAST ha s its own limitations; although CT findings can be conclusive it involves time for analysis and the patient should be cooperative. Blunt trauma abdomen may present with life threatening internal haemorrhage due to visceral or vascular injuries prompting em ergency surgical intervention at odd hours with limited investigations and resources, Pre anaesthetic optimization by maintenance of adequate tissue oxygenation with optimal blood volume replacement and judicious use of inotropes, determine outcome of such emergency procedures. Careful selection of anaesthetic techniques and drugs particularly the inducing agents can be life - saving. Agility of the attending anesthesiologist to handle unforeseen intra operative critical events plays a pivotal role in overall outcome. We are discussing Anaesthetic management of a 23 year old victim of road traffic accident, who sustained blunt trauma abdomen about 24 hrs. Back, was conscious, oriented and ambulatory till the time of shifting to the operating theatre but on exp loration sudden gush of blood from a preoperatively undetected 7 cms long tear of the sub diaphragmatic part of IVC, and lacerated liver almost exsanguinated the patient.

  14. Radionuclide evaluation of lung trauma.

    Science.gov (United States)

    Lull, R J; Tatum, J L; Sugerman, H J; Hartshorne, M F; Boll, D A; Kaplan, K A

    1983-07-01

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs. PMID:6226097

  15. Radionuclide evaluation of lung trauma

    Energy Technology Data Exchange (ETDEWEB)

    Lull, R.J.; Tatum, J.L.; Sugerman, H.J.; Hartshorne, M.F.; Boll, D.A.; Kaplan, K.A.

    1983-07-01

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

  16. Radionuclide evaluation of lung trauma

    International Nuclear Information System (INIS)

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs

  17. The value of chest CT scan and tumor markers detection in sputum for early diagnosis of peripheral lung cancer

    Institute of Scientific and Technical Information of China (English)

    WANG Xu; CAO Aihong; PENG Mengqing; HU Chunfeng; LIU Delin; GU Tao; LIU Hui

    2004-01-01

    Objective To investigate the diagnostic value of chest CT scan combined with telomerase activity and p16 gene methylation from exfoliated cells of sputum in 55 cases of solitary pulmonary nodules (SPN; ≤30 mm)suspected early peripheral lung cancer. Methods The sputum specimens from 34 cases of cancer nodules and 21 cases of benign lesion were detected for telomerase activity by TRAP-PCR-ELISA and p16 gene methylation by PCR-based methylation analysis. Results The qualitative diagnostic accuracy of CT scan was 61.8%(34/55) for SPN provided by pathology. Cytology analysis of sputum was positive in 13 cases (38.2%). Telomerase activity was positive in 29 cases: sensitivity was 79.4%, specificity was 90.5%, accuracy was 83.6%; p16 gene methylation was found in 11 cases: sensitivity was 32.4%, specificity was 100.0%, and accuracy was 58.2%. The sensitivity was increased to 86.1% by combination of telomerase activity and p16 gene methylation. Compared with nodules without malignant CT signs, expression of telomerase activity and p16 methylation of SPN with malignant CT signs (lobulation or spiculate protuberance or spicule sign) had a significant difference (P<0.01). Conclusion The results suggest that chest CT scan combined with telomerase activity and p16 gene methylation detection in sputum for patients with peripheral lung cancer may enhance the diagnostic value of radiology and conventional cytology.

  18. The chest

    International Nuclear Information System (INIS)

    Radiographic interpretation of chest films of newborns in respiratory distress remains one of the most difficult aspects of pediatric radiology. Complex pulmonary and cardiac adjustments to extrauterine life are rapidly taking place. The small, fluid-filled fetal lung must rid itself of fluid and fill with air. The high vascular resistance of the fetal pulmonary bed and the open ductus arteriosus allow shunting of blood in both directions. Films taken in this period of time may show lungs that resemble those seen in congestive heart failure or fluid overload. When these findings are observed in infants who may appear dusky or even cyanotic, the result may be the diagnosis of disease in normal infants passing through a stormy transition period. To make things worse, the films are taken as portable surpine films, usually in an isolette in the intensive care unit (ICU). The phase of respiration is difficult, if not impossible, to control, and lateral films are usually not obtained. Many of the infants are on assisted ventilation either by tube or nasal prongs-nasal continuous positive airway pressure (CPAP)-and lungs can appear over-inflated or whited out, depending on the pressures used and the phase of the respiratory cycle. Prolonged crying itself can make lungs appear semiopaque; the next breath may show such a dramatic reinflation that it is hard to believe the two films are of the same infant, made only seconds apart. Is the heart large? Or is it the thymus? Are the lungs ''wet''? Is there infection? Is there pulmonary vascular engorgement? Why are these films so hard to interpret? They have no easy answers. The radiologist must realize that the neonatal intensive care personnel, armed though they may be with blood gas values, are no better at interpreting films. If anything, they read into them what they wish to see

  19. High-resolution computed tomography versus chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis; Avaliacao da tomografia de alta resolucao versus radiografia de torax na doenca intersticial pulmonar na esclerose sistemica

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, Ana Beatriz Cordeiro de; Calderaro, Debora; Moreira, Caio [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Reumatologia; Guimaraes, Silvana Mangeon Meirelles [Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Secao de Tomografia Computadorizada; Tavares Junior, Wilson Campos; Leao Filho, Hilton Muniz; Andrade, Diego Correa de [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Radiologia e Diagnostico por Imagem]. E-mail: wilsontavaresjrmd@yahho.fr; Ferreira, Cid Sergio; Vieira, Jose Nelson Mendes [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina. Dept. de Radiologia

    2005-04-01

    Objective: To compare the accuracy of high-resolution computed tomography (HRCT) with chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis (SSc). Materials And Methods: HRCT scans and chest radiographs in postero-anterior and lateral views were performed in 34 patients with systemic sclerosis, according to the American College of Rheumatology preliminary criteria for the diagnosis of SSc. The prevalence of radiological findings suggestive of interstitial lung disease in SSc seen on both imaging methods was compared. Results: Interstitial disease was observed on HRCT images of 31 patients (91%) and in the chest radiographs of 16 patients (47%). The most frequent findings observed on HRCT were septal lines (74%), honeycombing (56%) and parenchymal bands (26%). Chest radiographs showed reticular areas of attenuation in 11 patients (32%) and parenchymal distortion in 12% of the patients. In 18 patients (53%) with normal chest radiographs HRCT showed septal lines in 55%, ground glass in 44%, honeycombing in 38.5% and cysts in 33%. Conclusion: HRCT is more sensitive than chest radiography in the evaluation of incipient interstitial lung involvement in patients with SSc and can provide a justification for immunosuppressive therapy in patients with early disease. (author)

  20. 双腔气管插管提高严重胸部创伤开胸手术疗效的应用体会%Double-lumen endotracheal intubation to improve the efficacy of thoracotomy for severe chest trauma

    Institute of Scientific and Technical Information of China (English)

    向江侠; 高劲谋; 胡平; 刘朝普; 王建柏

    2013-01-01

    目的 探讨应用双腔气管插管对胸外伤开胸手术的应用价值.方法 58例严重胸外伤伴有气道出血或(和)支气管断裂需要开胸手术的患者中,其中36例应用双腔气管插管,22例按常规行单腔气管插管.回顾分析两组患者氧分压、二氧化碳分压、氧饱和度、氧合指数、术后肺部感染、肺不张、急性肺损伤(ALI)的差异.结果 两组氧分压、二氧化碳分压、氧饱和度、氧合指数比较,其统计学有差异(P<0.05).两组术后肺部感染,肺不张及急性肺损伤发生率统计学有差异(P<0.05).结论 严重胸外伤伴有气道出血或(和)支气管断裂需要开胸手术的患者中应用双腔气管插管,能减少支气管断裂伤后潮气量的丢失,防止气道出血进入健侧导致窒息的危险,更好地保证患者呼吸平稳,降低术后并发症.%Objective To evaluate the value of the double -lumen endotracheal intubation in thoracotomy in chest trauma patients. Methods There were 58 patients with severe chest trauma associated with airway bleeding and/or bronchial rupture requiring thoracotomy , including 36 cases of double -lumen endotracheal intubation ,22 cases of conventional single -lumen endotracheal intubation. Data differences in partial pressure of oxygen , carbon dioxide partial pressure , oxygen saturation , oxygenation index , pulmonary infection , atelectasis , acute lung injury ( ALI) were retrospectively analyzed between the two groups . Results There was statistical difference in partial pressure of oxygen, carbon dioxide partial pressure , oxygen saturation and oxygenation index in the double -lumen intubation group (P < 0. 01). And there was statistical difference in pulmonary infection and in the incidence of atelectasis and acute lung injury (ALI) (P <0. 05 ) between the two groups. Conclusion Performing double -lumen endotracheal intubation in severe chest trauma patients associated with airway bleeding and /or bronchial rupture

  1. 重症胸部创伤并创伤性休克急诊手术的护理配合%Severe chest trauma and traumatic shock with emergency surgery care

    Institute of Scientific and Technical Information of China (English)

    梁姣; 王丽霞

    2015-01-01

    Objective:To investigate severe chest trauma and traumatic shock clinical methods with emergency surgical care , and summarizes their nursing experience.Methods: 32 patients with severe chest trauma and traumatic shock underwent emergency surgery, there is predictability in the surgery to take timely and effective rescue and care measures.Results:Intraoperative fully prepared to rescue timely, accurate, except for one case in which she died , the rest were rescued. Conclusion:Emergency surgery nurses familiar with first aid knowledge , proficiency solid first-aid skills , can be timely and effective care with the emergency surgery. Surgical nurses should have some knowledge of medical aid , has to identify diagnostic capabilities and skilled rescue techniques , familiar cardiothoracic surgery procedures. In the course of the emergency cardiothoracic surgery , nurses should have a high degree of responsibility, stand ready and pre-treatment of the emergency rescue , skilled with the rescue program , effective rescue for patients to gain time , for severe chest trauma and traumatic shock emergency successful surgery is important.%目的 探讨重症胸部创伤并创伤性休克急诊手术护理配合的临床方法,总结其护理经验.方法 32例重症胸部创伤并创伤性休克的患者施行急诊手术,在术中有预见性地采取及时有效的抢救及护理措施.结果 术中准备充分、抢救及时、准确,其中除1例抢救无效死亡外,其余均抢救成功.结论 急诊手术护理人员熟悉掌握急救知识,熟练扎实急救技能,可在急诊手术中进行及时有效的护理配合.手术护理人员应掌握一定的医学急救知识,具有辨别诊断能力和熟练的抢救技术,熟悉心胸外科手术程序.在急诊心胸外科手术过程中,护理人员应具备高度责任心,随时做好抢救的准备和各项应急预处理,熟练配合抢救程序,为患者有效抢救赢得时间,对重症胸部创伤并创伤性

  2. Chest drainage.

    Science.gov (United States)

    Carter, Chris

    2014-07-15

    As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD article useful in reviewing the pathophysiology of a pneumothorax, use of intrapleural chest drains, observations that should be recorded, and nursing care and management of a patient with an intrapleural chest drain. Reflecting on the time out activities in the CPD article was valuable. PMID:25005418

  3. Correção de aneurisma do tronco braquiocefálico, 10 anos após traumatismo torácico fechado Correction of an innominate artery aneurysm, 10 years after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    José Almeida Lopes

    2012-03-01

    Full Text Available Aneurismas do tronco braquiocefálico são extremamente raros. Os autores apresentam o caso clínico de um doente de 22 anos de idade, com antecedente de atropelamento de alta energia há cerca de 10 anos por motociclo, com traumatismo toraco-abdominal anterior, em quem foi acidentalmente descoberto um aneurisma do tronco braquiocefálico com 52mm. Para a exclusão do referido aneurisma o doente foi submetido com sucesso à construção de um bypass aorta ascendente-carotídio-subclávio com prótese bifurcada de Dacron® (14x7mm, com abordagem por esternotomia mediana, cervical e supra-clavicular. É feita uma revisão da literatura, sendo descritas e discutidas as características clínicas, o tratamento cirúrgico e o mecanismo de traumatismo torácico sobre o tronco braquiocefálico.Innominate artery aneurysms are extremely rare. The authors present a case report of a 22-year-old patient, in whom was accidently discovered an innominate artery aneurysm of 52 mm, 10 years after a blunt thoraco-abdominal trauma caused by a high energy running over by a motorcycle. For the exclusion of the aneurysm, the patient was successfully submitted to the construction of an ascending aorta-carotid-subclavian bypass with bifurcated Dacron® graft (14x7mm, by means of a median sternotomy, right cervical and supra-clavicular approaches. Review of the literature, clinical features, surgical treatment and chest trauma mechanisms over the innominate artery are described and discussed.

  4. Abdominal trauma

    International Nuclear Information System (INIS)

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  5. Preservation of the kidney with delayed diagnosis of traumatic pelvi-ureteric junction disruption secondary to blunt abdominal trauma in children

    Institute of Scientific and Technical Information of China (English)

    LI Ming-lei; LI Ning; SUN Ning; ZHANG Wei-ping; HUANG Cheng-ru; BAI Ji-wu; LIANG Ruo-xin; TIAN Jun; XIE Xiang-hui; SONG Hong-cheng

    2011-01-01

    Background The delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays. Methods A retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up. Results The interval from trauma to diagnosis of PUJ disruption was (52±52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40±20) days. The average time between injury and first treatment was (49±25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4patients, respectively. lleal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%. Conclusion Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.

  6. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure

    OpenAIRE

    Cardinale, Luciano; Priola, Adriano Massimiliano; Moretti, Federica; Volpicelli, Giovanni

    2014-01-01

    Hydrostatic pulmonary edema is as an abnormal increase in extravascular water secondary to elevated pressure in the pulmonary circulation, due to congestive heart failure or intravascular volume overload. Diagnosis of hydrostatic pulmonary edema is usually based on clinical signs associated to conventional radiography findings. Interpretation of radiologic signs of cardiogenic pulmonary edema are often questionable and subject. For a bedside prompt evaluation, lung ultrasound (LUS) may assess...

  7. Contemporary management of flail chest.

    Science.gov (United States)

    Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

    2014-06-01

    Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management. PMID:24887787

  8. Contemporary management of flail chest.

    Science.gov (United States)

    Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

    2014-06-01

    Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

  9. [The differential diagnosis of the types of trauma caused by wheeled tractors].

    Science.gov (United States)

    Zaval'niuk, A Kh

    1993-01-01

    Examinations of 23 corpses and study of 282 expert conclusions concerning the deaths of subjects aged 6 to 78 dead because of wheeled tractor injuries under agricultural conditions helped detect the specific characteristic signs of tractor injury types. Mathematical method of analysis of the characteristic features' quantitative parameters permitted the author to find statistically reliable criteria for differential diagnosis of the types of injuries inflicted by wheeled tractors. The possibility of correct conclusions of an expert using this method is at least 95%. PMID:7940629

  10. Traumatic avulsion of kidney and spleen into the chest through a ruptured diaphragm in a young worker: a case report

    Directory of Open Access Journals (Sweden)

    Stamatiou Konstantinos

    2007-12-01

    Full Text Available Abstract Introduction Rupture of the diaphragm is almost always due to major trauma. Diaphragmatic injuries are rare (5–7%, usually secondary to blunt, or more rarely to penetrating, thoracic or abdominal trauma. No single investigation provides a reliable diagnosis of diaphragmatic rupture when a patient first arrives at hospital. Almost 33% are suspected on initial chest x-ray, but the percentage is lower in patients who are immediately intubated. Mortality in patients with diaphragmatic rupture following blunt abdominal trauma is generally associated with coexistent vascular and visceral injuries that could be rapidly fatal. It's mandatory that the right diagnosis is reached as soon as possible given that mortality is influenced by the time elapsing between trauma and diagnosis. Case presentation A 35-year-old worker was hit by a heavy object while working in the factory. He was transferred immediately to our emergency room. Chest x-ray showed massive left hemothorax without any additional signs to suggest diaphragmatic injury. It was decided to perform immediate surgical exploration before further radiological examination. During surgery, the right kidney and liver appeared normal, but the left kidney and spleen were not found in their anatomical position. The left hemidiaphragm had a10-cm oblique posterior tear. The left kidney was found lacerated in the left side of the chest, separated completely from its vascular pedicle and ureter, along with the entire spleen which was also separated from its vascular tree. Conclusion The avulsion of both kidney and spleen following abdominal trauma is uncommon and survival depends on prompt diagnosis and treatment.

  11. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high,duodenal trauma should be treated in time and tactfully.And application of new technology can help improve the management. In this review, we discussed the incidence,diagnosis, management, and complications as well as mortality of duodenal trauma.

  12. What Is Chest MRI?

    Science.gov (United States)

    ... from the NHLBI on Twitter. What Is Chest MRI? Chest MRI (magnetic resonance imaging) is a safe, noninvasive test. "Noninvasive" means that ... your chest wall, heart, and blood vessels. Chest MRI uses radio waves, magnets, and a computer to ...

  13. Diagnosis and treatment of duodenal trauma%十二指肠损伤的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    艾涛; 高劲谋; 胡平; 赵山红; 王建柏

    2014-01-01

    Objective To assess the experience in the diagnosis and treatment of duodenal trauma.Methods The clinical data of 58 patients with duodenal trauma who were admitted to the Chongqing Emergency Medical Center from March 1994 to March 2013 were retrospectively analyzed.There were 47 patients with blunt injury and 11 with penetrating injury.The surgical procedure was selected by patient's condition and extent of injury combined with the clinical symptoms,imaging examination,abdominal puncture and the Organ Injury Scale grading system of the American Association for the Surgery of Trauma (AAST-OIS).All patients were followed up through outpatient examination and telephone interview till September 2013.Results Seventeen patients were diagnosed as with duodenal trauma before operation,and 41 patients were diagnosed during the operation.The injury of the first part of the duodenum was observed in 7 patients,second part in 28 patients,third part in 17 patients and fourth part in 6 patients.According to the AAST-OIS,7 patients were with grade Ⅰ injury,17 in grade Ⅱ,20 in grade m,9 in grade Ⅳ and 5 in grade Ⅴ.The 58 patients received operation,including 23 with simple suture,4 with serosa section,hematoma evacuation and repair,7 with pedicled ileal flap to repair duodenal defect,5 with resection of ruptured intestine and end-to-end anastomosis,12 with Roux-en-Y duodenojejunostomy,2 with gastrojejunostomy,4 with pancreaticoduodenectomy,1 with doudenal,choledochal and pancreatic duct extensive drainage.Forty-eight patients were cured successfully and 10 patients died,including 4 died of complications of the duodenal trauma.The duodenal stenosis,duodenal fistula and abdominal abscess were the main complications.Six patients were lost to follow-up and 42 patients were followed up from 6 to 36 months.There were 3 patients with gastrointestinal tract defect and obstructive symtoms,with a missing of complications at postoperative month 6 to 12.One patient with

  14. 肠内营养混悬液在重症胸部创伤患者中的早期应用%Early application of enteral nutrition suspension to patients with severe chest trauma

    Institute of Scientific and Technical Information of China (English)

    丁盛; 张小虹; 向可翠; 梁瑜

    2013-01-01

    目的 观察肠内营养混悬液(TPF-FOS)在重症胸部创伤患者早期肠内营养(EN)治疗中的疗效和安全性.方法 2010年1月~2012年1月,将收治的48例重症胸部创伤患者随机分成观察组和对照组,观察组于入住ICU 48 h内开始EN治疗(经鼻饲管给予TPF-FOS),对照组则在入住ICU 48 h后开始EN治疗,达到目标喂养量125.52 kJ(30 kcal)/(kg·d)至少3 d,观察患者入住ICU后1、3、5、7、10 d的血清蛋白水平、胃肠道不良反应发生率、机械通气时间、平均ICU住院时间等,并记录不良事件.结果 早期EN支持后第7 d及第10 d,观察组血清前白蛋白水平明显优于对照组(P<0.05);第1 d至第10 d两组间血清白蛋白与转铁蛋白水平均无显著差异.两组间胃肠道反应发生率无显著差异,观察组的机械通气时间、平均ICU住院时间均少于对照组(P<0.05).结论 重症胸部创伤患者早期管饲TPF-FOS可使血清前白蛋白水平及早得到恢复,尽早改善患者的营养状态,缩短患者机械通气和ICU住院时间.%Objective To observe the efficacy and safety of enteral nutrition suspension ( total protein fiber fruto -oligosaccharide, TPF - FOS )in the early enteral nutrition! EN treatment of patients with severe chest trauma. Methods From January 2010 to January 2012,48 patients with severe chest trauma were randomly divided into observation group and control group. The observation group began to receive the EN treatment within 48 hours after the admission to ICU( receiving TPF - FOS via nasogastric feeding tube ),while the control group began to receive the EN treatment 48 hours after the admission to ICU. A targeted content of 125. 52 J( 30 kcal )/( kg ? d )was given at least for 3 days. Observation was made in the level of serum proteins, the incidence of gastrointestinal adverse reactions,the time of mechanical ventilation,and the average length of stay in ICU,etc,on day 1 ,3 ,5 ,7 and 10 after admission to ICU. And the

  15. The chest X-ray manifestations of children with highly pathogenic H5N1 avian influenza virus infection (a report of 1 final diagnosis case and 1 borderline case)

    International Nuclear Information System (INIS)

    Objective: To describe the chest X-ray manifestations of children with highly pathogenic H5N1 avian influenza virus infection. Methods: The pulmonary X-ray findings in 1 patient was confirmed by the World Health Organization infected H5N1 avian influenza vires and 1 borderline patient was retrospectively analyzed. Results: Both sides of lung field showed the cloudy and massive infiltration in chest X-ray film. The lesions of lung distributed extensively and symmetrically. Radiological dynamic changes showed the variation of the lesions of lung was quick in a short time. It had a characteristic of roving around. The lesions of lung appeared fibrosis at the period of the end. Conclusion: There are some radiographic characteristics in children with H5N1 avian influenza vires infection. It will be helpful for its diagnosis when getting familiar with its X-ray manifestations, but the final diagnosis is dependent on the epidemiology history and laboratory results. (authors)

  16. Sandstorm in the chest?

    Directory of Open Access Journals (Sweden)

    Talluri MR

    2011-07-01

    Full Text Available A 32 year old female presented with dry cough and progressive breathlessness of one year duration. There was no history suggestive of collagen vascular disease, lung parenchymal infection or allergic airway disease. Clinical evaluation showed basal fine inspiratory crepitations. Radiographic examination of the chest revealed a black pleura line and lung parenchymal calcification. CT scan of the chest demonstrated nodular calcification of lung parenchyma with a “crazy pavement” pattern, which is suggestive of alveolar calcification. Pulmonary function test showed a severe restrictive defect. On transbronchial lung biopsy calcific spherules suggestive of the alveolar microlithiasis were seen. Diagnosis of pulmonary alveolar microlithiasis was made and symptomatic treatment was given, as there is no specific therapy available. The case illustrates an unusual cause of shortness of breath in a young female with striking radiographic features.

  17. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander;

    2012-01-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTrauma...

  18. Musculoskeletal problems of the chest wall in athletes.

    Science.gov (United States)

    Gregory, Peter L; Biswas, Anita C; Batt, Mark E

    2002-01-01

    Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain

  19. Computer-aided diagnosis workstation and teleradiology network system for chest diagnosis using the web medical image conference system with a new information security solution

    Science.gov (United States)

    Satoh, Hitoshi; Niki, Noboru; Eguchi, Kenji; Ohmatsu, Hironobu; Kaneko, Masahiro; Kakinuma, Ryutaro; Moriyama, Noriyuki

    2010-03-01

    Diagnostic MDCT imaging requires a considerable number of images to be read. Moreover, the doctor who diagnoses a medical image is insufficient in Japan. Because of such a background, we have provided diagnostic assistance methods to medical screening specialists by developing a lung cancer screening algorithm that automatically detects suspected lung cancers in helical CT images, a coronary artery calcification screening algorithm that automatically detects suspected coronary artery calcification and a vertebra body analysis algorithm for quantitative evaluation of osteoporosis. We also have developed the teleradiology network system by using web medical image conference system. In the teleradiology network system, the security of information network is very important subjects. Our teleradiology network system can perform Web medical image conference in the medical institutions of a remote place using the web medical image conference system. We completed the basic proof experiment of the web medical image conference system with information security solution. We can share the screen of web medical image conference system from two or more web conference terminals at the same time. An opinion can be exchanged mutually by using a camera and a microphone that are connected with the workstation that builds in some diagnostic assistance methods. Biometric face authentication used on site of teleradiology makes "Encryption of file" and "Success in login" effective. Our Privacy and information security technology of information security solution ensures compliance with Japanese regulations. As a result, patients' private information is protected. Based on these diagnostic assistance methods, we have developed a new computer-aided workstation and a new teleradiology network that can display suspected lesions three-dimensionally in a short time. The results of this study indicate that our radiological information system without film by using computer-aided diagnosis

  20. Trauma Kimia

    OpenAIRE

    Lubis, Rodiah Rahmawaty

    2015-01-01

    Mata merupakan organ yang keberadaannya berhubungan langsung dengan lingkungan luar sehingga sering menyebabkan mata terkena dampak dari posisi anatominya tersebut. Mata sering terpapar dengan keadaan lingkungan sekitar seperti udara, debu, benda asing dan suatu trauma yang dapat langsung mengenai mata. Trauma pada mata meliputi trauma tumpul, trauma tajam, trauma kimia, dan trauma radiasi. Rodiah Rahmawaty Lubis

  1. 川芎嗪干预钝性肺挫伤急性期大鼠肺组织细胞的凋亡*%Ligustrazine prevents lung cell apoptosis in the acute stage of pulmonary contusion induced by blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    曹晨; 邓应忠; 郑明安; 刘芳; 孟庆涛

    2013-01-01

      背景:急性胸部撞击后所致的肺挫伤(钝性肺挫伤)常引起呼吸功能异常和继发性炎性反应,并参与全身炎性反应综合征和多器官功能障碍综合征,其发病原因及致病机制亟待明确。目的:观察胸部撞击所致钝性肺挫伤急性期细胞凋亡的变化及其川芎嗪对其的影响。方法:健康雄性 SD 大鼠随机分为正常对照组、模型组、川芎嗪治疗组,后两组制备胸部撞击伤模型,川芎嗪治疗组建模后立即腹腔注射川芎嗪80 mg/kg 1次。在创伤发生后1,2,3 h 观察肺组织病理形态学及细胞凋亡的改变、检测肺水肿程度和肺血管通透性改变,免疫组织化学检测肺组织 Bcl-2、Bax和 Caspase-3的表达及血液中肿瘤坏死因子α水平变化。结果与结论:模型组肿瘤坏死因子α水平在创伤后1 h 即显著增加,创伤后2 h 及3 h 间急剧增加(P <0.05);创伤后2 h 及3 h 肺组织细胞凋亡指数及肺组织损伤程度显著增高(均 P <0.05);肺血管通透性及肺水肿程度增加(P <0.05);Caspase-3表达显著增高(P <0.05),Bcl-2/Bax 比值显著降低(P <0.05)。川芎嗪治疗组在相应时间点相对于模型组肿瘤坏死因子α水平显著降低(P <0.05),肺组织内细胞凋亡指数及肺组织损伤程度降低(P <0.05),肺血管通透性及肺水肿程度减轻(P <0.05);Caspase-3表达下降(P <0.05),Bcl-2/Bax 比值增加(P <0.01)。结果提示,川芎嗪可通过抑制肿瘤坏死因子α表达,下调 Caspase-3的表达并提高 Bcl-2/Bax 的比值,以降低胸部撞击所致肺组织急性期的异常凋亡并减轻胸部撞击所致急性期肺挫伤。%BACKGROUND: Pulmonary contusion induced by blunt chest trauma can result in respiratory dysfunction and secondary inflammatory reaction, which can take part in the occurrence of systemic inflammatory response syndrome and multiple-organ dysfunction syndrome. However, the reason and mechanism

  2. Infarto do miocárdio causado por lesão arterial coronariana após trauma torácico fechado Infarto de miocardio causado por lesión arterial coronaria post traumatismo torácico cerrado Myocardial infarction caused by coronary artery injury after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Márcio Silva Miguel Lima

    2009-07-01

    Full Text Available Relatamos o caso de um indivíduo do sexo masculino de 29 anos de idade, vítima de um acidente de carro no qual sofreu trauma torácico fechado, evoluindo com insuficiência cardíaca congestiva. O paciente apresentava boa saúde previamente, sem sintomas de doença cardiovascular. Na avaliação inicial, o eletrocardiograma mostrou ondas Q nas derivações precordiais e o ecocardiograma mostrou disfunção ventricular esquerda importante. A angiografia coronária mostrou uma lesão na artéria coronária descendente anterior esquerda (ADE, com acinesia da parede anterior na ventriculografia com contraste. A tomografia computadorizada por emissão de fóton único (SPECT com Tálio-201 não mostrou viabilidade. O paciente foi mantido em tratamento clínico com boa evolução.Relatamos el caso de un individuo del sexo masculino, de 29 años de edad, víctima de accidente automovilístico en el cual sufrió traumatismo torácico cerrado, evolucionando con insuficiencia cardíaca congestiva. El paciente presentaba buena salud previamente, sin síntomas de enfermedad cardiovascular. En la evaluación inicial, el electrocardiograma mostró ondas Q en las derivaciones precordiales y el ecocardiograma mostró disfunción ventricular izquierda importante. La angiografía coronaria mostró una lesión en la arteria coronaria descendente anterior izquierda (ADI, con acinesia de la pared anterior en la ventriculografía de contraste. La tomografía computada por emisión de fotón único (SPECT con Talio-201 no mostró viabilidad. El paciente fue mantenido en tratamiento clínico con buena evolución.We report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. He had previously had a good overall health status, with no symptoms of cardiovascular disease. At the initial assessment, the electrocardiogram showed Q waves in the precordial leads and the echocardiogram

  3. Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery

    Science.gov (United States)

    Nicolas, Gregory; Kfoury, Tony; Shimlati, Rasha; Koury, Elliott; Tohme, Maroon; Gharios, Elie; Wakim, Raja

    2016-01-01

    Case series Patients: Male, 33 • Male, 18 • Male, 19 Final Diagnosis: Congenital band causing a small bowel obstruction Symptoms: Progressive abdominal pain that eventually becomes excessive Medication: — Clinical Procedure: Laparoscopic band removal Specialty: Surgery Objective: Rare disease Background: Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. Case Reports: All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. Conclusions: Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative. PMID:27713389

  4. Encuesta a neumonólogos sobre el diagnóstico y tratamiento de EPOC Survey of chest physicians regarding copd diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Martín L. Sívori

    2004-04-01

    encuestados indican la vacuna antigripal y el 91.4% la antineumocóccica. Según los encuestados el 37% de los pacientes continúan fumando. Nuestros especialistas utilizan pautas que están de acuerdo con las guías de diagnóstico y tratamiento. Como primera opción en el tratamiento crónico es muy utilizada la asociación de AC + BAAC y escasamente los CI y los BAAL.A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed. They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria. Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S, and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8% followed by nebulization (16.5%, dry powder inhalation (13.7% and oral administration (4.8%. First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC + short acting b2-agonists (SABA (65.5%, AC alone (18.8%, long acting b2-agonists (LABA (9.7%, inhaled corticosteroids (IC (3.5% and SABA alone (2.8%. Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice

  5. Green turtle head trauma with intracerebral hemorrhage: image diagnosis and treatment Traumatismo craniano com hemorragia intracerebral em tartaruga verde: diagnóstico por imagem e tratamento

    Directory of Open Access Journals (Sweden)

    Daphne Wrobel Goldberg

    2010-11-01

    Full Text Available Sea turtles are threatened to the point of extinction. The major goal of rehabilitating injured individuals is to eventually reintroduce them back into their habitat. Sea turtles are vulnerable to anthropogenic effects, and impact traumas are a common cause of death among these animals. Carapace and skull fractures are usually related to vessel collisions or propeller impacts. However, intentional traumas inflicted by humans are also considered as a potential threat. The purpose of this article is to describe the diagnosis and rehabilitation procedures of a juvenile green turtle (Chelonia mydas after severe head trauma with brain hemorrhage. The data presented here can be used as a reference for future cases of head trauma in chelonians.Tartarugas marinhas são animais ameaçados de extinção. Por isso, o principal objetivo em reabilitar indivíduos feridos é posteriormente reintroduzi-los em seu habitat. Quelônios marinhos apresentam grande vulnerabilidade a efeitos antropogênicos, e a ocorrência de traumatismos impactantes constituem uma importante causa de óbitos entre esses animais. Fraturas de carapaça e crânio estão normalmente associadas a colisões por embarcações. No entanto, lesões intencionais provocadas por humanos também podem ser consideradas ameaças em potencial. O objetivo deste estudo é descrever o diagnóstico e a reabilitação de um indivíduo jovem de tartaruga verde (C. mydas após traumatismo craniano severo com hemorragia cerebral. Os dados apresentados poderão ser utilizados como referências para casos futuros de traumatismos afetando a região da cabeça de quelônios.

  6. Isolated blunt chest injury leads to transient activation of circulating neutrophils

    OpenAIRE

    Visser, T.; Hietbrink, F.; Groeneveld, K. M.; Koenderman, L; Leenen, L.P.H.

    2010-01-01

    Introduction The acute respiratory distress syndrome (ARDS) is a severe and frequently seen complication in multi-trauma patients. ARDS is caused by an excessive innate immune response with a clear role for neutrophils. As ARDS is more frequently seen in trauma patients with chest injury, we investigated the influence of chest injury on the systemic neutrophil response and the development of ARDS. Materials and methods Thirteen patients with isolated blunt chest injury [abbreviated injury sco...

  7. Linguistic characteristics in a non-trauma-related narrative task are associated with PTSD diagnosis and symptom severity.

    Science.gov (United States)

    Papini, Santiago; Yoon, Patricia; Rubin, Mikael; Lopez-Castro, Teresa; Hien, Denise A

    2015-05-01

    Linguistic characteristics of trauma narratives have been linked to the development and severity of posttraumatic stress disorder (PTSD). However, it remains unclear if linguistic markers of PTSD exist beyond the scope of trauma narratives. This study used ambiguous visual prompts to elicit spontaneous narratives from trauma-exposed individuals with (n = 23) and without PTSD (n = 30). Individuals with PTSD used more singular pronouns and death-related words, and fewer plural pronouns. Within the PTSD group, increased severity of reexperiencing symptoms was associated with greater use of singular pronouns and lower use of cognitive words; increased severity of avoidance symptoms was associated with lower use of death words; and increased severity of hyperarousal symptoms was associated with less frequent use of anxiety words. Together, these linguistic variables accounted for 53% of the variance in total PTSD symptom severity. These findings are consistent with previous research suggesting that language use is a strong predictor of PTSD psychopathology, and extend the evidence to include the linguistic characteristics of non-trauma-related narratives. PMID:25961121

  8. Chest X-Ray

    Medline Plus

    Full Text Available ... by: Image/Video Gallery Your radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

  9. Radiology illustrated. Chest radiology

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Radiology; Han, Joungho [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Pathology; Chung, Man Pyo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Medicine; Jeong, Yeon Joo [Pusan National Univ. Hospital, Busan (Korea, Republic of). Dept. of Radiology

    2014-04-01

    Pattern approach to the diagnosis of lung diseases based on CT scan appearances. Guide to quick and reliable differential diagnosis. CT-pathology correlation. Emphasis on state-of-the-art MDCT. The purpose of this atlas is to illustrate how to achieve reliable diagnoses when confronted by the different abnormalities, or ''disease patterns'', that may be visualized on CT scans of the chest. The task of pattern recognition has been greatly facilitated by the advent of multidetector CT (MDCT), and the focus of the book is very much on the role of state-of-the-art MDCT. A wide range of disease patterns and distributions are covered, with emphasis on the typical imaging characteristics of the various focal and diffuse lung diseases. In addition, clinical information relevant to differential diagnosis is provided and the underlying gross and microscopic pathology is depicted, permitting CT-pathology correlation. The entire information relevant to each disease pattern is also tabulated for ease of reference. This book will be an invaluable handy tool that will enable the reader to quickly and easily reach a diagnosis appropriate to the pattern of lung abnormality identified on CT scans.

  10. [Bronchial rupture in blunt thoracic trauma].

    Science.gov (United States)

    López Espadas, F; Zabalo, M; Encinas, M; Díaz Regañón, G; Pagola, M A; González Fernández, C

    2000-12-01

    In closed chest trauma, bronchial rupture is an unusual but potentially serious complication, with an associated mortality rate of 30%. Recent decades have seen an increase in incidence parallel to greater use of transport. Eighty percent of injuries are located 2.5 cm from the carina. Diagnosis is based on clinical signs, imaging and bronchoscopy. Subcutaneous emphysema and respiratory insufficiency are the most common findings. Images show the presence of pneumothorax, pneumomediastinum or both. Bronchoscopy is the diagnostic method of choice and must be performed early. Treatment consists of reestablishing anatomical continuity of the tracheobronchial tree by surgical repair if the lesion affects more than a third of the circumference and/or pneumothorax is not resolved after two chest drainages. This type of injury should be recognized and treated early, both to restore lung function and to prevent associated complications caused by delay. However, initial findings are seldom specific, requiring the physician to display a high degree of suspicion and explaining why diagnosis often comes late. PMID:11171438

  11. Diagnosis of post-traumatic sepsis according to "Sepsis guidelines": a cross-sectional survey of sepsis in a trauma intensive care unit

    Directory of Open Access Journals (Sweden)

    Hao TANG

    2016-04-01

    .0%, respectively, that of the group B, 82.2% and 41.7%, respectively, and that of the group C, 72.2% and 41.7%, respectively. No statistical difference was found in diagnostic performance among the three versions of sepsis criteria. Conclusion  The prevalence of sepsis is high in the ICU trauma patients. There is no difference in diagnostic performance for post-traumatic sepsis among the three versions of the diagnostic criteria. The 1992 international sepsis criteria is relatively simple and may be more feasible for the diagnosis of post-traumatic sepsis. DOI: 10.11855/j.issn.0577-7402.2016.04.07

  12. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

    OpenAIRE

    Bravman Jonathan T; Ipaktchi Kyros; Biffl Walter L; Stahel Philip F

    2008-01-01

    Abstract Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by th...

  13. Role of brain CT scan in the diagnosis of patients with minor head injury in trauma emergency center

    Directory of Open Access Journals (Sweden)

    Ali Mousavi Jafarabad

    2014-07-01

    Full Text Available Currently, a large burden of hospital admissions is related to minor head trauma and its related imaging studies. One of the challenging issues for emergency physicians is brain computed tomography scan. Sensible use of computed tomography studies could minimize unnecessary radiation exposure and resource use. On the other hand, it can result in delayed or missed early treatment of intracranial injury. The aim of this review is to evaluate and summarize the costs and benefits of using diagnostic measurements in minor head trauma with particular focus on computed tomography scan and the advances and limitations of available guidelines. We studied different issues related to the current approach to minor head trauma in emergency departments. Altogether, it seems using brain computed tomography scan in the setting of emergency is a cost-effective method for the selected patients with minor head injury. However, concerning considerable costs of caring for patients with head injury and high sensitivity of brain computed tomography in terms of minor head injury, it seems reasonable to use brain computed tomography scan for a wider range of patients with minor head injury.

  14. Acurácia da radiografia de tórax associada a eletrocardiograma no diagnóstico de hipertrofia em hipertensos Accuracy of chest radiography plus electrocardiogram in diagnosis of hypertrophy in hypertension

    Directory of Open Access Journals (Sweden)

    Sergio Marrone Ribeiro

    2012-09-01

    Full Text Available FUNDAMENTO: A radiografia de tórax e o eletrocardiograma (ECG tem sido criticados em razão de sua baixa sensibilidade no diagnóstico da Hipertrofia Ventricular Esquerda (HVE quando comparada ao ecocardiograma. Entretanto, esse exame não está disponível nos centros de atendimento primário para toda a população de hipertensos. OBJETIVO: Avaliar se a radiografia de tórax associada ao eletrocardiograma apresenta acurácia que justifique seu uso na detecção de HVE em hipertensos, bem como a utilidade do índice cardiotorácico e das radiografias oblíquas na avaliação das dimensões das câmaras cardíacas esquerdas. MÉTODOS: Estudo prospectivo realizado em 177 pacientes hipertensos consecutivos, através da radiografia do tórax, eletrocardiograma e ecocardiograma. Testes de acurácia foram utilizados para comparar esses métodos utilizando a ecocardiografia convencional como padrão de referência. RESULTADOS: O índice cardiotorácico mostrou sensibilidade de 17% para o diagnóstico de HVE, somente detectando alterações cardíacas mais acentuadas. As incidências póstero-anterior e perfil tiveram sensibilidade de 52%, aumentando para 54% quando a radiografia de tórax foi associada ao eletrocardiograma. As incidências oblíquas não melhoraram significativamente a acurácia da radiografia de tórax que, por sua vez, apresentou alta especificidade e boa sensibilidade para a detecção do aumento da aorta. Foi interessante notar que essa alteração estava presente em metade dos hipertensos com HVE. CONCLUSÃO: A associação da radiografia de tórax com eletrocardiograma é útil na avaliação inicial de hipertensos para o diagnóstico de hipertrofia ventricular esquerda, especialmente se a ecocardiografia não estiver disponível. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0BACKGROUND: Chest radiography and electrocardiogram have been criticized due to their low sensitivity for Left Ventricular Hypertrophy diagnosis

  15. Diagnosis and Treatment of Penetrating Cardiac Injury One Year after Thoracic Stab Wound

    Directory of Open Access Journals (Sweden)

    MH Soltani

    2005-10-01

    Full Text Available In any patient with a history of penetrating thoracic trauma, cardiac injury must be kept in mind. Here, we describe a 36 years-old female referred to this hospital with severe chest pain and hypotension. After primary evaluation and suggestion of AMI, streptokinase was started for the patient and because of deterioration of vital signs, cardiac surgery consultation was requested. After performing urgent echocardiography, massive pericardial tamponade was detected. Visualization of a knife blade on C.X.R and past medical history of thoracic stab injury led to a diagnosis of delayed cardiac tamponade and urgent sternotomy was performed. The blade that had penetrated the right ventricular chamber was extracted. Six days after operation, patient was discharged without any problem. This case study suggests the importance of high suspicion to cardiac injury in any patient with chest pain and a history of chest trauma.

  16. Chest Radiography Findings in Primary Pulmonary Tuberculosis in Children

    OpenAIRE

    Milković, Đurđica; Richter, Darko; Zoričić-Letoja, Ivka; Raos, Miljenko; Koncul, Ivan

    2005-01-01

    Plain chest radiography plays a major role in the diagnosis and follow-up of pulmonary tuberculosis in childhood. The aim of our study was to investigate the distribution of characteristic chest radiographic findings at diagnosis in children with pulmonary tuberculosis. The age of the patients and the type and localization of radiographic changes at admission were retrospectively analyzed. We reviewed chest radiographs in 204 children admitted from January 1, 1991 until June 30, 1994 for newl...

  17. CT detection of occult pneumothorax in head trauma

    International Nuclear Information System (INIS)

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia

  18. Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult

    Directory of Open Access Journals (Sweden)

    Vacek TP

    2014-09-01

    Full Text Available Thomas P Vacek, Shahnaz Rehman, Shipeng Yu, Ankush Moza, Ragheb Assaly Department of Internal Medicine, The University of Toledo Medical Center, Toledo OH, USAAbstract: Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient's blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause.Keywords: substernal, pleuritic, myocardial infarction, differential

  19. Bone scintigraphy as an aid in the diagnosis of occult distal tarsal bone trauma in three horses

    International Nuclear Information System (INIS)

    History, physical examination, and bone scintigraphy were used to diagnose central and/or third tarsal bone trauma in 3 acutely lame horses. In all 3 cases, the results of initial radiographic examination were negative. Bone scintigraphy revealed focal, intense radioisotope uptake at the level of the distal tarsal bones in the 3 horses. Radiographs obtained 4 weeks after injury in one horse demonstrated a slab fracture of the central tarsal bone. Conservative management of the tarsal bone disease resulted in acceptable return to function in all 3 horses

  20. Actinomycosis - Left Post Chest Wall

    Directory of Open Access Journals (Sweden)

    Kafil Akhtar, M. Naim, S. Shamshad Ahmad, Nazoora Khan, Uroos Abedi, A.H. Khan*

    2008-01-01

    Full Text Available A forty year old female of weak body built presented with recurring small hard lumps in let posteriorchest wall for 3 years and discharging ulcers for 3 months duration. Clinically, the provisional diagnosiswas malignancy with secondary infection. FNAC showed features suggestive of dysplasia buthistopathology confirmed the diagnosis as actinomycosis. The present case is reported due to rare incidenceof actinomycosis at post chest wall with muscle involvement.

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... chest x-ray is used to evaluate the lungs, heart and chest wall and may be used ... diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A ...

  2. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

    Directory of Open Access Journals (Sweden)

    Bravman Jonathan T

    2008-11-01

    Full Text Available Abstract Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.

  3. The ralue of Tumor markers combined chest imaging in the early diagnosis of lung cancer%肿瘤标志物联合胸部影像学在肺癌早期诊断中的价值

    Institute of Scientific and Technical Information of China (English)

    余会丽; 解洪泉; 王惠君; 侯晗; 卫方方

    2013-01-01

    目的:探讨肿瘤标志物联合胸部影像学在肺癌早期诊断中的应用价值。方法运用电化学发光法对40例肺癌患者、40例肺部良性病变者、40例健康查体者的 cea、nse、CY211、ca125的血清水平进行检测并比较。结果肺癌组患者的四种肿瘤标志物水平均明显高于健康查体组及良性病变组,存在差异性(P<0.05)。结论肿瘤标志物联合胸部影像学检查能够尽早的对肺癌做出较为准确的诊断,有利于临床的诊疗。%Objective To the diagnosis value of combined detection of tumor markers combined chest imaging for lung cancer.Methods The electro- chemiluminescence immunoassay was used to detect theCY211、cea、nse、ca125 in serum of 40 patients with lung caner,40 patients with benign diseases and 40 normal healthy people and statistics was used to conduct comparative analysis.Results The serum level of five tumor markers in lung caner group were higher than those in the benign disease group and the control group. There was statistics difference(P<0.05).the tumor markers combined chest imaging can make an accurate diagnosis as early as possible for lung cancer,and it is helpful to clinical diagnosis and treatment.

  4. Chest computed tomography

    DEFF Research Database (Denmark)

    Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret;

    2013-01-01

    are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

  5. Chest x-ray

    Science.gov (United States)

    Chest radiography; Serial chest x-ray; X-ray - chest ... You stand in front of the x-ray machine. You will be told to hold your breath when the x-ray is taken. Two images are usually taken. You will ...

  6. Chest pain: a time for concern?

    Science.gov (United States)

    King, Joan E; Magdic, Kathy S

    2014-01-01

    When a patient complains of chest pain, the first priority is to establish whether the situation is life threatening. Life-threatening differential diagnoses that clinicians must consider include acute coronary syndrome, cardiac tamponade, pulmonary embolus, aortic dissection, and tension pneumothorax. Nonthreatening causes of chest pain that should be considered include spontaneous pneumothorax, pleural effusion, pneumonia, valvular diseases, gastric reflux, and costochondritis. The challenge for clinicians is not to be limited by "satisfaction of search" and fail to consider important differential diagnoses. The challenge, however, can be met by developing a systematic method to assess chest pain that will lead to the appropriate diagnosis and appropriate treatment plan.

  7. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    OpenAIRE

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours.

  8. Multidisciplinary Approach to Lifesaving Measures in the Elderly Individuals With Flail Chest Injury With ORIF of Rib Fractures: A Report of 2 Cases

    OpenAIRE

    Zegg, Michael; Kammerlander, Christian; Schmid, Stefan; Roth, Tobias; Kammerlander-Knauer, Ursula; Gosch, Markus; Luger, Thomas J.

    2012-01-01

    In this case report, we present 2 cases of flail chest in geriatric patients after severe blunt chest trauma, which were treated at the University Hospital Innsbruck (Level I Trauma Center and Tyrolean Geriatric Fracture Center) by a multidisciplinary team of physicians from anesthesia, intensive care, trauma surgery, and acute geriatrics. We want to point out the benefit of a multidisciplinary approach in geriatric patients with flail chest.

  9. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  10. A pilot study evaluating erect chest imaging in children, using the Lodox Statscan digital X-ray machine

    Directory of Open Access Journals (Sweden)

    Rupesh Baloo Daya

    2009-11-01

    Full Text Available ABSTRACT Background: Chest radiography accounts for a significant proportion of ionising radiation in children. The radiation dose of radiographs performed on the Lodox Statscan system has been shown to be lower than that of a computed radiography (CR system. The role of the Lodox Statscan (hereafter referred to as the Statscan in routine erect chest radiography in children has not been evaluated. Objective: To evaluate the image quality and diagnostic accuracy of erect paediatric chest radiographs obtained with the Statscan and compare this with conventional erect chest images obtained with a CR system. Materials and Methods: Thirty three children with suspected chest pathology were enrolled randomly over a period of three months. Erect chest radiographs were obtained with the Statscan, and a Shimadzu R-20J X-ray machine coupled with a Fuji FCR 5000 CR system. Image quality and diagnostic accuracy and diagnostic capability were evaluated between the two modalities. Results: The erect Statscan allowed superior visualisation of the three major airways. Statscan images however, demonstrated exposure and movement artifacts with hemidiaphragms and ribs most prone to movement. Bronchovascular clarity was also considered unsatisfactory on the Statscan images. Conclusion: The Statscan has limitations in erect chest radiography in terms of movement artefacts, exposure fluctuations, and poor definition of lung markings. Despite this, the Statscan allows better visualisation of the major airways, equivalent to a ‘high KV’ film at a fraction of the radiation dose. This supports the finding of an earlier study evaluating Statscan images in trauma cases, where the images were taken supine. Statscan has great potential in assisting in the diagnosis of childhood tuberculosis where airway narrowing occurs as a result of nodal compression.

  11. Chest injury in victims of Bam earthquake

    Institute of Scientific and Technical Information of China (English)

    Seyed Mohammad Ghodsi; Moosa Zargar; Ali Khaji; Mojgan Karbakhsh

    2006-01-01

    Objective: To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS)for better understanding the type and consequence of thoracic injuries in a major earthquake.Methods: After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.Results: This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multipletrauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P =0.003).Conclusions: Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.

  12. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

    Directory of Open Access Journals (Sweden)

    Tandon Ruchi

    2007-03-01

    Full Text Available Abstract Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.

  13. Value of ICU Bedside B-ultrasound and Chest X-ray in the Diagnosis of Traumatic Pneumothorax%重症监护病房床旁B超与胸部X线片检查对创伤性气胸的诊断价值研究

    Institute of Scientific and Technical Information of China (English)

    许庆林; 陈淑娟

    2013-01-01

    目的 比较重症监护病房(ICU)床边B超与胸部X线片检查对创伤性气胸的诊断价值.方法 选取我院ICU收治的84例钝性胸部创伤患者,均行CT检查,随机分为 B超组和X线组,各42例.B超组行床边B超检查,X线组行床边胸部X线片检查,将两组检查结果与CT结果对比.结果 B超组CT检查结果示气胸34例37侧,其中3例为双侧气胸,B超检查结果示气胸26例28侧,其中2例为双侧气胸;X线组CT检查结果示气胸33例35侧,其中2例为双侧气胸,胸部X线片检查结果示气胸25例26侧,其中1例为双侧气胸.B超组和X线组敏感度、特异度、阳性预测值、阴性预测值、准确度比较,差异均无统计学意义(P>0.05).结论 ICU床边B超与胸部X线片诊断气胸敏感性、特异性无显著差异,B超检查方便、无创、可动态观察,方便实用.%Objective To investigate the value of bedside ultrasonography and chest X - ray in the diagnosis of pneumothorax. Methods 84 patients with blunt chest trauma admitted to the ICU of our hospital were given CT examination and were randomly divided into B - ultrasonography group and X - ray group with each group 42 cases. B - ultrasonography group was given bedside B - ultrasonography examination while X - ray group was given bedside chest X - ray examination. The results of the two groups were compared with the CT results. Results In B - ultrasonography group, CT examination results showed 37 sides of pneumothorax in 34 cases and 3 cases were bilateral pneumothorax. While B - ultrasonography examination results showed 28 sides of pneumothorax in 26 cases and 2 cases were bilateral pneumothorax. In X - ray group, CT examination results showed 35 sides of pneumothorax in 33 cases and 2 cases were bilateral pneumothorax. While X - ray examination results showed 26 sides of pneumothorax in 25 cases and one case were bilateral pneumothorax. The sensitivity, specificity, positive predictive value, negative predictive

  14. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: ...

  15. CT quantification of pleuropulmonary lesions in severe thoracic trauma

    International Nuclear Information System (INIS)

    Purpose: Computed quantification of the extent of pleuropulmonary trauma by CT and comparison with conventional chest X-ray - Impact on therapy and correlation with mechanical ventilation support and clinical outcome. Method: In a prospective trial, 50 patients with clinically suspicious blunt chest trauma were evaluated using CT and conventional chest X-ray. The computed quantification of ventilated lung provided by CT volumetry was correlated with the consecutive artificial respiration parameters and the clinical outcome. Results: We found a high correlation between CT volumetry and artificial ventilation concerning maximal pressures and inspiratory oxygen concentration (FiO2, Goris-Score) (r=0.89, Pearson). The graduation of thoracic trauma correlated highly with the duration of mechanical ventilation (r=0.98, Pearson). Especially with regard to atelectases and lung contusions CT is superior compared to conventional chest X-ray; only 32% and 43%, respectively, were identified by conventional chest X-ray. (orig./AJ)

  16. A prehospital use of ITClamp for haemostatic control and fixation of a chest tube

    DEFF Research Database (Denmark)

    Barnung, S; Steinmetz, J

    2014-01-01

    We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube....

  17. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  18. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering. PMID:24617751

  19. Computerized tomography of chest in emphysema and interstitial diseases diagnosis. Tomografia computerizada del torax de alta resolucion en el diagnostico de enfisema y enfermedad intersticial

    Energy Technology Data Exchange (ETDEWEB)

    Souto Bayarri, M.; Malagari, K.; Ibarburen, C.; Arenas, G.; Correa Pombo, J.; Garcia Tahoces, P.; Tucker, D.; Barnes, G.T.; Luna, R.; Zerhouni, E.A.; Fraser, R.G.; Vidal Carrerira, J.J. (Hospital General de Galicia, Santiago de Compostela (Spain))

    1994-01-01

    To study the effect of increasing the spatial resolution on thin section (1.5 mm) computed tomography (CT) of the chest, we compared images reconstructed with the standard algorithm (SA) to three other images obtained with (1) a high spatial frequency algorithm, (2) retrospective targeting to a small field of view (FOV) reconstructed with the high spatial frequency algorithm, and (3) the same high spatial frequency algorithm with images acquired with the small (0.6 mm) rather the large (0.9 mm) focal spot. Examinations were performed on a phantom, on normal subjects, and on patients with emphysema and other diffuse lung diseases. Modulation transfer function (MTF) calculations revealed that higher resolution was achieved on the small focal spot and high spatial frequency algorithm than on the standard algorithm. Evaluation of the four images from 25 normal subjects, 16 patients with emphysema and 9 with interstitial disease was performed by means of an ROC study. Results from the areas under the ROC curves, sensitivity and specificity have shown that images reconstructed with the high spatial frequency algorithm were preferred. We conclude that the use of a high spatial frequency algorithm increases spatial resolution and improves visibility of lung parenchyma. Although more evaluation is needed, the potential of increasing spatial resolution further by using a smaller focal spot is currently limited by the mas Available per slice and the associated increased level of quantum noise. (Author)

  20. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  1. Determination of Sensitivity and Specificity of Ultrasonography Compared with CT-Scan in Diagnosis of Free Abdominal Fluid in Patients with Blunt Abdominal Trauma Admitted to Zahedan Khatam-al-anbia H

    Directory of Open Access Journals (Sweden)

    Mohammad Ghasemi Rad

    2010-05-01

    Full Text Available Background/Objective: Nowadays, trauma is the fourth cause of mortality and morbidity in developed countries. Intraabdominal hemorrhage due to blunt abdominal trauma is the major cause of these mortalities. Therefore, every action taken for quick diagnosis of intraabdominal hemorrhage could save the lives of patients more effectively."nPatients and Methods: This cross-sectional study concerns patients with blunt abdominal trauma admitted to the emergency of Khatam-al-anbia Hospital in a one-year period from 1385. Information from ultrasonography and CT scan were registered in a questionnaire and analyzed by statistical software SPSS 14. We used sensitivity, specifity, positive predictive value, negative predictive value and accuracy as statistical tools for comparison."nResuIts: Of the 100 patients surveyed, 20% were female and 80% were male. The most common clinical symptoms in both groups were abdominal pain and then abdominal tenderness. There was significant statistical difference between clinical symptoms from the point view of existing free abdominal fluid and CT-scan report (P =0.017. The sensitivity, specificity, negative predictive value and positive predictive value of ultrasonography in the diagnosis of free abdominal fluid were respectively, 84%, 86%, 91% and 75%, which were respectively, 54%, 90%, 65% and 79% in the diagnosis of intra abdominal damage. "nConclusion: Ultrasonography has sensitivity, specificity and enough accuracy to detect free abdominal fluid in blunt abdominal trauma in comparison with CT-scan in the children's and adult's age group which if combined with abdominal viscera parenchymal abnormalities, these parameters would sensitively increase in the children's age group."nKeywords: CT Scan, Ultrasonography, Abdominal Blunt Trauma, Sensitivity, Specificity

  2. Application of Ultrasound-Guided Biopsy in the Diagnosis of Chest Lesions%超声引导下穿刺活检在胸部病变的临床应用

    Institute of Scientific and Technical Information of China (English)

    冯萍娟; 魏淑萍; 刘桂苏; 吴杨; 蔡丽萍; 杨斌

    2011-01-01

    目的 评价超声引导下穿刺活检在胸部占位性病变中的临床应用价值.方法 83例外周型肺占位病变、胸壁病变和纵隔病变患者先行常规超声检查,明确病变的部位、大小、回声、毗邻以及血供情况,结合CT、MRI等影像学检查结果,综合分析后,在超声引导下使用一次性自动活检针穿刺活检,所取的标本送组织病理检查.结果 83例穿刺活检,3例因取材少或未取到病变处而未能明确诊断,其余病例与病理结果对照,良性病变28例,恶性病变52例,组织学确诊阳性率为96%( 80/83),且未出现血胸等重大并发症.结论 超声引导下胸部占位性病变穿刺活检,明确诊断率高,具有安全、简便、创伤小、无放射性、并发症少等优点,有较好的临床应用价值.%Objective To explore the application of ultrasound-guided automatic biopsy in the diagnosis of chest lesions. Methods Totally 83 cases with peripheral pulmonary space occupying lesions,pleura] disease,and mediastinal tumors were examined with conventional ultrasound,the information of their location,size,echo,adjacent and blood supply were gained,then ultrasound-guided automatic biopsy needle was performed after comprehensive analysis with the results of CT and MRI. Results All these 83 cases were biopsied,3 were diagnosed indefinitely as less sample or biopsy failed. The remaining cases were confirmed with pathology ,28 were benign lesions ,52 were malignant lesions, the correct histological diagnosis rate was 96% (80/83). There was not any serious complication as hemothorax. Conclusion Automatic biopsy under ultrasound-guided was an accurate, safe, convenient and minimally invasive method with non-radioactivity and less complication in the diagnosis of chest lesions, it was worth to be widely used.

  3. Imaging of fetal chest masses

    Energy Technology Data Exchange (ETDEWEB)

    Barth, Richard A. [Lucile Packard Children' s Hospital, Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)

    2012-01-15

    Prenatal imaging with high-resolution US and rapid acquisition MRI plays a key role in the accurate diagnosis of congenital chest masses. Imaging has enhanced our understanding of the natural history of fetal lung masses, allowing for accurate prediction of outcome, parental counseling, and planning of pregnancy and newborn management. This paper will focus on congenital bronchopulmonary malformations, which account for the vast majority of primary lung masses in the fetus. In addition, anomalies that mimic masses and less common causes of lung masses will be discussed. (orig.)

  4. The sensitivity and specificity of using a computer aided diagnosis program for automatically scoring chest X-rays of presumptive TB patients compared with Xpert MTB/RIF in Lusaka Zambia.

    Directory of Open Access Journals (Sweden)

    Monde Muyoyeta

    Full Text Available OBJECTIVE: To determine the sensitivity and specificity of a Computer Aided Diagnosis (CAD program for scoring chest x-rays (CXRs of presumptive tuberculosis (TB patients compared to Xpert MTB/RIF (Xpert. METHOD: Consecutive presumptive TB patients with a cough of any duration were offered digital CXR, and opt out HIV testing. CXRs were electronically scored as normal (CAD score ≤ 60 or abnormal (CAD score > 60 using a CAD program. All patients regardless of CAD score were requested to submit a spot sputum sample for testing with Xpert and a spot and morning sample for testing with LED Fluorescence Microscopy-(FM. RESULTS: Of 350 patients with evaluable data, 291 (83.1% had an abnormal CXR score by CAD. The sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of CXR compared to Xpert were 100% (95%CI 96.2-100, 23.2% (95%CI 18.2-28.9, 33.0% (95%CI 27.6-38.7 and 100% (95% 93.9-100, respectively. The area under the receiver operator curve (AUC for CAD was 0.71 (95%CI 0.66-0.77. CXR abnormality correlated with smear grade (r = 0.30, p<0.0001 and with Xpert CT(r = 0.37, p<0.0001. CONCLUSIONS: To our knowledge this is the first time that a CAD program for TB has been successfully tested in a real world setting. The study shows that the CAD program had high sensitivity but low specificity and PPV. The use of CAD with digital CXR has the potential to increase the use and availability of chest radiography in screening for TB where trained human resources are scarce.

  5. 大剂量沐舒坦在胸部创伤所致肺挫伤中的应用探讨%Investigation of the Application Effect of Large Dose of Mucosolvin on Pul-monary Contusion Caused by Chest Trauma

    Institute of Scientific and Technical Information of China (English)

    高永河

    2014-01-01

    分析大剂量沐舒坦在胸部创伤所致肺挫伤中的应用效果。方法收集2012年06月—2014年6月该院收治的66例胸部创伤所致肺挫伤患者临床资料,按照不同的剂量方法,将患者分为大剂量组33例、小剂量组33例。两组患者均采取常规综合治疗,大剂量组患者加以大剂量沐舒坦治疗,小剂量组患者加以小剂量沐舒坦治疗,最后分析两组患者的临床治疗效果。结果与小剂量组治疗有效率57.58%对比,大剂量组患者治疗总有效率明显更高为84.85%(P<0.05)。与小剂量组患者肺部感染、肺不张并发症发生率30.30%对比,大剂量组患者并发症发生率明显更低为9.09%(P<0.05)。治疗后,在PaO2、PaCO2、SaO2等指标改善方面,大剂量组患者明显优于对照组(P<0.05)。结论大剂量沐舒坦治疗胸部创伤所致肺挫伤,疗效显著,有利于降低肺部并发症发生率,促进肺功能恢复,值得临床推广。%Objective To analyze the application effect of large dose of mucosolvin on pulmonary contusion caused by chest trau-ma. Methods The clinical data of 66 cases with pulmonary contusion caused by chest trauma admitted in our hospital from June 2012 to June 2014 were selected. The patients were divided into the large dose group and small dose group with 33 cases in each according to the different dose used. Based on the conventional comprehensive treatment, the large dose group was given large dose of mucosolvin and small dose group was given small dose of mucosolvin for treatment. And the clinical treatment effects of the two groups were analyzed. Results The total effective rate of the large dose group was 84.85%, significantly higher than 57.58%of the small dose group(P<0.05). The incidence of complications such as lung infection and atelectasis of the large dose group was 9.09%, much lower than 30.30% of the control group (P<0.05). After treatment, the improvement in PaO2, PaCO2, SaO2 and so

  6. Chest X-Ray

    Medline Plus

    Full Text Available ... this Site RadiologyInfo.org is produced by: Image/Video Gallery Your radiologist explains chest x-ray. Transcript ... time! Spotlight Recently posted: Pediatric MRI Intravascular Ultrasound Video: Chest CT Video:Thyroid Ultrasound Video: Head CT ...

  7. Picture quiz: a case of sudden severe chest pain.

    Science.gov (United States)

    Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

    2007-01-01

    An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting. PMID:21611610

  8. 33例急性四肢血管损伤的诊治体会%Diagnosis and Treatment of Acute Trauma in Extremity Vascular

    Institute of Scientific and Technical Information of China (English)

    余立权; 高涌; 宋涛; 孙勇

    2011-01-01

    目的 探讨急性四肢血管损伤的诊断和治疗方法 .方法 回顾性分析33例四肢血管损伤病例的诊断、急救、血管修复重建治疗和术后处理方法 .注意患者全身生命体征变化,利用体检、影像学检查等手段,了解肢体的局部缺血情况.有效快速地术前准备,纠正休克,抢救患者生命,坚持保生命第一、保肢体第二的原则.采用人工血管移植损伤血管段4例,取自体大隐静脉行血管重建术20例,5例修剪损伤段直接吻合术,4例直接修补术.其中11例行动静脉Fogarty导管取栓术,行骨筋膜室切开减压术6例.对于合并骨折及神经损伤者请骨科医生手术台上会诊行骨折固定和神经修复.结果 肢体保留30例,术后26例肢体运动感觉功能良好.2例术后出现肢体严重感染坏死而行截肢术,3例肢体部分功能障碍,1例骨外露较多行皮瓣转移术,1例出现多器官功能障碍死亡.结论 血管损伤的早期准确诊断、及时修复重建血管和有效的术后处理可抢救患者的生命和肢体.%Objective To evaluate diagnosis and surgical treatment of acute trauma in extremity vascular. Methods The diagnosis and emergency treatment and revascularization and postoperative treatment methods of 33 patients with acute trauma in extremity vascular were analyzed retrospectively. The diversity vital sign of all over the body in patients was noticed. Extremity ischemia was diagnosed by medical examination and imageology. Preoperative preparation was effective and volant. Life was protected primary and extremity was protected secondary. The damaged blood vessel was adopted vasotransplantation with vascular prosthesis in 4 cases. Reconstructive vascular operation was adopted with self saphenous vein in 20 cases. Damaged blood vessel section was trimmed, and then vascular anastomosis was used directly with 5 cases. Blood vessel neoplasty was adopted directly with 4 cases. Embolectomy of artery and vein was

  9. Geriatric Trauma.

    Science.gov (United States)

    Reske-Nielsen, Casper; Medzon, Ron

    2016-08-01

    Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered. PMID:27475011

  10. Clinical significance of Ischemia Modified Albumin in the Early Diagnosis of Patients with Acute Chest Pain%缺血修饰蛋白在急性胸痛患者早期诊断中的临床意义

    Institute of Scientific and Technical Information of China (English)

    余琦; 钮炜西; 唐发宽; 华宁; 林乐健

    2013-01-01

    目的 探讨缺血修饰蛋白(IMA)在急性胸痛患者早期诊断中的临床意义.方法 急性胸痛患者125例,分为非冠心病组(UCAD) 32例,不稳定性心绞痛组(UAP)21例,急性心肌梗死组(AMI)72例.于入院时、末次症状后8h、末次症状后24h抽血,测定血清IMA、cTnI、MYO;采用SPSS13统计软件进行分析.结果 结果显示:入院时IMA值在UCAD组、UAP组和AMI组之间比较差异有统计学意义(P<0.05);末次症状后8h,AMI组和IMA值仍与其他两组间比较差异有统计学意义(P<0.05);末次症状后24h,三组患者所测IMA值之间比较差异无统计学意义(P>0.05).125例患者中,有92例患者诊断为急性冠脉综合症(ACS).IMA的诊断敏感性最高,为82.6%,ECG仅为29.7%,cTnI为42.8%,MYO为64.3%.不同判断指标的组合在入院后即刻诊断心源性疾病的阳性率为85.2% ~ 93.6%.结论 IMA对急性胸痛患者的早期诊断具有一定的临床意义.%Objective To investigate the clinical significance of ischemia modified albumin (IMA) in the diagnosis of patients with acute chest pain. Methods Among the 125 patients with chest pain who were hospitalized in our department, 32 were grouped into non-coronary heart disease (NCAD) group, 21 into unstable angina (UAP) group and 72 into acute myocardial infarction (AMI) group. Blood sample were drown at entry, 8 hours and 24 hours after last attacking, and the levels of IMA, cTnI and MYO were determined. Statistical analysis was done by SPSS 13.O statistical package. Results The levels of IMA at entry and 8 hour after last attacking in NCAD group were significantly different compared to the other groups (P 0.05). 92 patients in total 125 patients were diagnosed as the acute coronary syndrome (ACS). The diagnostic sensitivity of IMA (82.6% ) was higher than that of electrocardiogram (29. 7) , cTnI (42. 8% ) and MYO (64. 3% ). The heart source disease's immediate diagnosis positive rates of different judgment

  11. Onycholysis due to trauma

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-04-01

    Full Text Available Female patient, 35 years old who came to the private office due to discoloration of her left thumbnail and little pain since 1 month ago. Clinical examination shows nail disease on her left thumbnail with onycholysis and dyschromia, dermatoscopy showed white-yellowish discoloration (Fig. 1A, B. The rest of the clinical examination was normal. Patient use to using acrylic nails since 2 years ago and denied some trauma at the nail. The diagnosis of onycholysis due to trauma was done and recommended her not to use acrylic nail, maintain the nail short and avoid wetness.

  12. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  13. A case of Scimitar syndrome with H-type tracheoesophageal fistula and multiple anomalies: Diagnosis using electrocardiography-gate chest CT

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Kyung Jae; Kang, Eun Ju; Lee, Ki Nam; Jo, Jeong Hyun [Dept. of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of)

    2014-10-15

    Scimitar syndrome is a rare, combined abnormality of bronchopulmonary development and pulmonary vascular development characterized by an anomalous pulmonary venous return to the inferior vena cava. Although the scimitar syndrome has been associated with many anomalies, a tracheoesophageal fistula (TEF), especially from H-type, is extremely rare and only a few cases have been reported without detailed descriptions. Herein we report a rare case of scimitar syndrome with H-type TEF and multiple anomalies in a newborn infant, with a special emphasis on the imaging features associated with the radiologic diagnosis using an electrocardiography-gated computed tomography.

  14. Radiological chest manifestations in diffuse infiltrative lymphocytosis syndrome (DILS

    Directory of Open Access Journals (Sweden)

    F Ismail

    2011-06-01

    Full Text Available This report focuses on the radiological manifestations of diffuse interstitial lymphocytosis syndrome (DILS in the chest. Awareness of this entity and early diagnosis by radiologists will enable timeous intervention by clinicians.

  15. Radiographic evaluation of hepatic trauma

    International Nuclear Information System (INIS)

    The incidence of significant abdominal trauma continues to rise and accounts currently for approximately 10 percent of the annual 130,000 trauma-related deaths in the United States. Over 60 percent of patients are from 10 to 40 years of age, with a striking predominance of males. Children are mostly victims of blunt trauma, while some large reviews of liver trauma in adults show a prevalence of penetrating injuries. Injury to the liver is second only to the spleen in incidence of intraperitoneal injuries. Morbidity and mortality from hepatic trauma are related to the mechanism and extent of injury. Penetrating injuries generally have a lower mortality, about 5 percent, especially if they are due to stab wounds or low velocity gunshot wounds. Shotgun and high velocity gunshot wounds may cause massive fragmentation of the liver and are associated with proportionately greater mortality. The mortality from blunt trauma is from 15 to 45 percent in many large series. Death from isolated liver injury is uncommon, but is usually due to uncontrolled hemorrhage. Injury to other abdominal organs is associated in many cases, as are injuries to the head, chest, and limbs. The extraabdominal injuries are frequently more apparent clinically, but may mask potentially life-threatening abdominal visceral injuries

  16. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  17. Learning chest imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pedrozo Pupo, John C. (ed.) [Magdalena Univ., Santa Maria (Colombia). Respire - Inst. for Respiratory Care

    2013-03-01

    Useful learning tool for practitioners and students. Overview of the imaging techniques used in chest radiology. Aid to the correct interpretation of chest X-ray images. Radiology of the thorax forms an indispensable element of the basic diagnostic process for many conditions and is of key importance in a variety of medical disciplines. This user-friendly book provides an overview of the imaging techniques used in chest radiology and presents numerous instructive case-based images with accompanying explanatory text. A wide range of clinical conditions and circumstances are covered with the aim of enabling the reader to confidently interpret chest images by correctly identifying structures of interest and the causes of abnormalities. This book, which will be an invaluable learning tool, forms part of the Learning Imaging series for medical students, residents, less experienced radiologists, and other medical staff. Learning Imaging is a unique case-based series for those in professional education in general and for physicians in prarticular.

  18. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

    2015-01-01

    Background: Chest radiography is one of the most common examinations in radiology departments. In 2013 approximately 80,000 chest x-rays were performed on women in the fertile age. Even low dose for the examinationCorrect collimation Purpose: Quality improvement of basic radiography focusing...... on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...... of age are included in the study. The clinical research is performed between September and November 2014 where 3rd year Radiography students collect data on four Danish x-ray departments using identical procedures under guidance of clinical supervisors. Optimal collimation is determined by European...

  19. Management of chest keloids

    Directory of Open Access Journals (Sweden)

    Kim June Kyu

    2011-04-01

    Full Text Available Abstract Keloid formation is one of the most challenging clinical problems in wound healing. With increasing frequency of open heart surgery, chest keloid formations are not infrequent in the clinical practice. The numerous treatment methods including surgical excision, intralesional steroid injection, radiation therapy, laser therapy, silicone gel sheeting, and pressure therapy underscore how little is understood about keloids. Keloids have a tendency to recur after surgical excision as a single treatment. Stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. The authors treated 58 chest keloid patients with surgical excision followed by intraoperative and postoperative intralesional steroid injection. Even with minor complications and recurrences, our protocol results in excellent outcomes in cases of chest keloids.

  20. 腹腔镜在腹部外伤诊治中的应用(附326例报告)%Application of laparoscopy in diagnosis and treatment of abdominal trauma: A report of 326 cases

    Institute of Scientific and Technical Information of China (English)

    杨志奇; 王光链; 孙振纲

    2011-01-01

    目的 探讨腹腔镜在腹部外伤诊治中的临床意义.方法 1994年3月至2011年4月对326例腹部外伤病人使用腹腔镜诊治,并根据镜检结果选择腹腔镜手术或中转开腹手术.结果 腹部外伤病人腹腔镜探查及明确诊断326例,腹腔镜下手术284例,中转开腹42例.结论 腹腔镜诊治腹部外伤安全、可行、有效,并可早期正确诊断,减少不必要的剖腹手术.%Objective To explore clinical significance of laparoscopy in diagnosis and treatment of abdominal trauma. Methods A retrospective study from March 1994 to April 2011 was performed on 326 cases of abdominal trauma which was diagnosed and treated with laparoscopy. Laparoscopic surgery or open surgical operation was carried. Results Three hundred and twenty-six cases were definitely explored and diagnosed through laparoscopic surgery. Two hundred and eighty-four cases received laparoscopic surgery, and 42 cases were converted to open surgical operatioa All cases were diagnosed definitely. Conclusion Laparoscopic surgery is a safe, feasible and effective procedure for the early diagnosis and treatment of abdominal trauma.

  1. Isolated renal pelvis rupture secondary to blunt trauma: Case report

    Directory of Open Access Journals (Sweden)

    Kerem Taken

    2015-01-01

    Conclusion: Renal pelvic injury must be considered in the differential diagnosis of blunt trauma. Surgical intervention may be necessary in some cases. We present a case who underwent surgery due to isolated renal pelvis rupture caused by blunt abdominal trauma.

  2. Imaging of Chest Wall Lesions in Children

    Directory of Open Access Journals (Sweden)

    A. Hekmatnia

    2008-01-01

    Full Text Available Chest wall lesions in childhood include a wide range of pathologies; Benign lesions include lipoma, neurofibroma, lymphangioma, hemangioma, and mesenchymal hamartoma."nMalignant lesions include Neuroblastoma, Rhabdo-myosarcoma, Ewing sarcoma, and Askin tumor."nSystemic diseases such as leukemia, lymphoma, Langerhans cell histiocytosis, and also infections such as tuberculosis, and actinomycosis may also cause chest wall lesions."nThe imaging characteristics of these lesions are re-viewed, but only a minority of the lesions shows diagnostic imaging features, and most of lesions re-quire biopsy and histopathological examination for "ndefinitive diagnosis."nThe role of different modalities is discussed with an emphasis on magnetic resonance imaging for demonstrating lesion morphology and local spread. Computed tomography and neuclear medicine being used mainly to assess remote disease."nIn this lecture, we discuss about imaging of chest wall lesions in children.

  3. CRANIOROFACIAL TRAUMA - RADIODIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Zambrano JCR

    2013-09-01

    Full Text Available Clinical examination of Craniorofacial injuries are often limited in patients with trauma to the head and neck region due to obscuration by overlying edema, hematoma, hemorrhage, and soft-tissue injury. Craniorofacial injuries require accurate and prompt diagnosis for management. For Proper clinical examination and treatment plan, high resolution radiographs are always essential which will indirectly contribute to render a good medical care to the patients.

  4. [Fat embolism syndrome in skeletal trauma: particularities of the diagnosis, economic aspects and the role of non-invasive ventilation in intensive care].

    Science.gov (United States)

    Davydova, N S; Shen', N P; Boltaev, P G; Vasilenko, P B; Skorokhodova, L A

    2014-01-01

    The article deals with a multicenter study that demonstrates the possibility and feasibility of noninvasive ventilation in patients with skeletal trauma complicated wiith fat embolism syndrome. The authors found additional criteria for the severity of the condition of patients with trauma. Important criteria for the choose a type of ventilation (non-invasive and invasive) is the lack of consciousness, desynchronization of a patient with ventilator and the need for a specialized regimes or miorelaxation to synchronize with the respirator. PMID:25549488

  5. Videotoracoscopia no trauma de tórax Videothoracoscopy in thoracic trauma

    Directory of Open Access Journals (Sweden)

    Vicente Dorgan Neto

    2001-02-01

    of the Surgery Department of Santa Casa de São Paulo with the intention of defining the function of the procedure in cases of penetrating trauma caused by stab, fire-arms projectile or blunt, in diagnosis suspected clinical or radiologic of thoracic lesions. METHODS: Were selected patients victims of thoracic trauma with diagnosis of hemothorax, precordial contusions and wounds, wounds of thoracic-abdominal transition, embedded knife in the chest and transfixing wounds of mediastinum. The procedures were accomplished in having traumatized stable (blood pressure same or superior 90mmHg. All of them were submitted to videothoracoscopy. RESULTS: videoassisted thoracic surgery is an efficient procedure in the diagnostic investigation, in cases of progressive hemothorax (4 cases and coagulated hemothorax (11 cases, precordial contusions and wounds (3 cases, wounds of thoracic-abdominal transition (24 cases, diaphragmatic injury was confirmed in 9, 37.5% and embedded knife from the chest (2 cases. The procedure was efficient as well in the management of progressive and coagulated hemothorax and to remove embedded knife from the chest, having avoided the thoracotomy in 33.3% of the examined individuals. CONCLUSIONS: the videothoracoscopy is efficient procedure for diagnosis and treatment in thoracic trauma and it can still avoid the thoracotomy in expressive number of patients submitted to the procedure.

  6. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  7. Dental Trauma. A Case Report

    Directory of Open Access Journals (Sweden)

    Alain Soto Ugalde

    2015-06-01

    Full Text Available Dental traumas in children are common; therefore the dentist should be trained to solve them. This paper presents the diagnosis, treatment and outcome of a child with a 12 mm overjet, mouth breathing habit and bilabial incompetence who suffered a severe trauma to tooth number 11, causing its mobility. A splint was applied to the affected tooth and subsequently, a root canal filling was performed, all with a satisfactory outcome. Although these traumas are common, the presentation of this case is important due to its use in the teaching context.

  8. 胸部X线、CT和纤维支气管镜对肺癌诊断的应用研究%Study of Diagnosis of Chest X ray, CT and Bronchoscopy in Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    董乐; 张锡海; 韩璐璐; 刘钊

    2015-01-01

    Objective To analyze and discuss the meaning and value of chest X-ray, CT and fibrobronchoscope. Methods Select-ed 140 cases of patients with lung cancer in our hospital from January 2013 to January 2015 as a study object, according to the different of imaging detection scheme divided into CT group, X-gray group and fibrobronchoscope group, and analysis of the effect of the three detection methods in the treatment of patients. Results The accuracy rate of X-ray was 171/235 (72.77%), accuracy of CT examination for 211/235 (89.79%), the accuracy rate of fiberoptic bronchoscopy for 221/235 (94.04%) was higher than that of X-ray, CT, there was significant difference(χ2=5.37, P<0.05); fiberoptic bronchoscopy was higher than that of X-ray, there were statistically significant differences (χ2=6.81,P<0.05);fiberoptic bronchoscopy the mirror is higher than that of CT, but the difference was not statistically significant(χ2=0.67, P<0.05).Over 60% lung cancer patients can be clinically diagnosed only by chest X-ray, the accurate rate of peripheral lung cancer can be diagnosed by CT while central lung cancer can be diagnosed by fibrobroncho-scope. Conclusion It was showed that Chest X-ray should be used firstly in the diagnosis of lung cancer, and CT or fibrobroncho-scope can greatly improve the diagnostic accuracy of lung cancer, which is worthy of promotion and application.%目的 分析和研究胸部X线、 螺旋 CT及纤维支气管镜在诊断中的价值和意义. 方法 随机抽取于 2013年1月-2015年1月间在该院就诊的140例肺癌患者作为研究对象,并根据检查方法的不同分为X线、CT、支气管镜,所有患者均进行以上检查,对比和分析各种方法在诊断中的准确性. 结果 X线检查的准确率为171/235(72.77%),CT检查的准确率为211/235(89.79%),纤维支气管镜的准确率为221/235(94.04%),CT高于X线,差异有统计学意义(χ2=5.37,P<0.05);纤维支气管镜高于X线,差异有统计学意义(χ2=6.81,P<0

  9. Plasmacytoma presenting as missing rib on chest film: a case report and review of the literature.

    Science.gov (United States)

    Caffery, Terrell; Foy, Matthew

    2014-01-01

    A 33-year-old man presented to the emergency department (ED) with chief complaint of chest pain, persisting for approximately one year. Chest X-ray revealed he was missing the right posterior fifth rib. Physical examination showed no surgical scars, and he reported no history of chest trauma. A CT of his chest demonstrated a mass involving the posterior aspect of the right fifth rib, and subsequent biopsy revealed plasma cells. Laboratory results indicated the tumor was a solitary plasmacytoma of the rib. He was referred to oncology and treated with radiation therapy. This case report illustrates an unusual presentation of a solitary plasmacytoma of the rib.

  10. 急诊腹部创伤早期SIRS评分及血清中C反应蛋白含量与创伤后感染的相关性分析%Correlation Analysis on Emergency Chest Trauma Patients with Early SIRS Score and Serum C-reactive Protein Levels after Infection and Trauma

    Institute of Scientific and Technical Information of China (English)

    徐辉; 郑坚江; 多力坤; 多鲁坤

    2015-01-01

    目的:研究急诊腹部创伤患者早期全身炎症反应综合征(SIRS)评分及血清中C反应蛋白含量与创伤后感染的相关性。方法:选取2011年1月~2013年1月间入院诊治的腹部创伤或腹部创伤为主的多发伤患者125例,所有患者入院后行紧急救治措施后均进行SIRS评分,并在伤后24h检测血清C反应蛋白的含量。根据患者是否感染分为感染组与非感染组,观察比较两组患者在SIRS评分与血清C反应蛋白含量差异。结果:125例患者中,创伤后感染的患者有18例,其中以呼吸系统感染最多,占55.56%。SIRS组与非SIRS组在年龄、性别等方面无显著差异,但ISS评分相对较高,感染组与非感染组在年龄、性别等方面无显著差异,但ISS评分相对较高;SIRS评分在3~4分者感染率显著高于SIRS评分<3分者,经Logistic逐步回归危险性分析后,SIRS评分在3~4分者为腹部创伤患者感染的独立预测因素。125例患者创伤后24h CRP含量与ISS进行spearman相关分析后,两者相关系数为0.565,呈显著正相关。感染组CRP含量中位数为34.98mg/L、四分位数间距为41.85mg/L;非感染组分别为63.75mg/L、89.04mg/L,两组差异显著(P<0.05)。结论:SIRS评分与创伤后24h CRP含量测定对于预测腹部创伤患者的感染有一定的临床参考价值。%Objective: To study the emergency abdominal trauma patients with early systemic inlfammatory response syndrome(SIRS) score and serum C-reactive protein levels after infection correlated with the trauma.Methods:January 2011~January 2013 between abdominal trauma or abdominal trauma hospitalized dominated the 125 cases of multiple trauma patients ,were performed in all patients after admission SIRS score underwent emergency treatment measures and detection 24h after injury serum C -reactive protein levels .Infection group and non- infected group were observed reactive protein levels were

  11. CT diagnosis of traumatic bronchial rupture in children

    International Nuclear Information System (INIS)

    Bronchial rupture is a rare and serious complication of blunt chest trauma in children. The diagnosis of this injury is challenging and requires a high degree of clinical suspicion. It is frequently associated with other severe injuries that may draw the focus of attention away from this potentially catastrophic but treatable injury. The radiographic findings of bronchial rupture have been reported in very few series. We report the findings in two children with bronchial rupture diagnosed by CT, in whom CT resulted in a significant change in patient management. (orig.)

  12. Anterior chest wall examination reviewed

    Directory of Open Access Journals (Sweden)

    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  13. PNEUMOTHORAX- DIAGNOSIS AND TREATMENT

    OpenAIRE

    Milisavljevic Slobodan; Spasic Marko; Milosevic Bojan

    2015-01-01

    Introduction: Pneumothorax is defined as the presence of air in the pleural cavity, ie, the space between the chest wall and the lung itself. Pneumothorax is classified ethiologically into spontaneous pneumothorax and traumatic pneumothorax. Spontaneous pneumothorax is further classified into primary and secondary. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. It can also be caused by iatrogenic injuries. Spontaneous pneumothorax is a sign...

  14. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Vejle-Sørensen, Jens Kristian; Thomsen, Henrik;

    2015-01-01

    of clinical supervisors. Optimal collimation is determined by European and Regional Danish guidelines. The areal between current and optimal collimation is calculated. The experimental research is performed in September - October 2014 Siemens Axiom Aristos digital radiography system DR using 150 kV, 1,25 -3......Purpose: Quality improvement of basic radiography focusing on collimation and dose reduction in digital chest radiography Methods and Materials:A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from...

  15. Applied Research on the Fluid Resuscitation in Geriatric Patients Undergoing Major Chest Trauma Operation by Monitoring ITBVI,EVLWI%ITBVI、EVLWI在老年重大胸部外伤手术中液体复苏的应用研究

    Institute of Scientific and Technical Information of China (English)

    王智钧; 韩全国; 刘永宏; 杜秀珍

    2015-01-01

    目的:观察以胸腔内血容量指数(intrathoracic blood volume index,ITBVI)/血管外肺水指数(extravascular lung water index,EVLWI)在老年重大胸部外伤手术中液体复苏的应用研究。方法:急诊行重大胸部外伤手术的老年患者48例,随机分为以ITBVI/EVLWI为导向的研究组(Study group S组)和对照组(Routine group,R组),每组各24例患者。对照组监测CVP指导补液,研究组应用PICCO监测血流动力学指标,测定ITBVI、EVLWI等指标,准确评估患者容量状况。比较术中患者心率(HR)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO2)、乳酸等指标。观察术后休克改善情况及氧合指数,术后呼吸机通气时间,以及急性肺水肿发生率、死亡率变化。结果:研究组患者组织灌注改善,休克改善明显好转,氧合指数明显增加,中心静脉血氧饱和度明显增加,血乳酸浓度明显降低,急性肺水肿、死亡率明显低于对照组,两组比较差异均有统计学意义(P<0.05)。结论:对比CVP,以ITBVI、EVLWI指导液体复苏,能更精确评估和指导老年重大胸部外伤手术患者术中液体管理,减少急性肺水肿发生率,减少呼吸机辅助时间,缩短ICU住院时间,降低死亡率。%Objective:To research the valve of ITBVI and EVLWI in fluid resuscitation of geriatric patients undergoing major chest trauma operation.Method:48 cases undergoing major chest trauma operation were included and randomly divided into two groups,24 cases in each group.The study group received pulse indicator continous output(PICCO) monitoring and ITBVI+EVLWI were used as indicator for fluid management.The control group was used central venous pressure (CVP) as indicator for fluid management.Heart rate (HR),mean arterial pressure (MAP),central venous oxygen saturation (ScvO2) and lactic acid were compared.Postoperative shock improvement and oxygenation

  16. Salmonella typhimurium abscess of the chest wall

    OpenAIRE

    Tonziello, Gilda; Valentinotti, Romina; Arbore, Enrico; Cassetti, Paolo; Luzzati, Roberto

    2013-01-01

    Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: — Medication: Ciprofloxacin Clinical Procedure:— Specialty: Infectious Diseases Objective: Unusual clinical course Background: Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be ...

  17. Chest X-Ray

    Medline Plus

    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  18. Chest X-Ray

    Medline Plus

    Full Text Available ... this Site RadiologyInfo.org is produced by: Image/Video Gallery Your radiologist explains chest x-ray. Transcript ... Recently posted: Focused Ultrasound for Uterine Fibroids Dementia Video: General Ultrasound Video: Pediatric Nuclear Medicine Radiology and ...

  19. 合并主胰管断裂的胰腺外伤诊断与治疗分析%Diagnosis and treatment of pancreatic trauma with main pancreas duct break

    Institute of Scientific and Technical Information of China (English)

    覃谦; 施开德; 王守军; 王力斌; 李洪

    2008-01-01

    目的 对胰腺外伤合并主胰管损伤的诊治进行探讨.方法 回顾性分析44例严重胰腺外伤同时合并主胰管断裂患者的临床资料及诊治经过.结果 B超联合CT检查对外伤性严重的胰腺损伤确诊率为100%,但是否合并主胰管损伤则需要手术中探查结果来实现.本组患者行远端胰腺空肠Roux-Y吻合术27例,改良十二指肠憩室化和十二指肠空肠Roux-Y吻合术3例,胰十二指肠切除2例.41例患者经救治均痊愈出院.并发症发生率为29.5%,病死率为6.8%.结论 胰腺损伤临床表现隐蔽,CT可提高术前确诊率.而降低严重胰腺外伤患者的病死率关键在于提高术前诊断率、及时和选择合理的手术方式以及加强手术并发症的预防与治疗措施.%Objective To analyze the diagnosis and treatment of pancreatic trauma with main pancreas duct break. Methods Forty-four cases of severe pancreatic trauma with main pancreas duet break were retrospectively analyzed including their diagnosis and different operation performed according to the severity of pancreatic trauma. Results All of severe pancreatic trauma could be diagnosed by CT scan and B-ultrasonic examination. But the main pancreas duct break or not should be determined by surgical exploration. Emergency operations were performed for all cases , distal part pancreaticojejunostomy in 27 cases; modified duodeno-divertiulaization in 3 cases, duode-nojejunostomy in 3cases, pancreaticeduodenectomy in 2 cases, 41 cases were cured. The mortality was 6.8%. Conclusion CT scan is the most helpful means to diagnose pancreatic trauma. An appropriate and timely emergen-cy operation is the key to reduce mortality.

  20. Traumatic ventricular septal defect in a 4-year-old boy after blunt chest injury

    Directory of Open Access Journals (Sweden)

    Yun Mi Kim

    2011-02-01

    Full Text Available Traumatic ventricular septal defect (VSD resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

  1. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation...

  2. Trauma Ultrasound.

    Science.gov (United States)

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  3. Chest X-ray in newborns and infants

    International Nuclear Information System (INIS)

    Chest X-ray in newborns and infants shows great differences to that in adults. Therefore all radiologists, who engage in X-rays in this age group, must be familiar with the special features. At the beginning specific items of examination methods are explained, which must be strictly followed due to radiological protection. Focus of the paper is the discussion of the important chest diseases in newborn and infants, which are mostly unknown in chest diagnosis in adults. Many of them can be life-threatening, thus their knowledge is essential. Pathophysiological explanations shall make the special radiological signs understandable. (orig.)

  4. Computer-aided recognition of emphysema on digital chest radiography.

    OpenAIRE

    Miniati, Massimo; Coppini, Giuseppe; Monti, Simonetta; Bottai, Matteo; Paterni, Marco; Ferdeghini, Ezio Maria

    2011-01-01

    Background Computed tomography (CT) is the benchmark for diagnosis emphysema, but is costly and imparts a substantial radiation burden to the patient. Objective To develop a computer-aided procedure that allows recognition of emphysema on digital chest radiography by using simple descriptors of the lung shape. The procedure was tested against CT. Methods Patients (N=225), who had undergone postero-anterior and lateral digital chest radiographs and CT for diagnostic purposes, were studied and ...

  5. Incidentally Detected Enhancing Breast Lesions on Chest Computed Tomography

    OpenAIRE

    Lin, Wen-Chiung; Hsu, Hsian-He; Li, Chao-Shiang; Yu, Jyh-Cherng; Hsu, Giu-Cheng; Yu, Cheng-Ping; Chang, Tsun-Hou; Huang, Guo-Shu

    2011-01-01

    Objective To evaluate the nature and imaging appearance of incidental enhancing breast lesions detected on a routine contrast-enhanced chest CT. Materials and Methods Twenty-three patients with incidental enhancing breast lesions on contrast-enhanced chest CT were retrospectively reviewed. The breast lesions were reviewed by unenhanced and enhanced CT, and evaluated by observing the shapes, margins, enhancement patterns and backgrounds of breast lesions. A histopathologic diagnosis or long-te...

  6. Shock trauma.

    Science.gov (United States)

    Trunkey, D D

    1984-09-01

    Trauma - accidental or intentional injury - is a major health and social problem. It is still the chief cause of death in people between the ages of 1 and 38 years. In the United States, the mortality due to trauma between the ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same period, the mortality for people aged 25 to 64 years declined by 16%. Murders have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of American teenagers and young adults is 50% higher than that of their counterparts in Britain, Sweden and Japan. Trauma affects young, productive citizens, and the estimated costs for death, disability and loss of productivity exceed $230 million a day. The most tragic statistic is that at least 40% of the deaths are needless and preventable if better treatment and prevention programs were available. Trauma deaths that might be prevented are those due to motor vehicle accidents, homicide, burns, and alcohol and drug abuse. In this paper suggestions for prevention are made. They include improved crash worthiness of motor vehicles, revocation of drunk drivers' licences, use of devices that limit drunk drivers, increased tax on alcohol and random breathalyser tests, and the use of seat belts and motorcycle helmets. Control of hand-guns and burn characteristics of cigarettes could also reduce deaths. The problems and issues in trauma care can be divided into two broad categories: system and professional. System problems include prehospital care, in-hospital care, rehabilitation and prevention. Professional problems include education, research, economics, and quality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6478325

  7. Skeleton scintigraphy in trauma

    International Nuclear Information System (INIS)

    severe osteoporosis are readily identified with skeletal scintigraphy. In marathon runners rhabdomyolysis can be diagnosed by skeletal scintigraphy as areas of local increased radiotracer uptake in the exercise-damages skeletal muscles. Another use of skeletal scintigraphy in trauma is the assessment of hip prosthesis and differentiation between osteotomy and prosthesis loosening. Some other applications of skeletal scintigraphy are detection of enthuse pat hies, Avulsion Injuries and other athletic lesions. SPECT has found a major role in the proper diagnosis of the suspicious lesions particularly in vertebral column

  8. CHEST PHYSIOTHERAPY FOR INFANTS

    OpenAIRE

    Preeti S. Christian (M.P.T Cardiopulmonary Conditions)

    2014-01-01

    In the normal lung, secretions are removed by Mucociliary activity, normal breathing cycles, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce the ability to clear secretions, and may increase exacerbations and infections. Many chest physiotherapy techniques like postural drainage, percussion and vibration are used since many years. These techniques are derived from adult studies but these techniques are quite str...

  9. 数字化X线摄影图像后处理参数调整在建立尘肺病诊断参考片中的作用%Effects of image post-processing parameters on digital radiography chest radiograph for the diagnosis of pneumoconiosis

    Institute of Scientific and Technical Information of China (English)

    陈钧强; 蒋兆强; 周斌; 诸强; 刘斌; 张幸

    2012-01-01

    Objective To explore the effects of image post-processing parameters on DR chest radiograph for the diagnosis of pneumoconiosis.Methods Eighty three coal miners were examined with high-kV and DR chest radiographs at the same time.Image post-processing parameters(density,contrast and so on)were designed in a Philips Essenta DR machine were designed,then differences of image quality between high-kV and DR chest radiographs were compared.Results After regulating image and proceeding the parameters,the OD (optical density)values of high density areas in the upper-middle lung fields,subphrenic and direct exposure areas were 1.58±0.10,0.23±0.02 and 2.80±0.21,respectively.The quality of chest films met the requirements of diagnostic criteria of pneumoconiosis.The rate of excellent chest films for DR chest radiograph was 95.18%,which was significantly higher than that(80.72%)for high-kV chest radiograph(P<0.01).Conclusion Appropriate parameters of image post-processing can make DR chest radiograph to meet the requirements of chest radiograph quality for the diagnosis of pneumoconiosis.%目的 探讨图像后处理参数在数字化X线摄影(digital radiography,DR)胸片用于尘肺病诊断中的作用.方法 随机选择83例某煤矿接尘工人,同时拍摄高仟伏X线胸片和DR胸片.在Philips Essenta DR机上对密度和对比度等图像后处理参数进行设置,研究合适的图像后处理参数.比较高仟伏X线胸片和DR胸片的质量.结果 通过调节图像后处理参数,DR胸片在上中肺野最高密度、膈下和直接曝光区的光密度分别为1.58±0.10、0.23±0.02和2.80±0.21,胸片质量符合尘肺病诊断标准的要求.83例DR胸片的优良片率(79例,95.18%)明显高于高仟伏X线胸片(67例,80.72%),差异有统计学意义(P<0.01).结论 合适的图像后处理参数可以使DR胸片达到尘肺病诊断的胸片质量要求.

  10. Behind armour blunt trauma--an emerging problem.

    Science.gov (United States)

    Cannon, L

    2001-02-01

    Behind Armour Blunt Trauma (BABT) is the non-penetrating injury resulting from the rapid deformation of armours covering the body. The deformation of the surface of an armour in contact with the body wall arises from the impact of a bullet or other projectile on its front face. The deformation is part of the retardation and energy absorbing process that captures the projectile. In extreme circumstances, the BABT may result in death, even though the projectile has not perforated the armour. An escalation of the available energy of bullets and the desire of armour designers to minimise the weight and bulk of personal armour systems will increase the risk of BABT in military and security forces personnel. In order to develop materials that can be interposed between the armour and the body wall to attenuate the transfer of energy into the body, it is essential that the mechanism of BABT is known. There is a great deal of activity within UK and NATO to unravel the interactions; the mechanism is likely to be a combination of stress (pressure) waves generated by the rapid initial motion of the rear of the armour, and shear deformation to viscera produced by gross deflection of the body wall. Physical and computer model systems are under development to characterise the biophysical processes and provide performance targets for materials to be placed between armours and the body wall in order to attenuate the injuries (trauma attenuating backings-TABs). The patho-physiological consequences of BABT are being clarified by research, but the injuries will have some of the features of blunt chest trauma observed in road traffic accidents and other forms of civilian blunt impact injury. The injuries also have characteristics of primary blast injury. An overview diagnosis and treatment is described. PMID:11307682

  11. Imaging of laryngeal trauma.

    Science.gov (United States)

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. PMID:24238937

  12. Imaging of laryngeal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

    2014-01-15

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  13. Imaging of laryngeal trauma

    International Nuclear Information System (INIS)

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

  14. Cost-effectiveness of high-sensitive troponin assays for the early rule-out or diagnosis of acute myocardial infarction (AMI) in people with acute chest pain : A nice diagnostic assessment

    NARCIS (Netherlands)

    Ramaekers, B.L.T.; Armstrong, N.; Joore, M.A.; Westwood, M.; Whiting, P.; Thokala, P.; Ross, J.; Kleijnen, J.; Severens, J.; Van Asselt, A.

    2014-01-01

    Objectives: To assess cost-effectiveness of high sensitivity troponin (hs-cTn) assays for the management of adults presenting with acute chest pain at the emergency department. Methods: An economic model was constructed to estimate lifetime costs and QALYs of five hs-cTn strategies (differing accord

  15. Diagnosis and treatment of liver trauma complicated with intra-abdominal infections%肝脏外伤并发腹腔感染的分析及诊治

    Institute of Scientific and Technical Information of China (English)

    张雯雯; 何蕾; 万涛; 吕少诚; 徐明月; 刘同友; 路辉; 史宪杰

    2013-01-01

    OBJECTIVE To explore the measures for diagnosis and treatment of liver trauma complicated with intraabdominal infections so as to guide the prevention and treatment of intra-abdominal infections.METHODS We retrospectively analyzed the clinical data of 64 patients with liver trauma between Jan 2000 and Sep 2012,including 7 cases of conservative treatment and 57 cases of surgical treatment,and all the cases were treated with prevention of infections,liver protection,and nutritional support.RESULTS Of the 64 cases of patients,there were 23 cases of peritoneal infections with the infection rate of 35.9 %.No simple liver trauma patients suffered from complicating intrabdominal infection,while among the patients with gastrointestinal trauma the incidence of peritoneal infections was 85.7%,and the incidence of the patients with the AAST grading Ⅳ was 51.5%.Totally 41 strains of pathogens were isolated,among which there were 15 (36.6%) strains of Escherichia coli,10 (24.4%) strains of Enterococcus faecalis,and 8 (19.5%) strains of Enterococcus faecium,which ranked the top three species of the pathogens.Of totally 23 cases of patients with peritoneal infections,22 cases were cured with the cure rate of 95.65 %.CONCLUSION The incidence of intraabdominal infections is high in the patients with complex liver trauma,especially the patients with multi-organ trauma.The integrated treatment with micro-invasive operations on the basis of trauma-control surgery idea can effectively cure the intraabdominal infections and decrease the mortality.%目的 探讨肝脏外伤并发腹腔感染的诊治方法,以期为肝脏外伤并发腹腔感染的预防治疗起到指导作用.方法 回顾性分析医院2000年1月-2012年9月64例肝脏外伤患者的临床资料,其中7例行保守治疗,57例行手术治疗,均予预防性抗感染、保肝、营养等治疗方法.结果 64例患者中23例出现腹腔感染,感染率为35.9%,其中单纯性肝脏外伤患者无

  16. Evaluation and Management of Chest Pain in the Elderly.

    Science.gov (United States)

    Gupta, Rohit; Munoz, Robert

    2016-08-01

    Geriatric patients are at increased risk for serious morbidity and mortality from life-threatening causes of chest pain. This article covers 5 life-threatening causes of chest pain in the elderly: acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, and esophageal rupture. Atypical presentations, frailty, and significant comorbidities that characterize the elderly make the diagnosis and treatment of these already complicated conditions even more complicated. The emergency provider must be vigilant and maintain a low threshold to test. When a diagnosis is made, treatment must be aggressive. The elderly benefit from optimal care. PMID:27475013

  17. Chest surgical disorders in ancient Egypt: evidence of advanced knowledge.

    Science.gov (United States)

    Jungraithmayr, Wolfgang; Weder, Walter

    2012-03-01

    The ancient Egyptians laid the foundation for the development of the earliest recorded systems of medical treatment. Many specialties such as gynecology, neurosurgery, ophthalmology, and chest disorders were subject to diagnosis, which were followed by an appropriate treatment. Here, we elucidate the remarkable level of their knowledge and understanding of anatomy and physiology in the field of chest medicine. Furthermore, we look at how ancient Egyptian physicians came to a diagnosis and treatment based on the thoracic cases in the Edwin Smith papyrus. PMID:22330033

  18. The neonatal chest

    Energy Technology Data Exchange (ETDEWEB)

    Lobo, Luisa [Servico de Imagiologia Geral do Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon (Portugal)]. E-mail: mluisalobo@gmail.com

    2006-11-15

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.

  19. The neonatal chest

    International Nuclear Information System (INIS)

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented

  20. Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis.

    Science.gov (United States)

    Morales-Uribe, Carlos; Ramírez, Ana; Suarez-Poveda, Tatiana; Ortiz, Margarita; Sanabria, Alvaro

    2016-10-01

    This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.

  1. The chest pain center in the emergency department.

    Science.gov (United States)

    Zalenski, R J; Grzybowski, M

    2001-05-01

    Despite the improvement of medical treatment for acute coronary syndromes throughout the 20th century, the authors believe that many cases of life-threatening coronary events could be avoided through early detection of CAD and the use of preventive strategies. Establishing chest pain units that are linked to the ED is one excellent strategy to risk-stratify patients with symptoms who are at risk for sustaining an AMI or having lethal arrhythmias. There is a need for more research on chest pain units to determine the value for cost and to further optimize strategies for ACI detection and screening. In EDs with high volumes of chest pain patients, or high pressures to avoid hospital admissions, a planned, systematic, and rapid approach to the treatment of AMI and the diagnosis of chest pain is a rewarding necessity. PMID:11373990

  2. American College of Chest Physicians

    Science.gov (United States)

    ... American College of Chest Physicians and Sunovion announce strategic initiative focused on the importance of drug delivery in the management of COPD Sunovion Pharmaceuticals, Inc. (Sunovion) and the ...

  3. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

    1998-05-01

    Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

  4. Severity of chest disease in cystic fibrosis patients in relation to their genotypes.

    OpenAIRE

    al-Jader, L. N.; Meredith, A L; Ryley, H C; Cheadle, J P; Maguire, S.; Owen, G.; Goodchild, M.C.; Harper, P S

    1992-01-01

    A detailed comparison of the severity of chest disease with mutational status was carried out by cross sectional study of 127 cystic fibrosis patients, aged 1 to 31 years, living in Wales. Lung disease was classified according to severity, depending on pulmonary function tests (carried out on 76 patients) and chest radiograph status; information was obtained also on age at diagnosis in relation to severity of chest disease and colonisation with Pseudomonas species. Genotypes were determined b...

  5. Penetrating abdominal trauma.

    Science.gov (United States)

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  6. Dose and perceived image quality in chest radiography

    International Nuclear Information System (INIS)

    Chest radiography is the most commonly performed diagnostic X-ray examination. The radiation dose to the patient for this examination is relatively low but because of its frequent use, the contribution to the collective dose is considerable. Consequently, optimization of dose and image quality offers a challenging area of research. In this article studies on dose reduction, different detector technologies, optimization of image acquisition and new technical developments in image acquisition and post processing will be reviewed. Studies indicate that dose reduction in PA chest images to at least 50% of commonly applied dose levels does not affect diagnosis in the lung fields; however, dose reduction in the mediastinum, upper abdomen and retrocardiac areas appears to directly deteriorate diagnosis. In addition to patient dose, also the design of the various digital detectors seems to have an effect on image quality. With respect to image acquisition, studies showed that using a lower tube voltage improves visibility of anatomical structures and lesions in digital chest radiographs but also increases the disturbing appearance of ribs. New techniques that are currently being evaluated are dual energy, tomosynthesis, temporal subtraction and rib suppression. These technologies may improve diagnostic chest X-ray further. They may for example reduce the negative influence of over projection of ribs, referred to as anatomic noise. In chest X-ray this type of noise may be the dominating factor in the detection of nodules. In conclusion, optimization and new developments will enlarge the value of chest X-ray as a mainstay in the diagnosis of chest diseases.

  7. The spectrum of agricultural trauma.

    Science.gov (United States)

    Cogbill, T H; Busch, H M

    1985-01-01

    During the past 6 years, 375 patients were hospitalized with injuries resulting from farm accidents. The mechanism of injury was farm animal in 135 patients (36%), tractor in 89 (24%), corn picker or auger in 57 (15%), power take-off in 29 (8%), other farm machinery in 50 (13%), and miscellaneous in 15 (4%). Injury severity score (ISS) of 25 or greater was calculated for 29 individuals (8%). Eleven groups of surgical subspecialists performed 539 procedures. Eight patients (2.1%) died as a result of their injuries. All eight deaths occurred after tractor accidents secondary to pelvic fractures, head and spinal cord injury, or blunt chest trauma. Thirty-nine patients (10%) were left with serious permanent disability. Unnecessary morbidity and mortality in many cases were attributed to excessive prehospital care times within a largely rural area. Better prevention by farmer education and the initiation of mandatory safety devices on agricultural equipment may lower the incidence of farm accidents. Major agricultural trauma is frequent and diverse and is optimally managed in a regional trauma center. PMID:4093573

  8. Treatment strategy for hepatic trauma

    Institute of Scientific and Technical Information of China (English)

    Wu-Yong Yu; Qu-Jin Li; Jian-Ping Gong

    2016-01-01

    Liver is one of the organs with the highest injury rate,and in recent decades,the guidelines for the treatment of liver trauma have changed considerably.Now,there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity,non-operative therapy is the main treatment method for hepatic trauma if conditions permit.For serious hepatic trauma patients such as those with hemodynamic instability,they should be operated upon as soon as possible.Regardless of the surgical options,doctors should control damage to patients and try to prevent complications.New therapies such as hepatic artery embolization and liver transplantation have been more and more used for the treatment of serious hepatic damage in clinics.

  9. Evaluation of a novel portable capacitive ECG system in the clinical practice for a fast and simple ECG assessment in patients presenting with chest pain: FIDET (Fast Infarction Diagnosis ECG Trial)

    OpenAIRE

    Rasenack, Eva; Oehler, Martin; Elsässer, Albrecht; Schilling, Meinhard; Maier, Lars

    2012-01-01

    Background Electrocardiogram (ECG) assessment plays a crucial role in patients presenting with chest pain and suspected acute coronary syndrome (ACS). In a pilot study, we previously evaluated a capacitive ECG system (cECG) as a novel ECG technique for a fast and simple ECG assessment in patients with ST-elevation myocardial infarction (STEMI). In a next step, the sensitivity and specificity of this novel ECG technique have to be assessed in patients with ACS. Hypothesis The Fast Infarction D...

  10. Pitfalls and variants in pediatric chest imaging.

    Science.gov (United States)

    García Asensio, D; Fernández Martín, M

    2016-05-01

    Most pitfalls in the interpretation of pediatric chest imaging are closely related with the technique used and the characteristics of pediatric patients. To obtain a quality image that will enable the correct diagnosis, it is very important to use an appropriate technique. It is important to know how technical factors influence the image and to be aware of the possible artifacts that can result from poor patient cooperation. Moreover, radiologists need to be familiar with the normal anatomy in children, with the classic radiologic findings, and with the anatomic and developmental variants to avoid misinterpreting normal findings as pathological.

  11. Poor interpretation of chest X-rays by junior doctors

    DEFF Research Database (Denmark)

    Christiansen, Janus Mølgaard; Gerke, Oke; Karstoft, Jens;

    2014-01-01

    INTRODUCTION: Studies targeting medical students and junior doctors have shown that their radiological skills are insufficient. Despite the widespread use of chest X-ray; however, a study of Danish junior doctors' skills has not previously been performed. MATERIAL AND METHODS: A total of 22...... participants per-used a standardised series of ten chest X-rays. The test used a multiple-choice form for each image, and the clinical data and the tentative diagnosis of each image were also made available to the participants. For each image, the participant chose a single primary diagnosis; and for each......): 0.41-0.57) and the specificity to 0.55 (95% CI: 0.41-0.68). CONCLUSION: Based on the results from this study, we conclude that BCE doctors do not meet the minimum requirements for radiological diagnostic skills for the use of chest X-ray that were established for this study. FUNDING: not relevant...

  12. Subclavian artery injury following blunt trauma: A report of three cases

    Directory of Open Access Journals (Sweden)

    Amr Fares

    2012-04-01

    Full Text Available Subclavian artery injuries are rare in blunt chest trauma, constituting just 1-2 percent of all acute vascular injuries. The diagnosis of injury to the subclavian artery is challenging as a good percentage of patients with such vascular injuries have palpable distal pulses, no signs of any external local trauma and associated injuries often divert the attention of treating physicians. Subclavian artery injuries are the second most common injuries to occur to the aortic arch vessels. The mechanism of injury to these vessels varies from deceleration to traction on upper extremity and neck. Angiography is vital in diagnosis and surgical planning of these patients depends on the site and side of the vascular injuries. Early surgical treatment is an important part of management of these patients. Endovascular treatment is of value in a selected subgroup of subclavian artery injury patients. Reported mortality of subclavian artery injuries varies according to haemodynamic status of patient, time of presentation and other associated injuries. A high degree of suspicion is key to diagnosing these vascular injuries. Early appropriate surgical repair of vascular injury, in combination with aggressive treatment of associated injuries, is important for the optimal outcome of these cases. Here we report three cases of subclavian artery injury, which were successfully treated in Hamad General Hospital by vascular surgery and intensive care teams.

  13. Sudden chest pain and cardiac emergencies in the obstetric patient.

    Science.gov (United States)

    Mabie, W C; Freire, C M

    1995-03-01

    The differential diagnosis and work-up of a patient with chest pain during pregnancy is presented in this article. This is followed by discussions of cardiac emergencies including hypertensive crisis, pulmonary edema, arrhythmias, cardiopulmonary resuscitation, myocardial infarction, and aortic dissection. PMID:7784039

  14. Value of emergency bedside ultrasound in diagnosis of blunt abdominal trauma%急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    张惠萍; 刘燕; 尹毅

    2010-01-01

    目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.%Objective To discuss the value of emergency bedside ultrasound in diagnose of blunt abdominal injury. Methods Portable ultrasound was used in 184 patients with blunt abdominal trauma in emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results The emergency bedside ultrasound identified 169 (91.8%) patients with blunt abdominal injury, of whom 149 patients (95.5%) with single-organ injury and 20 patients (71.4%) with multi-organ injury. There were 21 patients missed diagnosis and three misdiagnosed, with rate of missed diagnosis and misdiagnosis of 13%. Surgical treatment was performed in 119 patients and conservative treatment in 65, which were proved by CT/MRI examination or clinic conservative treatment. Conclusion Emergency bedside ultrasound can provide fast and credible diagnostic information for blunt abdominal trauma, with high diagnosis accordance rate.

  15. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain.

    Science.gov (United States)

    Bolaños-Vergaray, Juan Javier; de la Gala García, Francisco; Obaya Rebollar, Juan Carlos; Bové Alvarez, Maria

    2015-11-01

    Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. Although it is a diagnosis of exclusion, misdiagnosis may lead to an excessive workup. A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome. PMID:26528703

  16. Spinal trauma.

    Science.gov (United States)

    Hernández-Fernández, A; Massó, A; Beristain, M; G Esnal, I; Pardo, E; Carrillo, I; Lersundi, A

    2016-04-01

    The treatment of a patient with a vertebral fracture requires an accurate diagnosis and categorization of the problem. Treatment decisions must be based on clinical data and information about the lesion itself, which is provided by imaging studies and their interpretation.

  17. Management of Temporal Bone Trauma

    OpenAIRE

    Patel, Alpen; Groppo, Eli

    2010-01-01

    The temporal bones are paired structures located on the lateral aspects of the skull and contribute to the skull base. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Complications can include intracranial hemorrhage, cerebral contusion, CSF leak and meningitis, hearing loss, vertigo, and facial paralysis. To prevent these complications, diagnosis followed by appropriate medical and surgic...

  18. Neuroimaging differential diagnoses to abusive head trauma

    International Nuclear Information System (INIS)

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  19. Neuroimaging differential diagnoses to abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Girard, Nadine [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Aix Marseille University, UMR CNRS 7339, Marseille (France); Brunel, Herve; Dory-Lautrec, Philippe [AP-HM Timone 2, Department of Neuroradiology, Marseille cedex 05 (France); Chabrol, Brigitte [AP-HM Timone, Department of Pediatric Neurology, Marseille (France)

    2016-05-15

    Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury. (orig.)

  20. Chest radiographic findings of leptospirosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mee Hyun; Jung, Hee Tae; Lee, Young Joong; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. 2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2, massive confluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinar nodular type 3, massive confluent consolidation type 1, and increased interstitial markings type 1 respectively. 3. It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

  1. [Chest pain - not always the heart! Clinical impact of gastrointestinal diseases in non-cardiac chest pain].

    Science.gov (United States)

    Frieling, T; Bergdoldt, G; Allescher, H D; Riemann, J F

    2015-02-01

    Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart disease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70 % and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50 %, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. Especially gastroenterological expertise is required because in 50 - 60 % of cases gastroesophageal reflux disease (GERD), in 15 - 18 % hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia and in 32 - 35 % other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagitis) as cause of chest pain may be detected. This implicates that regular interdisciplinary round wards and management of chest pain units are mandatory.

  2. Clinical utility of coronary CT angiography with low-dose chest CT in the evaluation of patients with atypical chest pain: a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Jin [Kimhae Bokum Hospital, Kimhae (Korea, Republic of); Choo, Ki Seok; Kim, Chang Won [Pusan National University Hospital, Busan (Korea, Republic of)] (and others)

    2008-04-15

    To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis.

  3. A Rare Cause of Chest Pain in a Young Man: Primary Pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Mehmet Ekiz

    2013-06-01

    Full Text Available Spontaneous pneumomediastinum (SPM is described as the presence of air in the mediastinum. It is a rare clinical condition that often affects adult young men. Patients are rarely symptomatic and detected incidentally. Symptoms often resolve without need of treatment. Diagnosis is made by physical examination and chest X-ray, and further study is rarely needed. We aimed to highlight spontaneous pneumomedisatinum as the differential diagnosis of chest pain.

  4. Comparison of quality control for trauma management between Western and Eastern European trauma center

    Directory of Open Access Journals (Sweden)

    Gambale Giorgio

    2008-11-01

    Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  5. Chest radiography in acute traumatic rupture of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Heystraten, F.M.; Rosenbusch, G.; Kingma, L.M.; Lacquet, L.K.; Boo, T. de; Lemmens, W.A.

    Of 123 patients who had suffered blunt trauma to the chest traumatic aortic rupture was eventually confirmed in 61 and absent in 62 patients. The chest radiographs of these patients were examined for 15 signs reported in the literature as being associated with traumatic aortic rupture. Although many individual signs were significantly more frequent in the aortic rupture group they were not useful in differentiating between patients with and those without rupture of the aorta. By using discriminant analysis combining 2 or 3 signs, patients were classified as having aortic rupture or not. The best discrimination between the two groups was obtained using the combined signs of a widened paratracheal stripe, and opacified pulmonary window, a widened right paraspinal interface and a displaced nasogastric tube.

  6. Multidetector CT of blunt abdominal trauma.

    Science.gov (United States)

    Soto, Jorge A; Anderson, Stephan W

    2012-12-01

    The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial. The "panscan" (computed tomographic [CT] examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. CT has virtually replaced diagnostic peritoneal lavage for the detection of important injuries. Over the past decade, substantial hardware and software developments in CT technology, especially the introduction and refinement of multidetector scanners, have expanded the versatility of CT for examination of the polytrauma patient in multiple facets: higher spatial resolution, faster image acquisition and reconstruction, and improved patient safety (optimization of radiation delivery methods). In this article, the authors review the elements of multidetector CT technique that are currently relevant for evaluating blunt abdominal trauma and describe the most important CT signs of trauma in the various organs. Because conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, the authors emphasize the CT findings that are indications for direct therapeutic intervention. PMID:23175542

  7. HRCT findings of chest complications in patients with leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Nobuyuki; Matsumoto, Tsuneo; Miura, Gouji; Emoto, Takuya; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University School of Medicine (Japan)

    2002-06-01

    High-resolution CT (HRCT) findings of several chest complications occurring in leukemic patients were reviewed. Although most entities show non-specific HRCT findings including ground-glass opacity and air-space consolidation, characteristic findings are observed in several pulmonary complications including Pneumocystis carinii pneumonia, fungal infections, miliary tuberculosis, leukemic infiltration, pulmonary edema, bronchiolitis obliterans, and bronchiolitis obliterans organizing pneumonia. A combination of these characteristic HRCT findings and the information obtained from the clinical setting may help in achieving a correct diagnosis of chest complications occurring in leukemic patients. (orig.)

  8. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-05-15

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

  9. Chest Pain (Beyond the Basics)

    Science.gov (United States)

    ... number of problems related to the stomach and intestines can cause pain that spreads to or even begins in the chest, including ulcers, gallbladder disease, pancreatitis, and irritable bowel syndrome. (See "Patient information: Peptic ulcer disease (Beyond the ...

  10. Relationship between trauma narratives and trauma pathology.

    Science.gov (United States)

    Amir, N; Stafford, J; Freshman, M S; Foa, E B

    1998-04-01

    In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narrative as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma. PMID:9565923

  11. Percutaneous artherial embolization in the treatment of liver trauma

    International Nuclear Information System (INIS)

    Percutaneous arterial embolization in the treatment of liver trauma. Liver trauma requires emergency therapy. Because it is highly vascular and because of its location, the hemostasis is difficult to achieve. The main causes of death associated to liver trauma are due to prolonged hipovolemia. The current forms of surgical treatment of liver wounds are associated with a high morbidity rate. In some hepatic injuries, hemorrage is so massive that operative control of bleeding is necessary, bu t in most cases, particularly in blunt trauma, an angiographic approach with diagnosis and embolotherapy is preferable. Six patients with blunt or perforating hepatic trauma were managed with percutaneous arterial embolization. Hemostasis was achieved immediately in all of them withoyt recurrence. Surgical intervention with additional trauma was thus avoided, decreasing the morbidity rate. The percutaneous arterial embolization presents an efficient alternative in the management of hemorrage due to liver trauma, being particularly useful in the poor risk patient. (author)

  12. Actinomicose pulmonar com envolvimento da parede torácica Lung actinomycosis with chest wall involvement

    Directory of Open Access Journals (Sweden)

    Marcelo Cunha Fatureto

    2007-02-01

    Full Text Available A Actinomicose é uma infecção rara, crônica, supurativa e granulomatosa que pode envolver diversos órgãos. A infecção pulmonar geralmente está relacionada à imunodepressão e à saúde bucal precária. O envolvimento torácico é incomum (10 - 20%, a parede torácica é acometida em apenas 12% destes casos. No presente trabalho, é descrito o caso de um paciente de 26 anos, não HIV e sem co-morbidades, assintomático respiratório, com massa infra-escapular, de crescimento progressivo, muito dolorosa, com sinais locais flogísticos, sem trauma local, apresentando febre persistente, com três meses de evolução. O diagnóstico inicial foi de neoplasia de partes moles de parede torácica. À biopsia incisional da referida massa, houve saída de secreção gelatinosa vinhosa com grânulos amarelados, sugestivos de actinomicose, sendo confirmado por exame anatomopatológico. Empiricamente foi instituída ciprofloxacina devido alergia à cefalosporina. Houve excelente resposta clínica à drenagem externa e à medicação prescrita. Não houve recaída da doença em 18 meses de seguimento.Actinomycosis is an uncommon suppurative granulomatous chronic infection that may involve several organs. Lung infection is usually related to immunodepression and poor oral hygiene. Cases of thoracic involvement are rare (10 - 20% and only 12% of such cases affect the chest wall. This report describes the case of a 26-year-old HIV-negative patient without comorbidities or respiratory complaints who presented a very painful, progressively growing infrascapular mass, with local phlogistic signs and no local trauma, and persistent fever. It had been progressing for three months. The initial diagnosis was neoplasia of chest wall soft tissue. However, incision biopsy in this mass produced a red wine-colored gelatinous secretion containing yellowish granules suggestive of actinomycosis, which was later confirmed by anatomopathological examination

  13. Head Trauma, First Aid

    Science.gov (United States)

    ... rashes clinical tools newsletter | contact Share | Head Trauma, First Aid A A A Head trauma signs and symptoms ... to take care for potential neck/spinal injury. First Aid Guide If you suspect either a serious head ...

  14. Common Reactions After Trauma

    Science.gov (United States)

    ... here Enter ZIP code here Common Reactions After Trauma Public This section is for Veterans, General Public, Family, & Friends Common Reactions After Trauma Available in Spanish: Reacciones Comunes Después de un ...

  15. Chest X-ray imaging of patients with SARS

    Institute of Scientific and Technical Information of China (English)

    陆普选; 周伯平; 陈心春; 袁明远; 龚小龙; 杨根东; 刘锦清; 袁本通; 郑广平; 杨桂林; 王火生

    2003-01-01

    Objective To investigate the chest X-ray manifestations of SARS cases.Methods A retrospective study was conducted among 52 clinically confirmed SARS patients from February 9 to May 10, 2003. Chest X-ray scanning was performed at a interval of 1-3 days according to the requirements. The manifestations and special features of SARS in X-ray were analyzed. Results Small or large patchy shadows with intensive density in both lungs were observed in 31 cases, ground-glass like opacification in 16, small patchy shadows in one lung lobe or one lung segment in 18, nodular shadows in one lung segment in 1, and increased lung marking in lung interstitial tissues in 2. Rapidly changing consolidations revealed in chest X-ray images were found to be associated with SARS infections, and they were not affected by treatment with antibiotics.Conclusion Chest X-ray provides a sensitive and specific method for the diagnosis and treatment of SARS, and those present with symptoms and signs should undergo chest X-ray scanning every 1-3 days.

  16. Bedside Ultrasound in a Case of Blunt Scrotal Trauma

    Directory of Open Access Journals (Sweden)

    Mark Cannis

    2013-03-01

    Full Text Available This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedsideemergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompturological consultation and timely surgical repair. The utility of bedside emergency ultrasound inthe evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

  17. MANAGEMENT OF LIVER TRAUMA

    OpenAIRE

    Dova Subba; Mallapraggada Rama Chandra; Erabatti

    2016-01-01

    AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and h...

  18. Necrotizing Fasciitis Secondary to a Primary Suture for Anoperineal Trauma by Motorcycle Accident in a Healthy Adult

    Directory of Open Access Journals (Sweden)

    Susumu Saigusa

    2015-01-01

    Full Text Available A 41-year-old man experienced a swollen scrotum three days after a motorcycle accident and presented to our hospital. He had had a primary suture repair for anoperineal trauma in an outside hospital at the time of the injury. He presented to us with general fatigue, low grade fevers, and perineal pain. Abdominal computed tomography showed subcutaneous emphysema from the scrotum to the left chest. The sutured wound had foul-smelling discharge and white exudate. We made the diagnosis of necrotizing fasciitis and immediately opened the sutured wound and performed initial debridement and lavage with copious irrigation. We continued antibiotics and lavage of the wound until the infection was controlled. Fortunately, the necrotizing fasciitis did not worsen and he was discharged after 15 days. Our experience indicates that anoperineal injuries should not be closed without careful and intensive follow-up due to the potential of developing necrotizing fasciitis.

  19. Helping Youth Overcome Trauma

    Science.gov (United States)

    Chambers, Jamie C.

    2005-01-01

    The effects of trauma can roll on unchecked like a spirit of death. In its path are strewn its once vibrant victims. Human bonds are rent asunder by the disgrace of trauma. These are the youngsters who have been verbally bashed, physically battered, sexually assaulted, and spiritually exploited. Other traumas of childhood neglect include: (1)…

  20. 急诊超声检查在腹部闭合性损伤诊断中的应用价值%Value of Emergency Ultrasonography in Diagnosis of Blunt Abdominal Trauma

    Institute of Scientific and Technical Information of China (English)

    吴隽; 李毅; 徐俊; 陈旭东; 赖会君

    2016-01-01

    Objective:To explore the value of emergency ultrasonography in diagnosis of bluntabdominal injury. Methods:Emergency ultrasonography was used in102 patients with blunt abdominal traumain emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results: All patients were proved by CT examinationor surgical operation.The emergency ultrasonography identified 87(85.3%)patients with blunt abdominal injury,of whom 93 patients with solid organ injury and 9 patients with hollow organ injury.The accordance rate of diagnosis in the solid organs was significantly higher than that in the hollow organs (89.2% vs 44.4%,P<0.01). Conclusion: Emergency ultrasonographycan show high diagnosis accordance rate in abdominal solid organ injury after blunt abdominal trauma. Thus ,it is of great value in clinical application.%目的:探讨急诊超声检查在腹部闭合性损伤诊断中的应用价值。方法:对我院102例腹部闭合性损伤患者进行急诊超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体。结果:所有患者均经CT检查或手术证实,超声诊断总体符合率85.3%(87/102),其中实质性脏器损伤93例,空腔脏器损伤9例,实质性脏器损伤诊断符合率明显高于空腔脏器损伤(89.2% vs44.4%,P<0.01)。结论:对腹部闭合性损伤尤其是实质性脏器损伤,急诊超声检查诊断符合率高,具有较好的临床应用价值。

  1. Chest Wall tumor: combined management

    International Nuclear Information System (INIS)

    Cancer is relatively rare disease among children and adolescents. The incidence of solid tumors other than CNS is less than 2/100,000. Tumors of the chest wall can arise either from the somatic tissue or ribs. These are rare, so either institutional reviews or multi institutional studies should determine optimal therapeutic management. Of the bony chest wall, Ewing's sarcoma or the family of tumor (peripheral neuro epithelioma, Askin tumor), are the most common. These lesions are lytic and have associated large extra pleural component. This large extra pleural component often necessitates major chest wall resection (3 or more ribs), and when lower ribs are involved, this entails resection of portion of diaphragm. Despite this resection, survival in the early 1970 was 10-20%. Since 1970 multi agent chemotherapy has increased survival rates. of importance, however, is these regimens have caused significant reduction of these extra pleural components so that major chest wall resections have become a rarity. With improved survival and decreased morbidity preoperative chemotherapy followed by surgery is now the accepted modality of treatment. Another major advantage of this regimen is that potential radiation therapy may be obviated. The most common chest wall lesion is rhabdomyosarcoma. In the IRS study of 1620 RMS patients, in 141 (9%) the primary lesion was in the chest wall. these are primarily alveolar histology. when lesions were superficial, wide local excision with supplemental radiation therapy was associated with low morbidity and good overall survival. however, a majority have significant intra- thoracic components. in these circumstances the resectability rate is less than 30% and the survival poor. Other lesions include non rhabdomyosarcomas, eosinophilic granuloma, chondrosarcoma, and osteomyelitis. The management of these lesions varies according to extent, histology, and patient characteristics

  2. Gunshot wounds to the chest

    OpenAIRE

    Holmen, Lillian Beate

    2013-01-01

    Introduction: This is a review of gunshot wounds to the chest. Although uncommon in Norway, they represent a big health problem in other parts of the world and in war situations. Method: A systematic literature search using PubMed and McMaster+. Results: Gunshot wounds to the chest can be highly lethal. Depending on the injured organ, a large percentage of the patients die before reaching the hospital. There is a big difference between low-velocity and high-velocity weapons. Low velocity inju...

  3. Relevance of an incidental chest finding

    Science.gov (United States)

    Cortés-Télles, Arturo; Mendoza, Daniel

    2012-01-01

    Solitary pulmonary nodule represents 0.2% of incidental findings in routine chest X-ray images. One of the main diagnoses includes lung cancer in which small-cell subtype has a poor survival rate. Recently, a new classification has been proposed including the very limited disease stage (VLD stage) or T1-T2N0M0 with better survival rate, specifically in those patients who are treated with surgery. However, current recommendations postulate that surgery remains controversial as a first-line treatment in this stage. We present the case of a 46-year-old female referred to our hospital with a preoperative diagnosis of a solitary pulmonary nodule. On initial approach, a biopsy revealed a small cell lung cancer. She received multimodal therapy with surgery, chemotherapy, and prophylactic cranial irradiation and is currently alive without recurrence on a 2-year follow-up. PMID:22345914

  4. An Atypical Cause of Atypical Chest Pain

    Directory of Open Access Journals (Sweden)

    Ahmad Zaheen

    2014-01-01

    Full Text Available The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.

  5. Radiation dose to the patient and the radiologist while performing on chest computed tomography: a program of early diagnosis of lung cancer, biopsy and treatment simulation guided radiation oncologist breast cancer

    International Nuclear Information System (INIS)

    In this paper we determine the equivalent dose received by the operator and patient lung biopsies using thermoluminescence dosimeters, are established recommendations that this dose is as low as possible. It also reviews the acquisition protocols in both CT scans in early diagnosis program cited as the acquisition of CT for treatment planning dosimetric radiation oncologist in breast cancer.

  6. Retrospective cohort analysis of chest injury characteristics and concurrent injuries in patients admitted to hospital in the Wenchuan and Lushan earthquakes in Sichuan, China.

    Directory of Open Access Journals (Sweden)

    Xi Zheng

    Full Text Available BACKGROUND: The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. METHODS: We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. RESULTS: The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. CONCLUSIONS: Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake

  7. Major gastroenteric injuries from blunt trauma.

    Science.gov (United States)

    Talton, D S; Craig, M H; Hauser, C J; Poole, G V

    1995-01-01

    Hollow visceral injuries are far less common in blunt abdominal trauma than in penetrating abdominal trauma. From 1982 through 1993 we treated 50 patients with 57 major blunt injuries to the gut, defined as perforation, transection, or devascularization. Thirty-two patients (64%) were injured in motor vehicle collisions. Of these, 29 wore no restraints; three were wearing lap belts (none wore lap-shoulder restraints). Mean injury Severity Score (ISS) in patients wearing lap belts was 13.3, compared with 28.6 in the 29 patients who were not using restraint devices (P injuries, followed by devascularization of the small bowel, colorectal injuries, duodenal, and gastric perforations. ISS and mortality rates were lowest in small bowel injuries and higher in the less common colonic and gastroduodenal injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest, or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma, and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to computed tomography scanning (false negatives = 6.7% versus 36%, respectively; P < 0.05). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.

  8. Tetanus after blunt lawn mower trauma

    Directory of Open Access Journals (Sweden)

    Camilla Normand

    2015-01-01

    Full Text Available A patient presented with tetanus ten days after blunt trauma with a lawn mower. Our case describes the diagnosis and treatment of this patient with an infectious disease commonly seen in the developing world but rarely seen in the developed world.

  9. Actinomycosis involving the chest wall: CT findings

    International Nuclear Information System (INIS)

    Two cases of pulmonary actinomycosis with extension to involve the chest wall that were evaluated using computerized tomography are reported. In both cases, the relation of pulmonary and chest wall disease was best shown using CT

  10. Analysis of chest image performance in patients with acute chlorine poisoning

    International Nuclear Information System (INIS)

    Objective: To explore chest image features of patients with acute chlorine poisoning and their clinical values. Methods: A retrospective analysis was performed by chest image features of 117 patients with acute chlorine poisoning. All the patients were classified according to Chinese management of occupational acute chlorine poisoning diagnosis standard. Results: Sixty-five patients presented with stimulus response, and normal or both lungs had a little more white on their chest images. Thirty-one cases presented with minor poisoning, and without or the texture of both lungs was increased, and grew hazy and coarse.seventeen cases were moderate, and small sample vague shadows or single or multiple limitations lamellar shadow. Four cases were serious,and two lungs had extensive and density homogeneous consolidation shadow. Conclusions: It would make the diagnosis and assessment of chlorine poisoning more easier based on the combination of chest image features, the clear history of acute chlorine poisoning and relevant clinical performance. (authors)

  11. Aspergillosis of bilateral breast and chest wall in an immunocompetent male masquerading as breast cancer

    Directory of Open Access Journals (Sweden)

    Jitendra G Nasit

    2013-01-01

    Full Text Available Fungal species are not frequently encountered in an immunocompetent host. Invasive aspergillosis typically occurs in severely immunocompromised patient. Aspergillus infection of breast and chest wall are rarely encountered in an immunocompetent as well as in immunocompromised host. Till date only 13 cases of fungal infection of breast and chest wall have been reported in the literature. This report presents a case of aspergillosis of bilateral breast and chest wall in an immunocompetent male, clinically mimicking breast cancer. Diagnosis was achieved by fine-needle aspiration cytology and subsequently Aspergillus flavus was identified on fungal culture. The patient was successfully treated with voriconazole. Prompt diagnosis by cytology and appropriate treatment is necessary to prevent adverse outcome. Here, we present this rare case of fungal infection of breast and chest wall with relevant review of the literature.

  12. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  13. Chest X-ray in newborns and infants; Konventionelle Thoraxdiagnostik bei Neugeborenen und Kleinkindern

    Energy Technology Data Exchange (ETDEWEB)

    Moritz, Joerg D. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Klinik fuer diagnostische Radiologie, Paediatrische Radiologie und Sonographie

    2012-12-15

    Chest X-ray in newborns and infants shows great differences to that in adults. Therefore all radiologists, who engage in X-rays in this age group, must be familiar with the special features. At the beginning specific items of examination methods are explained, which must be strictly followed due to radiological protection. Focus of the paper is the discussion of the important chest diseases in newborn and infants, which are mostly unknown in chest diagnosis in adults. Many of them can be life-threatening, thus their knowledge is essential. Pathophysiological explanations shall make the special radiological signs understandable. (orig.)

  14. Chest pain units: A necessity or only a name to encourage patients

    OpenAIRE

    Reza Assareh, Ahmad; Azadi, Nasim; Tahmasebi, Safar Ali; Sahraei, Tooba; Dabbagh, Razieh; Hajizadeh, Ebrahim; Mahdavi, Kamran; Heydari, Ali; Alasti, Mohammad

    2012-01-01

    BACKGROUND Acute chest pain is a common symptom among patients presenting to emergency wards. Identification and admission of patients with real acute coronary syndrome and preventing the hospitalization of people with false diagnosis of coronary syndrome are the most important tasks in emergency wards. The purpose of this study was to investigate the usefulness of designing a special chest pain unit in emergency department of Imam Khomeini Hospital (Ahvaz, Iran). METHODS The patients with ma...

  15. [ANMCO/SIMEU Consensus document: In-hospital management of patients presenting with chest pain].

    Science.gov (United States)

    Zuin, Guerrino; Parato, Vito Maurizio; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto Di Uccio, Fortunato; Valente, Serafina

    2016-06-01

    Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: 1) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; 2) the increasing percentage of hospitalizations of low-risk cases.It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country. PMID:27311086

  16. Management of duodenal trauma

    OpenAIRE

    Chen, Guo-Qing; Hua YANG

    2011-01-01

    【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature...

  17. Trauma is danger

    OpenAIRE

    Porterfield Nancy; Hwang Paul F; Pannell Dylan; Davis Thomas A; Elster Eric A

    2011-01-01

    Abstract Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusi...

  18. Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS registered concept

    International Nuclear Information System (INIS)

    Purpose: to determine the added diagnostic benefit of using MS-CT in multiple trauma patients differentiated by severity of injury and affected body region. Materials and methods: a retrospective analysis was performed of the 16-row whole-body spiral CT findings in 275 multiple trauma patients (73% men, 27% women; age 39.6 ± 18.9 years) with regard to additional findings and new findings obtained with CT compared to the findings obtained by conventional projection radiography and abdominal ultrasound in the emergency room. The additional and new findings were differentiated by body region (head, face, chest, pelvis, abdomen, spine) and the degree of severity according to the three classes of injuries distinguished by the ATLS registered concept (class 1: simple injury, class 2: potentially life threatening, class 3: immediately life threatening). Results: a total of 921 additional findings (findings potentially relevant for further diagnosis and therapy in addition to the findings obtained by conventional radiography or ultrasound) were obtained by MS-CT in all patients. The distribution by number of patients and body region was as follows: 22 neck, 76 face, 125 chest, 112 abdomen, 50 pelvis, and 91 spine. Most additional findings were categorized as potentially life threatening (ATLS class 2). In addition, there were 439 completely new findings, involving the head in 128 patients (mostly ATLS class 3), the face in 18, the chest in 47, the abdomen in 26, and the spine in 9 patients. Most new findings involving the face, abdomen, and spine were ATLS class 2 injuries. (orig.)

  19. Chest wall tuberculosis; CT findings in 14 patients

    International Nuclear Information System (INIS)

    To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis

  20. CT and MR findings of chest wall masses

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Woo; Kim, Jin Hee; Lee, Eun Suk; Kwon, Sun Young; Ko, Eun Ju [Eul Ji General Hospital, Daejeon (Korea, Republic of); Lee, Sang Young [Chonbuk National University Medical School, Jeonju (Korea, Republic of); Kang, Hye Jeong [Eul Ji General Hospital, Seoul (Korea, Republic of)

    1995-07-15

    To evaluate the characteristic radiological findings of various diseases forming chest wall masses by CT and MR. We retrospectively reviewed CT and MR findings of the chest wall masses in 31 patients. Morphology, density, features of contrast enhancement, and location of the mass within the bony thorax or soft tissue were analyzed. Benign lesions of bony thorax were osteochondritis (n = 2), tuberculosis (n = 1), and osteochon droma (n = 1). Malignant lesions of bony thorax were Ewing's sarcoma (n = 1) and metastasis (n = 3). Benign lesions of soft tissue were abscess (n = 1), tuberculosis (n = 7), lipoma (n = 1), cavernous hemangioma (n = 2), cavernous lymphangioma (n = 1), and neurofibroma (n = 1). Malignant lesions of soft tissue were lymphoma (n = 1), spindle cell sarcoma (n = 1), metastasis (n = 8). Tuberculosis of the chest wall (n = 8) were ill-defined hypodense (n = 7) or isodense (n = 1) mass than surrounding muscle on pre-enhanced CT scan. All massess showed peripheral rim enhancement after contrast enhancement. Five cases were associated with pulmonary or pleural tuberculosis. All malignant lesions of bony thorax showed bone destruction, but inflammatory processes also showed bone destruction. MR showed characteristic signal intensity in the case of lipoma (n = 1) and hemangioma (n = 1). We conclude that CT and MR are helpful for differential diagnosis of chest wall masses.

  1. Nuclear imaging of the chest

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Y.W. [Samsung Cheil General Hospital, Seoul (Korea, Republic of). Dept. of Radiology; Kim, E.E. [Texas Univ., Houston, TX (United States). Cancer Center; Isawa, T. [Yokohama Higashi National Hospital (Japan)

    1998-01-01

    This book provides up-to-the minute information on the diagnostic nuclear imaging of chest disorders. The authors have endeavored to integrate and consolidate the many different subspecialities in order to enable a holistic understanding of chest diseases from the nuclear medicine standpoint. Highlights of the book include in addition to the cardiac scan the description of aerosol lung imaging in COPD and other important pulmonary diseases and the updates on breast and lung cancer imaging, as well as imaging of the bony thorax and esophagus. It is required reading not only for nuclear medicine practitioners and researchers but also for all interested radiologists, traumatologists, pulmonologists, oncologists and cardiologists. (orig.) 217 figs., 25 tabs.

  2. Contemporary management of blunt aortic trauma.

    Science.gov (United States)

    Dubose, J J; Azizzadeh, A; Estrera, A L; Safi, H J

    2015-10-01

    Blunt thoracic aortic injury (BTAI) remains a common cause of death following blunt mechanisms of trauma. Among patients who survive to reach hospital care, significant advances in diagnosis and treatment afford previously unattainable survival. The Society for Vascular Surgery (SVS) guidelines provide current best-evidence suggestions for treatment of BTAI. However, several key areas of controversy regarding optimal BTAI care remain. These include the refinement of selection criteria, timing for treatment and the need for long-term follow-up data. In addition, the advent of the Aortic Trauma Foundation (ATF) represents an important development in collaborative research in this field. PMID:25868973

  3. Chest shape in preterm newborn infants

    International Nuclear Information System (INIS)

    The suggestion that thoracic shape of anteroposterior radiographs reflects lung compliance was examined in 62 preterm newborn infants (none with pulmonary hypoplasia) by measuring ratios of upper to lower chest widths. Chest shape did not vary significantly with the presence of respiratory distress syndrome (RDS) or with gender, Apgar score, endotracheal intubation, radiographic severity of RDS, or age at radiography. However, decreased maturity was associated with a relatively wide upper chest and narrow lower chest. Developmental factors may be more important than lung compliance (and the other factors noted) in determining the radiographic configuration of the infantile chest

  4. Profile of care given to patients with blunt chest injuries within the first 48 hours

    Directory of Open Access Journals (Sweden)

    E Nyangena

    2000-09-01

    Full Text Available This study was conducted in the trauma unit of a large academic hospital in Johannesburg, South Africa. The study aimed at describing the nature of care that patients with blunt chest injuries received during the first 48 hours after injury. A descriptive survey was chosen using retrospective and prospective record review to obtain data. The sample comprised 60 records of patients who were admitted to the hospital due to blunt chest injuries between January 1997 and June 1998. Descriptive statistics were used to present and analyse data. The study showed that: (i Blunt chest trauma victims received a thorough initial assessment and care. No missed injuries were identified on subsequent assessment; (ii More than half of the patients spent over one hour in the accident/emergency department before admission to the trauma ward or intensive care unit (ICU; (iii Motor vehicle accidents (MVA were the commonest cause of injury while pedestrian vehicle accidents (PVA were often fatal; (iv Nurses are good providers of care but poor in prescribing and documenting care; (v Pain assessment and psychosocial care was often neglected; (vi Less than half the patients developed complications during the first 48 hours; pain and pneumonia being the most common complications encountered.

  5. [Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

    Science.gov (United States)

    Lanfrey, E; Grolleau, J L; Glock, Y; Chavoin, J P; Costagliola, M

    1996-04-01

    Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials. PMID:8761064

  6. Gastric tumors on chest radiographs

    International Nuclear Information System (INIS)

    Gastric neoplasms of three patients protruded into their gas-containing fornices and were first visualized on plain chest radiographs. Endoscopy and/or surgery confirmed these to be a polyp, a leiomyoma, and an adenocarcinoma. The polyp, 1.3 cm in diameter, was the smallest of these three, but smaller lesions may be detectable under suitable conditions. Adequate technique and positioning, sufficiently large lesions in the upper portion of the stomach, a central beam tangential to the tumor, sufficient gas in the stomach, and careful scrutiny by the observer are required. Lesions may be more readily visualized during chest radiography when oral sodium bicarbonate is used to distend the stomach. In chest radiography, exposure limited to the lung fields has been advocated for economy and dose reduction. However, too small an exposure field may result in loss of information potentially beneficial to the patient. Using the smaller of two popular film sizes (35 x 43 cm and 35 x 35 cm), the saving in surface and bone marrow doses is negligible, and the saving in gonad dose may be nil over that when shielding is used. The interest of the observer may be absorbed by a concomitant cardiac or pulmonary lesion. Careful scrutiny of the entire radiograph is therefore essential. (author)

  7. [Psychosomatic medicine for non-cardiac chest pain].

    Science.gov (United States)

    Funakoshi, Seiko; Hosoi, Masako; Tsuchida, Osamu

    2009-09-01

    Recently, it has become problematic that the number of noncardiac chest pain (NCCP) patients are increasing among those who come to the emergency room with chest pain as a chief complaint. They tend to come to hospitals often and over many years, even after cardiac-chest pain has been excluded from their diagnosis. Moreover, studies have shown that NCCP patients have a high prevalence of anxiety, depression and disability. However, most NCCP patients are usually treated by cardiologists or primary physicians. Ordinary biomedical approaches often fail to treat NCCP. NCCP is one of the most important functional somatic syndromes from the view of medical economics. The cause of NCCP includes gastroesophageal reflux disease, panic disorder and esophageal dysmotility. In this review article, we summarize the definition, epidemiology, pathology, and process of diagnosis of NCCP. Finally, we propose a pathological hypothesis from a psychosomatic view. We discuss the effects of anxiety, fear and hyperactive behavior induced by affective stressors on the dysmotility and the lowering of the pain threshold.

  8. Trauma in pregnancy.

    Science.gov (United States)

    Oxford, Corrina M; Ludmir, Jonathan

    2009-12-01

    In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. Blunt trauma to the abdomen increases the risk of placental abruption. Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record. PMID:20393413

  9. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg;

    2012-01-01

    Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined......, the result is, that more than 100 trauma scenario exist when the two dentitions are combined. Each of these trauma scenarios have a specific treatment demand and prospect for healing. With such a complexity in diagnose and treatment it is obvious that even experienced practitioners may have problems may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...

  10. Correlation analysis between plasma D-dimer levels and orthopedic trauma severity

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-dan; LIU Hong-bo; LI Yu-neng; MA Hai-mei; LIU Ya-bo; WANG Man-yi

    2012-01-01

    Background The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies.The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.Methods Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured.Plasma D-dimer levels in patients of these two groups were compared.The relationship between the plasma D-dimer level and the severity of the trauma was also studied.Results There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group.The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P <0.01).In the acute trauma group,the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r=0.9532).Conclusions Elevated plasma D-dimer is common in trauma patients.The D-dimer level and the number of fractures in the trauma patients are closely correlated.D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus,but also an indicator of the severity of trauma in acute trauma patients.

  11. Chest roentgenology in the intensive care unit: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Maffessanti, M. [Istituto di Radiologia, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Berlot, G. [Istituto di Anestesia e Rianimazione, Universita di Trieste, Ospedale di Cattinara, I-34 100 Trieste (Italy); Bortolotto, P. [Servizio di Radiologia, Ospedale Maggiore, I-34 100 Trieste (Italy)

    1998-02-01

    Chest roentgenology in the intensive care unit is a real challenge for the general radiologist. Beyond the basic disease, the critically ill is at risk for developing specific cardiopulmonary disorders, all presenting as chest opacities, their diagnosis often being impossible if based only on the radiological aspect. To make things harder, their appearance can vary with the subject`s position and the mechanical ventilation. Patients require a continuous monitoring of the vital functions and their mechanical and pharmacological support, for which they are connected to different instruments. The radiologist should know the normal position of these devices, and promptly recognize when they are misplaced or when complications from their insertion occurred. Our aim is to suggest for each of the above-mentioned conditions a guideline of interpretation based not only on the radiological aspect and distribution of the lesions, but also on the physiopathological and clinical grounds. (orig.) With 13 figs., 58 refs.

  12. Computerized detection of pneumothorax on digital chest radiographs

    International Nuclear Information System (INIS)

    This paper reports on neumothoraces that are clinically important abnormalities that usually appear as a subtle, fine line pattern on chest radiographs. We are developing a computer vision system for automated detection of pneumothorax to aid radiologists diagnosis. Chest images were digitized with a 0.175-mm pixel size, yielding a 2,000 x 2,430 matrix size, and 10 bits of gray scale. After indentification of the lung regions, an edge detection filter was employed in the apical areas to enhance a pneumothorax pattern. Ribs were detected with a technique based on statistical analysis of edge gradients and their orientations. Points located on a curved line suggestive of a pneumothorax in this enhanced image were detected with a Hough transform

  13. COMPARTMENT SYNDROME IN TRAUMA PATIENTS

    Directory of Open Access Journals (Sweden)

    Alexander Beck

    2007-07-01

    Full Text Available Acute limb compartment syndrome (LCS is a limb-threatening and occasionally life-threatening condition caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone, which leads to muscle and nerve ischemia. Well-known causative factors are acute trauma and reperfusion after treatment for acute arterial obstruction. Untreated compartment syndrome usually leads to muscle necrosis, limb amputation, and, if severe, in large compartments, renal failure and death. Alertness, clinical suspicion of the possibility of LCS, and occasionally intracompartmental pressure (ICP measurement are required to avoid a delay in diagnosis or missed diagnosis. Open fasciotomy, by incising both skin and fascia, is the most reliable method for adequate compartment decompression. The techniques of measuring ICP have advantages and disadvantages, whereas the pressure level that mandates fasciotomy is controversial. Increased awareness of the syndrome and the advent of measurements of ICP pressure have raised the possibility of early diagnosis and treatment. This presentation reports LCS, including etiology, diagnosis, ICP measurement, management, and outcome.

  14. Chest neoplasms with infectious etiologies.

    Science.gov (United States)

    Restrepo, Carlos S; Chen, Melissa M; Martinez-Jimenez, Santiago; Carrillo, Jorge; Restrepo, Catalina

    2011-12-28

    A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi's sarcoma, Castleman's disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.

  15. ACR Appropriateness Criteria chronic chest pain-low to intermediate probability of coronary artery disease.

    Science.gov (United States)

    Woodard, Pamela K; White, Richard D; Abbara, Suhny; Araoz, Philip A; Cury, Ricardo C; Dorbala, Sharmila; Earls, James P; Hoffmann, Udo; Hsu, Joe Y; Jacobs, Jill E; Javidan-Nejad, Cylen; Krishnamurthy, Rajesh; Mammen, Leena; Martin, Edward T; Ryan, Thomas; Shah, Amar B; Steiner, Robert M; Vogel-Claussen, Jens; White, Charles S

    2013-05-01

    Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are etiologies of chronic noncardiac chest pain. Noncardiac chest pain is most commonly related to gastroesophageal reflux disease or other esophageal diseases. Alternatively, it may be related to costochondritis, arthritic or degenerative diseases, old trauma, primary or metastatic tumors, or pleural disease. Rarely, noncardiac chest pain may be referred pain from organ systems below the diaphragm, such as the gallbladder. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:23542027

  16. Comparison of Color Doppler Ultrasound, CT and CR Inspection in the Diagnosis of Ocular Trauma%眼外伤的彩色多普勒超声、CT及CR检查诊断分析比较

    Institute of Scientific and Technical Information of China (English)

    何继武; 刘爽; 田耀军; 刘伟超

    2013-01-01

    目的:探讨彩色多普勒超声(CDFI)、CT及CR三种影像检查对眼部异物、眼眶血肿的诊断价值.方法:对57例眼外伤的眼部彩超、CT及常规CR检查结果进行比较.结果:本组15例金属异物眼部彩超、常规CR及CT诊断均符合临床,眼部彩超及普通CR均有漏诊.本组25例非金属异物常规CR发现15例,眼部彩超发现14例,CT全部发现并提示异物位置.超声检查血肿22例声像图显示为边界清楚的异常回声占位病变;CDFI检查的情况:19例未发现血流信号,2例肿物边缘发现少许血流信号,1例间隔上有少许血流信号.CT检查:57例行CT扫描,血肿均表现为不同形状的高密度软组织影.CR检查57例中22例血肿均表现为局部高密度影.结论:①超声检查简便,无创;能发现大多数眼部异物,可作为眼部异物的筛查方法.CR是检查眼部异物的方法,其定位准确性不高,对植物性异物几乎不能诊断.CT不仅能检出细小的眼部异物,还分辨眼部异物位置.螺旋CT三维成像的运用,图像立体感强,定位更为准确,是眼部异物诊断的理想方法.三种方法有机合用可以明显提高检查的准确性.②超声检查可确定血肿的位置和形状,有助于血肿性质的判断,并可明确血肿的范围及其与视神经的关系.CT检查对眼眶占位病变的判断,具有一定的优势.%Objective: To study the color Doppler ultrasound, CT and CR diagnosis value for eye foreign body and orbital hematoma. Methods: The color Doppler ultrasound, CT and conventional CR inspection results of 57 cases of ocular trauma were compared. Results: The diagnosis of 15 cases of metal foreign body eye diagnosed by color Doppler ultrasound, CR, and CT were identified by surgery, while some cases were miss-diagnosed by eye color Doppler and conventional CR. Of the 25 cases of non-metal foreign bodies, 15 cases were found by conventional CR found in, 14 cases were discovered by color Doppler

  17. Trauma Induced Coagulopathy

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard;

    2013-01-01

    It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...

  18. A study of diagnostic imaging in pancreatic trauma

    International Nuclear Information System (INIS)

    Pancreatic trauma treatment depends on pancreatic ductal injury. We examined the usefulness and problems of diagnostic imaging, such as enhanced CT, ERP, and CT after ERP, in pancreatic trauma. Subjects were 12 patients with pancreatic trauma treated in our hospital between April 1993 and March 2000. Enhanced CT was performed in 6 patients undergoing diagnostic imagings and ERP in 4 of the 6. Overall diagnostic accuracy of pancreatic ductal injury in enhanced CT was 16.7% and accuracy in ERP with CT after ERP was 100%. Intraoperative diagnosis of main pancreatic ductal injury was difficult in 1 of 2 patients in whom ERP failed. The importance of preoperative diagnostic imaging is thus clear. We expect that MRCP, recently evaluated in pancreatic disease diagnosis, will become a new pancreatic trauma modality. (author)

  19. Potential of ultrasound in the pediatric chest

    Energy Technology Data Exchange (ETDEWEB)

    Trinavarat, Panruethai, E-mail: pantrinavarat@hotmail.com [Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330 (Thailand); Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at [Department of Radiology, Division of Pediatric Radiology, University Hospital Graz (Austria)

    2014-09-15

    Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

  20. Trauma no idoso Trauma in the elderly

    Directory of Open Access Journals (Sweden)

    JOSÉ ANTONIO GOMES DE SOUZA

    2002-03-01

    Full Text Available O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, desproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave diferently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and reabilitation of the elderly victims of trauma.

  1. Histiocytic disorders of the chest: imaging findings.

    Science.gov (United States)

    Ahuja, Jitesh; Kanne, Jeffrey P; Meyer, Cristopher A; Pipavath, Sudhakar N J; Schmidt, Rodney A; Swanson, Jonathan O; Godwin, J David

    2015-01-01

    Histiocytic disorders of the chest comprise a broad spectrum of diseases. The lungs may be involved in isolation or as part of systemic disease. Some of these disorders are primary and have unknown etiology, and others result from a histiocytic response to a known cause. Among primary histiocytic disorders, pulmonary Langerhans cell histiocytosis (PLCH) is the most common; others include Erdheim-Chester disease and Rosai-Dorfman disease. Adult PLCH occurs almost exclusively in adults aged 20-40 years who smoke. Pediatric PLCH is extremely rare and typically occurs as part of multisystemic disease. Erdheim-Chester disease affects middle-aged and older adults; thoracic involvement usually occurs as part of systemic disease. Rosai-Dorfman disease affects children and young adults and manifests as painless cervical lymphadenopathy. Examples of secondary histiocytic disorders are storage diseases such as Gaucher disease, Niemann-Pick disease, and Fabry disease; pneumoconiosis such as silicosis and coal workers' pneumoconiosis; and infections such as Whipple disease and malakoplakia. These disorders are characterized at histopathologic examination on the basis of infiltration of alveoli or the pulmonary interstitium by histiocytes, which are a group of cells that includes macrophages and dendritic cells. Dendritic cells are a heterogeneous group of nonphagocytic antigen-presenting immune cells. Immunohistochemical markers help to distinguish among various primary histiocytic disorders. Characteristic radiologic findings in the appropriate clinical context may obviate biopsy to establish a correct diagnosis. However, in the absence of these findings, integration of clinical, pathologic, and radiologic features is required to establish a diagnosis. PMID:25763722

  2. Clinical protocol for assessment and management in dental trauma

    OpenAIRE

    Maria Carolina Bandeira Macena; Ana Catarina Leite; Viviane Colares; Sandra vieira; Luiz Guedes de Carvalho Neto

    2009-01-01

    Objective: To present a clinical protocol based on current literature in order to optimize the emergency care of dental trauma in deciduous and permanent dentition. Methods: A documental study held by means of literature review of studies available in the following data basis: MEDLINE, Cochrane, Pubmed, Lilacs, and BBO SCIELO, using as keywords: dental injury, classification, diagnosis and epidemiology. The protocols produced by the International Association of Dental Trauma (IADT) and the Am...

  3. Trauma from occlusion — An orthodontist’s perspective

    OpenAIRE

    R. Saravanan; Babu, Prajeeth J.; Rajakumar, P.

    2010-01-01

    Orthodontic therapy has a big role in the treatment and prevention of malpositions. The signs and symptoms experienced by patients with occlusal trauma are mobility of teeth, temperomandibular joint pain, pain on mastication and periodontal disease. Early diagnosis, proper treatment plan and correction of malocclusion can lead to a successful outcome. Lack of awareness of orthodontic treatment in patients with occlusal trauma can even lead to loss of tooth structure.

  4. Adenoma Malignum Detected on a Trauma CT

    OpenAIRE

    McEachern, James; Butcher, Matthew; Burbridge, Brent; Zhu, Yu

    2013-01-01

    Adenoma malignum is a rare subtype of cervical adenocarcinoma. Clinical presentation is variable with watery vaginal discharge being the most commonly associated finding. We report a case of adenoma malignum incidentally detected on pelvic computed tomography (CT) performed for a trauma patient. The cervical mass was further characterized by magnetic resonance (MR) imaging and remained compatible with adenoma malignum. Local cervical biopsy was suggestive of the diagnosis which was subsequent...

  5. Trauma and Coagulation

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2011-08-01

    Full Text Available Bleeding and coagulation disorders related to trauma are pathological processes which are frequently seen and increase mortality. For the purpose, trauma patients should be protected from hypoperfusion, hypothermia, acidosis and hemodilution which may aggravate the increase in physiological responses to trauma as anticoagulation and fibrinolysis. Performing damage control surgery and resuscitation and transfusion of adequate blood and blood products in terms of amount and content as stated in protocols may increase the rate of survival. Medical treatments augmenting fibrin formation (fibrinogen, desmopressin, factor VIIa or preventing fibrin degradation (tranexamic acid have been proposed in selected cases but the efficacy of these agents in trauma patients are not proven. (Journal of the Turkish Society Intensive Care 2011; 9:71-6

  6. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... such fatalities often are referred to as "harnessinduced pathology" or "suspension trauma." Signs & symptoms that may be ... move legs Hypothermia Pain Shock Injuries during fall Cardiovascular disease Fatigue Respiratory disease Dehydration Blood loss References: ...

  7. Platelet aggregation following trauma

    DEFF Research Database (Denmark)

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders;

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED......). Inclusion criteria were trauma team activation and arterial cannula insertion on arrival. Blood samples were analyzed by multiple electrode aggregometry initiated by thrombin receptor agonist peptide 6 (TRAP) or collagen using a Multiplate device. Blood was sampled median 65 min after injury; median injury...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...

  8. Acute coagulopathy of trauma

    DEFF Research Database (Denmark)

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  9. Anterior chest wall tuberculous abscess: a case report

    Directory of Open Access Journals (Sweden)

    Papavramidis Theodossis S

    2007-11-01

    Full Text Available Abstract The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes. Musculoskeletal tuberculosis (TB occurs in 1–3% of patients with TB, while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Furthermore, nowadays it is rarer to find extrapulmonary TB in immunocompetent rather that non-immunocompetent patients. The present case reports a fifty-six-year-old immunocompetent man with an anterior chest wall tuberculous abscess. The rarity of the present case relates both to the localization of the tuberculous abscess, and to the fact that the patient was immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.

  10. London Trauma Conference 2015

    OpenAIRE

    Avery, Pascale; Salm, Leopold; Bird, Flora; Hutchinson, Anja; Jarman, Heather; Nilsson, Maria Bergman; Konig, Tom; Tai, Nigel; Fevang, Espen; Hognestad, Børge; Abrahamsen, Håkon B.; Cheetham, Olivia V.; Thomas, Matthew J C; Rooney, Kieron D.; Murray, Josephine

    2016-01-01

    Table of contents I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015 Pascale Avery, Leopold Salm, Flora Bird A1: Retrospective evaluation of HEMS ‘Direct to CT’ protocol Anja Hutchinson, Ashley Matthies, Anthony Hudson, Heather Jarman A2 Rush hour – Crush hour: temporal relationship of cyclist vs. HGV trauma admissions. A single site observational study Maria Bergman Nilsson, Tom Konig, Nigel Tai A3 Semiprone position endotracheal intubation during continuous cardiopulmonary resuscitation ...

  11. Noninvasive ventilation in trauma

    OpenAIRE

    Karcz, Marcin K; Peter J. Papadakos

    2015-01-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop ...

  12. Trauma registry reengineered.

    Science.gov (United States)

    Wargo, Christina; Bolig, Nicole; Hixson, Heather; McWilliams, Nate; Rummerfield, Heather; Stratton, Elaine; Woodruff, Tracy

    2014-01-01

    A successful trauma registry balances accuracy of abstraction and timeliness of case submissions to achieve quality performance. Staffing to achieve quality performance is a challenge at times based on competitive institutional need. The aim of this performance improvement timing study was to identify trauma registry job responsibilities and redesign the responsibilities to create increased abstraction time and maintain accuracy of data abstraction. The outcome is measured by case submission rates with existing staffing and interrater reliability outcomes. PMID:25397337

  13. Childhood trauma in bipolar disorder

    OpenAIRE

    Watson, S; Gallagher, P.; Dougall, D.; R Porter; Moncrieff, J.; Ferrier, I. N.; Young, A. H.

    2014-01-01

    Objective: There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder. Methods: Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipo...

  14. Novel Influenza A (H1N1) Virus Infection in Children: Chest Radiographic and CT Evaluation

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the chest radiographic and CT findings of novel influenza A (H1N1) virus infection in children, the population that is more vulnerable to respiratory infection than adults. The study population comprised 410 children who were diagnosed with an H1N1 infection from August 24, 2009 to November 11, 2009 and underwent chest radiography at Dankook University Hospital in Korea. Six of these patients also underwent chest CT. The initial chest radiographs were classified as normal or abnormal. The abnormal chest radiographs and high resolution CT scans were assessed for the pattern and distribution of parenchymal lesions, and the presence of complications such as atelectasis, pleural effusion, and pneumomediastinum. The initial chest radiograph was normal in 384 of 410 (94%) patients and abnormal in 26 of 410 (6%) patients. Parenchymal abnormalities seen on the initial chest radiographs included prominent peribronchial marking (25 of 26, 96%), consolidation (22 of 26, 85%), and ground-glass opacities without consolidation (2 of 26, 8%). The involvement was usually bilateral (19 of 26, 73%) with the lower lung zone predominance (22 of 26, 85%). Atelectasis was observed in 12 (46%) and pleural effusion in 11 (42%) patients. CT (n = 6) scans showed peribronchovascular interstitial thickening (n = 6), ground-glass opacities (n = 5), centrilobular nodules (n = 4), consolidation (n = 3), mediastinal lymph node enlargement (n = 5), pleural effusion (n = 3), and pneumomediastinum (n = 3). Abnormal chest radiographs were uncommon in children with a swine-origin influenza A (H1N1) virus (S-OIV) infection. In children, H1N1 virus infection can be included in the differential diagnosis, when chest radiographs and CT scans show prominent peribronchial markings and ill-defined patchy consolidation with mediastinal lymph node enlargement, pleural effusion and pneumomediastinum

  15. Novel Influenza A (H1N1) Virus Infection in Children: Chest Radiographic and CT Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Min Jeong; Lee, Young Seok; Lee, Jee Young; Lee, Kun Song [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of)

    2010-12-15

    The purpose of this study was to evaluate the chest radiographic and CT findings of novel influenza A (H1N1) virus infection in children, the population that is more vulnerable to respiratory infection than adults. The study population comprised 410 children who were diagnosed with an H1N1 infection from August 24, 2009 to November 11, 2009 and underwent chest radiography at Dankook University Hospital in Korea. Six of these patients also underwent chest CT. The initial chest radiographs were classified as normal or abnormal. The abnormal chest radiographs and high resolution CT scans were assessed for the pattern and distribution of parenchymal lesions, and the presence of complications such as atelectasis, pleural effusion, and pneumomediastinum. The initial chest radiograph was normal in 384 of 410 (94%) patients and abnormal in 26 of 410 (6%) patients. Parenchymal abnormalities seen on the initial chest radiographs included prominent peribronchial marking (25 of 26, 96%), consolidation (22 of 26, 85%), and ground-glass opacities without consolidation (2 of 26, 8%). The involvement was usually bilateral (19 of 26, 73%) with the lower lung zone predominance (22 of 26, 85%). Atelectasis was observed in 12 (46%) and pleural effusion in 11 (42%) patients. CT (n = 6) scans showed peribronchovascular interstitial thickening (n = 6), ground-glass opacities (n = 5), centrilobular nodules (n = 4), consolidation (n = 3), mediastinal lymph node enlargement (n = 5), pleural effusion (n = 3), and pneumomediastinum (n = 3). Abnormal chest radiographs were uncommon in children with a swine-origin influenza A (H1N1) virus (S-OIV) infection. In children, H1N1 virus infection can be included in the differential diagnosis, when chest radiographs and CT scans show prominent peribronchial markings and ill-defined patchy consolidation with mediastinal lymph node enlargement, pleural effusion and pneumomediastinum

  16. Noninvasive ventilation in trauma.

    Science.gov (United States)

    Karcz, Marcin K; Papadakos, Peter J

    2015-02-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  17. The surgical treatment of traumatic rupture of aortic valve and atrial septum after blunt chest trauma: literature review and presentation of a rare case Tratamento cirúrgico de ruptura traumática da valva aórtica e do septo interatrial, após traumatismo fechado do tórax: revisão da literatura e apresentação de um caso raro

    Directory of Open Access Journals (Sweden)

    Mauro Barbosa Arruda Filho

    2003-06-01

    Full Text Available The case of a 49-year-old man who suffered a car accident responsible for several chest injuries including fractures of the left ribs, large subcutaneous emphysema and left hemopneumothorax arrived in shock in the Emergency Room of the Real Hospital Português de Beneficência in Pernambuco (RHPBPE. He was hospitalized for 30 days including some time in the intensive care unit and but did not show signs of diastolic murmur or heart failure. He was submitted to an echocardiography examination that diagnosed slight aortic incompetence, good left ventricular function and was discharged after clinical improvement. Three months later he started to feel symptoms of heart failure and returned to cardiac Emergency Room of the same Hospital. He repeated transthoracic and transesophageal echocardiography examinations presenting severe aortic incompetence due to leaflet disruption, rupture of atrial septum with enlargement of the right cardiac chambers and poor left ventricular function. He underwent surgical treatment of these lesions, with direct approach of the atrial septum and the aortic valve was replaced with a mechanical prosthesis, with a good result.Paciente do sexo masculino, 49 anos, atendido na Emergência do Real Hospital Português de Beneficência (RHPBPE, após acidente automobilístico, apresentando dispnéia, fraturas de múltiplos arcos costais, enfisema subcutâneo extenso e hidropneumotórax à esquerda e fratura da clavícula direita. Submetido inicialmente à drenagem torácica subaquática à esquerda e traqueostomia, tendo sido mantido em respiração controlada no respirador de volume na Unidade de Terapia Intensiva. Recebeu alta após um mês da admissão com ecocardiograma transtorácico que mostrava insuficiência aórtica e insuficiência mitral leve, com leve aumento das câmaras cardíacas esquerdas, com função global preservada, não se relacionando os achados ao trauma. Após três meses, retornou à Emergência cardiol

  18. Imaging of orthopedic trauma and surgery

    Energy Technology Data Exchange (ETDEWEB)

    Berquist, T.H.

    1985-01-01

    This book presents papers on imaging techniques for diagnosis of trauma of bones. A comparative evaluation is presented for planning of proper diagnosis and treatment. Various techniques discussed are routine radiography; computerized tomography, NMR imaging, angiography, ultrasonography; and use of radioisotopes. The mechanism of injury of bone joints of upper and lower limbs and spine is discussed after discussing the anatomy of each in the beginning of each paper. Topics titled are healing of fractures; fractures of pelvis; knee; shoulder; foot and ankle; fractures of humerus; stress fractures; and orthopedic radiology. Prosthesis use and plastic surgery of joints is also discussed.

  19. Jaw locking after maxillofacial trauma

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja

    2007-09-01

    Full Text Available The purpose of this report is to present two cases of jaw locking with two different etiologies. In case #1, jaw locking occured 5.5 months after a surgical reduction and internal fixation on the fractured maxilla and mandible. Some plain radiographic x-ray were made but failed to give adequate information in establishing the cause of trismus. The three dimensional computed tomography (3D-CT was finally made and able to help guide the pre-operative diagnosis and treatment. Two-steps gap arthroplasty were done comprising a gap arthroplasty leading to acceptable outcome. An adult patient in case #2 with a history of trauma at his childhood and bird-like face apprearance clinically, was unable to open the mouth since the time of accident. The patient was diagnosed with bilateral ankylosis of temporomandibular joints. One side (right gap arthroplasty was done and resulted in normal mouth opening.

  20. Chest dynamics asymmetry facilitates earlier detection of pneumothorax.

    Science.gov (United States)

    Waisman, D; Landesberg, A; Kohn, S; Faingersh, A; Klotzman, I C; Gover, A; Kessel, I; Rotschild, A

    2016-02-01

    Pneumothorax is usually diagnosed when signs of life-threatening tension pneumothorax develop. The case report describes novel data derived from miniature superficial sensors that continuously monitored the amplitude and symmetry of the chest wall tidal displacement (TDi) in a premature infant that suffered from pneumothorax. Off-line analysis of the TDi revealed slowly progressing asymmetric ventilation that could be detected 38 min before the diagnosis was made. The TDi provides novel and valuable information that can assist in early detection and decision making. PMID:26814803

  1. Remote interpretation of chest roentgenograms.

    Science.gov (United States)

    Andrus, W S; Hunter, C H; Bird, K T

    1975-04-01

    A series of 98 chest films was interpreted by two physicians on the basis of monitor display of the transmitted television signal representing the roentgenographic image. The transmission path was 14 miles long, and included one active repeater station. Receiver operating characteristic curves were drawn to compare interpretations rendered on television view of the image with classic, direct view interpretations of the same films. Performance in these two viewing modes was found to be quite similar. When films containing only hazy densities lacking internal structure or sharp margins, were removed from the sample, interpretation of the remaining films was essentially identical via the two modes. Since hazy densities are visible on retrospective examination, interpretation of roentgenograms at a distance via television appears to be a feasible route for delivery of radiologic services.

  2. Trauma-specific Grey Matter Alterations in PTSD.

    Science.gov (United States)

    Meng, Linghui; Jiang, Jing; Jin, Changfeng; Liu, Jia; Zhao, Youjin; Wang, Weina; Li, Kaiming; Gong, Qiyong

    2016-01-01

    Previous studies have demonstrated that patients with posttraumatic stress disorder (PTSD) caused by different types of trauma may show divergence in epidemiology, clinical manifestation and treatment outcome. However, it is still unclear whether this divergence has neuroanatomic correlates in PTSD brains. To elucidate the general and trauma-specific cortical morphometric alterations, we performed a meta-analysis of grey matter (GM) changes in PTSD (N = 246) with different traumas and trauma-exposed controls (TECs, N = 347) using anisotropic effect-size signed differential mapping and its subgroup analysis. Our results revealed general GM reduction (GMR) foci in the prefrontal-limbic-striatal system of PTSD brains when compared with those of TECs. Notably, the GMR patterns were trauma-specific. For PTSD by single-incident traumas, GMR foci were found in bilateral medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, left hippocampus and amygdala; and for PTSD by prolonged traumas in the left insula, striatum, amygdala and middle temporal gyrus. Moreover, Clinician-Administered PTSD Scale scores were found to be negatively associated with the GM changes in bilateral ACC and mPFC. Our study indicates that the GMR patterns of PTSD are associated with specific traumas, suggesting a stratified diagnosis and treatment for PTSD patients. PMID:27651030

  3. Epidemiological evaluation of hepatic trauma victims undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mitre Kalil

    2016-02-01

    Full Text Available Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01. The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05. Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  4. The Impact of Social Trauma among Outpatients with Social Anxiety Disorder Compared to Individuals with No Mental Disorders

    OpenAIRE

    Karen Guðmundsdóttir 1977

    2016-01-01

    Trauma have mostly been researched in the context of post-traumatic stress disorder (PTSD). In this study, we explored whether there may exist at least two types of trauma; imminent threat to life and social trauma (humiliation, rejection or ridicule), and whether there were differences in the type and severity of social trauma endured by outpatients with a primary diagnosis of social anxiety disorder (SAD) compared to individuals with no mental disorders (the comparison group). The SAD group...

  5. Value of the lateral chest radiograph in tuberculosis in children

    International Nuclear Information System (INIS)

    The value of the lateral chest radiograph, often considered a useful adjunct in the detection of hilar adenopathy, was evaluated in a prospective study of 449 children assessed for tuberculosis. Of these children 298 presented to the hospital with signs and symptoms suggestive of tuberculosis, while 151 were investigated in a regional clinic solely because they were in close contact with an adult household member on treatment for tuberculosis. Tuberculosis was confirmed by culture in 176 of the 449 children (39%). In 40 of these (23%) hilar adenopathy was visible on frontal and lateral view, in 19 of the 176 confirmed cases (11%) only on a frontal view and in 22 (13%) on a lateral view only. Probable tuberculosis was diagnosed in a further 140 of the 449 children (31%), and hilar adenopathy was visible on frontal and lateral views in 39 of these children (28%), on the frontal view only in 8 (6%) and on the lateral view only in 27 (19%). In the symptomatic children investigated in the hospital, and the asymptomatic children investigated in the clinic, hilar adenopathy was detected on the lateral chest radiograph only in 36 (12%) and 14 (9%) cases respectively. Lateral chest radiographs will considerably improve the accuracy of the diagnosis of childhood tuberculosis. (orig.)

  6. Imaging of chest disease due to intravenous heroin abuse

    International Nuclear Information System (INIS)

    Objective: To study the imaging findings of the chest disease due to intravenous heroin abuse. Methods: Twenty-five cases of clinically confirmed chest disease due to intravenous heroin abuse were retrospectively analyzed. 25 cases had conventional X-ray film, 6 cases had CT scanning, and 6 cases had echocardiography scanning. Results: On X-ray and CT, the following signs were found: lung making manifold (n = 5), small patchy shadow (n = 15), pneumatocele (n = 16), small cavity (n = 16), small node (n = 7), pleural effusion (n = 8 ), pneumothorax (n = 2), hydropneumothorax (n = 6), pulmonary edema (n = 2), megacardia (n = 11), multiple-shaped lesion (n = 20). On echocardiography, tricuspid vegetation (n = 4) and tricuspid insufficiency (n = 4) were found. Conclusion: The X-ray and CT manifestations of chest inflammation due to intravenous heroin abuse are multiple. The multiple small cavities and pneumatoceles sign are of some value in the diagnosis of lung inflammation due to intravenous heroin abuse among young patients

  7. Differential points of mediastinal cystic lesion in chest computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Jin; Baek, Jang Mi; Song, Jang Hyeon; Seon, Hyun Ju [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kim, Yun Hyeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2013-10-15

    To find differential diagnostic imaging findings of mediastinal cystic lesions in chest computed tomography. We retrospectively reviewed imaging findings of 70 patients with histopathologically proven mediastinal cystic lesions. They were 33 male and 37 female patients. Among 70 cases, 49 cases were in the anterior mediastinum, 12 cases were in the middle mediastinum, and 9 cases were in the posterior mediastinum. 19 patients had symptoms. Chest discomfort was the most common symptom. When the cystic lesion was located in the anterior mediastinum, and unilocular, the possibility of thymic cyst was the most likely (p < 0.0027). When the cystic lesion was located in the anterior mediastinum and was multilocular with a relatively thick wall, the possibility of a mature cystic teratoma was the most likely (p < 0.001). When the lesion was a high attenuation cystic lesion located around the air-way, the possibility of a bronchogenic cyst was the most likely (p < 0.001). Chest CT gives information about the location, loculation, wall thickness and internal attenuation of mediastinal cystic lesions. And certain details seen on CT imaging can help with the correct diagnosis, especially in the cases of thymic cyst, mature cystic teratoma and bronchogenic cyst.

  8. Chest pain in focal musculoskeletal disorders

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

    2010-01-01

    The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several...

  9. Chest pain and exacerbations of bronchiectasis

    Directory of Open Access Journals (Sweden)

    King PT

    2012-12-01

    Full Text Available Paul T King,1,2 Stephen R Holdsworth,2 Michael Farmer,1 Nicholas J Freezer,1 Peter W Holmes11Department of Respiratory and Sleep Medicine, 2Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, AustraliaBackground: Bronchiectasis is a common disease and a major cause of respiratory morbidity. Chest pain has been described as occurring in the context of bronchiectasis but has not been well characterized. This study was performed to describe the characteristics of chest pain in adult bronchiectasis and to define the relationship of this pain to exacerbations.Subjects and methods: We performed a prospective study of 178 patients who were followed-up for 8 years. Subjects were reviewed on a yearly basis and assessed for the presence of chest pain. Subjects who had chest pain at the time of clinical review by the investigators were included in this study. Forty-four patients (25% described respiratory chest pain at the time of assessment; in the majority of cases 39/44 (89%, this occurred with an exacerbation and two distinct types of chest pain could be described: pleuritic (n = 4 and non-pleuritic (n = 37, with two subjects describing both forms. The non-pleuritic chest pain occurred most commonly over both lower lobes and was mild to moderate in severity. The pain subsided as patients recovered. Conclusion: Non-pleuritic chest pain occurs in subjects with bronchiectasis generally in association with exacerbations.Keywords: sputum, collapse, bronchitis, airway obstruction

  10. Video-assisted thoracoscopic surgery for acute thoracic trauma

    Directory of Open Access Journals (Sweden)

    Michael Goodman

    2013-01-01

    Full Text Available Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13% following blunt injury and 20 (87% after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.

  11. Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

    Directory of Open Access Journals (Sweden)

    Rastogi Rajul

    2008-01-01

    Full Text Available Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.

  12. Solitary Plasmacytoma of the Chest Wall

    Directory of Open Access Journals (Sweden)

    Servet Kayhan

    2014-03-01

    Full Text Available A previously healthy 55-year-old man with right sided lateral chest pain admitted to clinic. It was found a solid and painful mass at the right 4th rib in physical examination. Chest X-ray and thoracic computarized tomography showed an opacity measured 60x33 mm within the right chest wall destructing the 4th rib. Needle aspiration was performed from tumor and cytologic examination showed atypic plasma cell infiltration. The patient was scheduled for a chest wall resection and reconstructive surgery. Examination of a permanent section showed that the chest wall tumor was solitary plasmacytoma. There was no evidence of multiple myeloma recurrence after two years from the operation.

  13. Structured diagnostic imaging in patients with multiple trauma

    International Nuclear Information System (INIS)

    Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma.Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented.Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality.Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients.Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality. (orig.)

  14. Patterns of ocular trauma

    International Nuclear Information System (INIS)

    To describe the patterns of ocular trauma, cause of injury and its effects on eye. A retrospective case series. Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common (520 eyes (46.18%)) than closed globe injuries (484 eyes (42.98%)). 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes. (author)

  15. Systemic inflammation after trauma.

    Science.gov (United States)

    Lenz, Andreas; Franklin, Glen A; Cheadle, William G

    2007-12-01

    Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response.

  16. Radiological diagnosis of pulmonary hypertension

    International Nuclear Information System (INIS)

    In 43 patients with obstructive and restrictive lung disease a catheterisation of the right heart with measurement of pulmonary artery pressure was performed. In a retrospective study several radiological parameters of pulmonary hypertension were evaluated on the chest radiographs of these patients. Considering those parameters on the p.a. and lateral chest radiograph, the diagnosis of pulmonary hypertension in patients with elevated pulmonary artery pressure at rest can be made with great accuracy. When pulmonary artery pressure is elevated only during exercise, the accuracy of radiological diagnosis is much lower. (orig.)

  17. Salivary gland choristoma (heterotopic salivary gland tissue) on the anterior chest wall of a newborn.

    Science.gov (United States)

    Aby, Janelle L; Patel, Mayha; Sundram, Uma; Benjamin, Latanya T

    2014-01-01

    Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition typically seen in the newborn period. This developmental heterotopia is generally nonprogressive, with little risk of malignant transformation. We present the second known reported case of a salivary gland choristoma located on the anterior chest wall. Knowledge of this rare entity will allow for accurate diagnosis and management of this benign anatomic variant.

  18. Spinal trauma: first aid from cross-sectional imaging; Trauma der Wirbelsaeule: erste Hilfe durch Schnittbildverfahren

    Energy Technology Data Exchange (ETDEWEB)

    Schueller, G.; Schueller-Weidekamm, C. [Emergency Radiology Schueller, Neerach (Switzerland)

    2014-09-15

    The diagnosis of the traumatized spine is one of the key issues for trauma radiologists. The cross-sectional imaging procedures, computed tomography (CT) and magnetic resonance imaging (MRI) are the essential methods in spinal trauma radiology. These modalities are of great help in accurately assessing injury patterns and extent and in providing indications of patient outcome. In contrast to cross-sectional imaging, radiography has a role in the evaluation of minor spinal trauma only. It is generally accepted that trauma radiologists do not use typical classifications to evaluate the spine partly because such an ideal classification system does not yet exist. Not least because of this classification difficulty, eponyms and synonyms are widely used to describe traumatology of the spine as a high level of specific information is included in these various terms. The members of the trauma team should be aware of the strengths and limitations of the methods used in the assessment of the spine. This article provides a brief outline of fundamental knowledge about the diagnosis of spinal trauma. (orig.) [German] Die Beurteilung der verletzten Wirbelsaeule nimmt fuer Traumaradiologen eine zentrale Stellung ein. Die Schnittbildverfahren CT und MRT sind ihre wesentlichen Arbeitsmethoden. Sie helfen dabei, schnell und mit hoher Zuverlaessigkeit Aussagen ueber Art und Ausmass von Verletzungen zu treffen sowie Hinweise auf die Prognose der Patienten zu geben. Die Projektionsradiographie hat ihre Bedeutung lediglich in der Diagnostik des Bagatelltraumas und ist in ihrer Aussagekraft auch dort nicht unumstritten. Traumaradiologen bedienen sich nicht ausschliesslich typischer Klassifikationen des Wirbelsaeulentraumas, z. T. auch deshalb, da es die ideale Klassifikation aus heutiger Sicht nicht gibt. Vielmehr ist es wichtig, auch ueber Eponyme und Synonyme Bescheid zu wissen, da sie ein hohes Mass an spezifischen Informationen der spinalen Verletzungen verinnerlichen. Alle

  19. Trauma in pregnancy

    Directory of Open Access Journals (Sweden)

    A Rudra

    2007-01-01

    Full Text Available Trauma is the most common non-obstetrical cause of death in pregnant women. Pregnancy must always be suspected in any female trauma patient of childbearing age until proved otherwise. Unique changes in anatomy and physiology that takes place during pregnancy alter the pathophysiology and location of maternal injuries in pregnancy, which may be significantly different from the non-pregnant state. Trauma from road traffic accidents, falls and domestic violence are the most common causes of abdominal blunt trauma. As pregnancy progresses, the change of accidental injury increases. Head and neck injuries, respiratory failure, and hypovolemic shock constitute the most frequent causes of trauma related maternal death in pregnancy. Even the pregnant woman with minor injuries should be carefully observed. Initial management is directed at resuscitation and stabilization of the mother that takes precedence over that of the fetus, unless vital signs cannot be maintained and perimortem cesarean section decided upon. Fetal monitoring should be maintained after satisfactory resuscitation and stabilization of the mother. Preventive measures include proper seat belt use and identifying and counseling victims of suspected domestic violence.

  20. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions.

  1. Chest Wall Resection and Reconstruction as a Substitute to Treat Malignant Tumours in Chinese Patients

    Directory of Open Access Journals (Sweden)

    Y Yu

    2015-05-01

    Full Text Available Objectives: Chest wall cancers are a mixed group of lesions that offer an exciting diagnostic and therapeutic challenge for surgeons. The present study is an attempt to evaluate the pathology, treatment methodologies, role of surgical resection and reconstruction, and consequences of patients with these tumours. Methods: All the patients with malignant primary chest wall cancers treated at our institution between February 2007 and July 2013, were included in this study. Fifteen cases were identified with tumours. Seven of them were malignant small round cell tumour (MSRCT, six were rhabdomyosarcoma (RMS and the remaining two were other tumours. Five patients underwent initial biopsy, followed by chemotherapy (n = 4 and radiotherapy (n = 1. Results: Three of these five survived to undertake late chest wall resections. Six of the nine resected patients required en bloc resection of neighbouring muscles or organs; three required complex chest wall reconstruction. At the end of the study, we found that eight out of 15 patients (53% have survived (six years of follow-up, all with no evidence of disease; the other seven patients died of progressive disease. Two patients with tumour categories other than MSRCT or RMS, metastatic or not, at diagnosis, are alive with no indication of disease. There were no local recurrences. Conclusions: Surgical resection, with en bloc removal of involved structures and chest wall reconstruction, provides outstanding survival improvement in malignant chest wall tumours.

  2. Dynamic chest radiography: flat-panel detector (FPD) based functional X-ray imaging.

    Science.gov (United States)

    Tanaka, Rie

    2016-07-01

    Dynamic chest radiography is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view (FOV) of FPDs permits real-time observation of the entire lungs and simultaneous right-and-left evaluation of diaphragm kinetics. Most importantly, dynamic chest radiography provides pulmonary ventilation and circulation findings as slight changes in pixel value even without the use of contrast media; the interpretation is challenging and crucial for a better understanding of pulmonary function. The basic concept was proposed in the 1980s; however, it was not realized until the 2010s because of technical limitations. Dynamic FPDs and advanced digital image processing played a key role for clinical application of dynamic chest radiography. Pulmonary ventilation and circulation can be quantified and visualized for the diagnosis of pulmonary diseases. Dynamic chest radiography can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. Here, we focus on the evaluation of pulmonary ventilation and circulation. This review article describes the basic mechanism of imaging findings according to pulmonary/circulation physiology, followed by imaging procedures, analysis method, and diagnostic performance of dynamic chest radiography. PMID:27294264

  3. Normalized mean shapes and reference index values for computerized quantitative assessment indices of chest wall deformities

    Science.gov (United States)

    Kim, Ho Chul; Park, Man Sik; Lee, Seong Keon; Nam, Ki Chang; Park, Hyung Joo; Kim, Min Gi; Song, Jae-Jun; Choi, Hyuk

    2015-11-01

    We previously proposed a computerized index (eccentricity index [EI]) for chest-wall deformity measurements, such as pectus excavatum. We sought to define mean shapes based on normal chest walls and to propose for computerized index reference values of that are used in the quantitative analysis of the severity of chest-wall deformities. A total of 584 patients were classified into 18 groups, and a database of their chest-wall computed tomography (CT) scan images was constructed. The boundaries of the chest wall were extracted by using a segmentation algorithm, and the mean shapes were subsequently developed. The reference index values were calculated from the developed mean shapes. Reference index values for the EI were compared with a conventional index, the Haller index (HI). A close association has been shown between the two indices in multiple subjects (r = 0.974, P < 0.001). The newly developed mean shapes and reference index values supply both reliability and objectivity to the diagnosis, analysis, and treatment of chest-wall deformities. They promise to be highly useful in clinical settings.

  4. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ghanei, Mostafa E-mail: m.ghanei@bmsu.ac.ir; Mokhtari, Majid; Mohammad, Mehdi Mir; Aslani, Jafar

    2004-11-01

    Background: Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapons of mass destruction (WMD) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook this study to evaluate the chest high resolution computerized tomography (HRCT) as a diagnostic tool in patients with documented exposure to SM and chronic respiratory symptoms. Method: The medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were reviewed. Chest HRCTs of these patients were examined. Ten healthy controls with no history of exposure to HD were matched for age, gender, and chest HRCT protocol applied. Results: Fifty chest HRCTs of these patients were randomly selected for this study. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) bronchial wall thickening (BWT) 45 (90%), and interlobular septal wall thickening (SWT) 13 (26%), respectively. Air trapping in one patient (10%) was the only positive finding in the control group. Conclusions: Chest HRCT findings of bronchiectasis, air trapping, MPA, SWT, and BWT were seen in our patients 15 years after exposure to HD. These findings suggest the diagnosis of bronchiolitis obliterans (BO). We did not encounter chest HRCT features consistent with pulmonary fibrosis.

  5. The role of principal and secondary diagnoses of hospitalized eye trauma: a nationwide cohort in Taiwan, 1996-2010.

    Directory of Open Access Journals (Sweden)

    Jiahn-Shing Lee

    Full Text Available To estimate the rate of hospitalized eye trauma in Taiwan and investigate the role between principal and secondary diagnoses of such trauma.Nationwide fixed cohort study of 1,000,000 beneficiaries from the Taiwan Longitudinal Health Database was used and 4819 patients who were hospitalized for eye trauma during 1996-2010 were analyzed.During 1996-2010, the incidence rates of hospitalized eye trauma (per 100 000 person-years were 35.0 (95% confidence interval (CI, 34.0 to 36.0 for total diagnosis, 9.8 (95% CI, 9.3 to 10.3 for a principal diagnosis, and 25.3 (95% CI, 24.4 to 26.1 for a secondary diagnosis. The sex risk ratio was 3.1 for a principal diagnosis and 2.1 for a secondary diagnosis. The main causes of eye trauma were traffic accident, work accident, assault (among males <60 years of age, and falls (among elderly men and women. The proportion admitted to an ophthalmic department among those with a principal diagnosis of eye trauma (64.8% was significantly higher than among those with a secondary diagnosis (2.3% (p<.0001. Patients with a principal diagnosis of eye trauma had shorter hospital stays (7.1±10.2 days and lower fatality (0.07% than those with a secondary diagnosis of eye trauma (10.0±31.6 days and 0.3%, respectively.Data only from ophthalmic admissions tends to underestimate the true incidence rate of hospitalized eye trauma. Patients with a principal diagnosis of eye trauma had less severe injuries than did those with a secondary diagnosis.

  6. Pediatric blunt splenic trauma: a comprehensive review

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

    2009-09-15

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  7. Childhood Trauma Exposure and Substance use. An Explorative Study Among Outpatients with dual Diagnoses.

    OpenAIRE

    Andreassen, Elisabeth Randall

    2010-01-01

    This paper explores associations between all forms of childhood trauma and drug debut age in a sample of 76 young, Norwegian, help-seeking substance users with a dual diagnosis. Childhood trauma (emotional, physical and sexual abuse, emotional and physical neglect), posttraumatic and general psychological symptoms and substance abuse characteristics were assessed with Childhood Trauma Questionnaire (CTQ), Impact of Event Scale-Revised (IES-R), Symptom Checklist-90-Revised (SCL-90-R) and Klien...

  8. Childhood trauma and cognitive function in first-episode affective and non-affective psychosis.

    LENUS (Irish Health Repository)

    Aas, Monica

    2011-06-01

    A history of childhood trauma is reportedly more prevalent in people suffering from psychosis than in the general population. Childhood trauma has also been linked to cognitive abnormalities in adulthood, and cognitive abnormalities, in turn, are one of the key clinical features of psychosis. Therefore, this study investigated whether there was a relationship between childhood trauma and cognitive function in patients with first-episode psychosis. The potential impact of diagnosis (schizophrenia or affective psychosis) and gender on this association was also examined.

  9. Novel computed tomographic chest metrics to detect pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Li Chin-Shang

    2011-03-01

    Full Text Available Abstract Background Early diagnosis of pulmonary hypertension (PH can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT of the chest may be an alternative non-invasive method of detecting PH. Methods This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. Results Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA diameter ≥29 mm (odds ratio (OR = 4.8, right descending PA diameter ≥19 mm (OR = 7.0, true right descending PA diameter ≥ 16 mm (OR = 4.1, true left descending PA diameter ≥ 21 mm (OR = 15.5, right ventricular (RV free wall ≥ 6 mm (OR = 30.5, RV wall/left ventricular (LV wall ratio ≥0.32 (OR = 8.8, RV/LV lumen ratio ≥1.28 (OR = 28.8, main PA/ascending aorta ratio ≥0.84 (OR = 6.0 and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7 were significant predictors of PH in this population of hospitalized patients. Conclusion This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients.

  10. Novel computed tomographic chest metrics to detect pulmonary hypertension

    International Nuclear Information System (INIS)

    Early diagnosis of pulmonary hypertension (PH) can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC) for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT) of the chest may be an alternative non-invasive method of detecting PH. This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA) diameter ≥29 mm (odds ratio (OR) = 4.8), right descending PA diameter ≥19 mm (OR = 7.0), true right descending PA diameter ≥ 16 mm (OR = 4.1), true left descending PA diameter ≥ 21 mm (OR = 15.5), right ventricular (RV) free wall ≥ 6 mm (OR = 30.5), RV wall/left ventricular (LV) wall ratio ≥0.32 (OR = 8.8), RV/LV lumen ratio ≥1.28 (OR = 28.8), main PA/ascending aorta ratio ≥0.84 (OR = 6.0) and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7) were significant predictors of PH in this population of hospitalized patients. This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients

  11. Trauma care system in Iran

    Institute of Scientific and Technical Information of China (English)

    Moussa Zargar; Sarah Ganji; Mahmoud Khodabandeh; Shahab Abdollahi Far; Morteza Abdollahi; Mohammad Reza Zarei; Seyed Mohammad Reza Kalantar Motamedi; Mojgan Karbakhsh; Seyed Mohammad Ghodsi; Vafa Rahimi-Movaghar; Farzad Panahi; Soheil Saadat; Ali Khaji; Seyed Mahdi Davachi

    2011-01-01

    Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries,but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement,hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance,financial resources), it is not yet established in our system of trauma care.Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

  12. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    Science.gov (United States)

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

    2015-01-01

    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  13. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  14. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  15. Trauma-Focused CBT for Youth who Experience Ongoing Traumas

    OpenAIRE

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based ...

  16. Transfusion practices in trauma

    Directory of Open Access Journals (Sweden)

    V Trichur Ramakrishnan

    2014-01-01

    Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

  17. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

    Science.gov (United States)

    Farquhar, Jaclyn; Almahrabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K.; Hameed, S. Morad

    2016-01-01

    Background Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Methods Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Results Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Conclusion Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials. PMID:27438051

  18. Classification of chest wall diseases.

    Science.gov (United States)

    Pozzi, E; Gulotta, C

    1993-01-01

    Several disorders of the thoracic cage are known to cause respiratory failure, by means of relatively simple mechanisms, such as the increased work of breathing, which results in alveolar hypoventilation. A variety of pathogenic mechanisms may be considered, as functions of the types of thoracic disorders present. As causes of these additional potential mechanisms, we considered the following: 1) ventilation-perfusion (V/Q) inhomogeneity; 2) inability to cough; 3) malformation or acquired defect of the respiratory centres; and 4) excess blood volume and fluid retention, which aggravate work of breathing and V/Q inhomogeneity. All of these disorders can be grouped into two major categories (which nevertheless have some of the pathophysiology in common): the mechanical syndrome and the neuromuscular or paralytic syndrome. In this paper we discuss chest wall diseases falling into the first category; namely, kyphoscoliosis, fibrothorax, thoracoplasty, ankylosing spondylitis and obesity-hypoventilation. Congenital deformities of the thoracic cage, which do not have important effects on ventilatory apparatus (e.g. pectus excavatum and pectus carinatum), were also considered. PMID:8472068

  19. Impacts to the chest of PMHSs - Influence of impact location and load distribution on chest response.

    Science.gov (United States)

    Holmqvist, Kristian; Svensson, Mats Y; Davidsson, Johan; Gutsche, Andreas; Tomasch, Ernst; Darok, Mario; Ravnik, Dean

    2016-02-01

    The chest response of the human body has been studied for several load conditions, but is not well known in the case of steering wheel rim-to-chest impact in heavy goods vehicle frontal collisions. The aim of this study was to determine the response of the human chest in a set of simulated steering wheel impacts. PMHS tests were carried out and analysed. The steering wheel load pattern was represented by a rigid pendulum with a straight bar-shaped front. A crash test dummy chest calibration pendulum was utilised for comparison. In this study, a set of rigid bar impacts were directed at various heights of the chest, spanning approximately 120mm around the fourth intercostal space. The impact energy was set below a level estimated to cause rib fracture. The analysed results consist of responses, evaluated with respect to differences in the impacting shape and impact heights on compression and viscous criteria chest injury responses. The results showed that the bar impacts consistently produced lesser scaled chest compressions than the hub; the Middle bar responses were around 90% of the hub responses. A superior bar impact provided lesser chest compression; the average response was 86% of the Middle bar response. For inferior bar impacts, the chest compression response was 116% of the chest compression in the middle. The damping properties of the chest caused the compression to decrease in the high speed bar impacts to 88% of that in low speed impacts. From the analysis it could be concluded that the bar impact shape provides lower chest criteria responses compared to the hub. Further, the bar responses are dependent on the impact location of the chest. Inertial and viscous effects of the upper body affect the responses. The results can be used to assess the responses of human substitutes such as anthropomorphic test devices and finite element human body models, which will benefit the development process of heavy goods vehicle safety systems. PMID:26687541

  20. Technique for chest radiography for pneumoconiosis

    International Nuclear Information System (INIS)

    Routine radiographic chest examinations have been performed using a variety of techniques. Although chest radiography is one of the most commonly performed radiographic examinations, it is often difficult to obtain consistently good quality roentgenograms. This publication provides a simple guide and relatively easy solution to the many problems that radiologic technologists might encounter. The language is purposely relatively simple and care has been taken to avoid difficult mathematical and physical explanations. The intent is to provide an easily referrable text for those who may encounter difficulties in producing acceptable chest radiographs

  1. Transfusion protocol in trauma

    Directory of Open Access Journals (Sweden)

    Kaur Paramjit

    2011-01-01

    Full Text Available Blood and blood components are considered drugs because they are used in the treatment of diseases. As with any drug, adverse effects may occur, necessitating careful consideration of therapy. Like any other therapeutic decision, the need for transfusion should be considered on the basis of risks and benefits and alternative treatments available to avoid over- and under-transfusion. This review is focused on the blood transfusion protocol in trauma patients with hemorrhagic shock. Besides, issues related to emergency and massive transfusion have also been elaborated. We conducted a comprehensive MEDLINE search and reviewed the relevant literature, with particular reference to emergency medical care in trauma.

  2. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  3. Spinal trauma: first aid from cross-sectional imaging

    International Nuclear Information System (INIS)

    The diagnosis of the traumatized spine is one of the key issues for trauma radiologists. The cross-sectional imaging procedures, computed tomography (CT) and magnetic resonance imaging (MRI) are the essential methods in spinal trauma radiology. These modalities are of great help in accurately assessing injury patterns and extent and in providing indications of patient outcome. In contrast to cross-sectional imaging, radiography has a role in the evaluation of minor spinal trauma only. It is generally accepted that trauma radiologists do not use typical classifications to evaluate the spine partly because such an ideal classification system does not yet exist. Not least because of this classification difficulty, eponyms and synonyms are widely used to describe traumatology of the spine as a high level of specific information is included in these various terms. The members of the trauma team should be aware of the strengths and limitations of the methods used in the assessment of the spine. This article provides a brief outline of fundamental knowledge about the diagnosis of spinal trauma. (orig.)

  4. Evaluation of chest pain in the emergency department.

    Science.gov (United States)

    Jesse, R L; Kontos, M C

    1997-04-01

    The evaluation of chest pain in the emergency setting should be systematic, risk based, and goal driven. An effective program must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having an MI. The initial evaluation is based on the history, a focused physical examination, and the ECG. This information is sufficient to categorize patients into groups at high, moderate, and low risk. Table 14 is a template for a comprehensive chest-pain evaluation program. Patients at high risk need rapid initiation of appropriate therapy: thrombolytics or primary angioplasty for the patients with MIs or aspirin/heparin for the patients with unstable angina. Patients at moderate risk need to have an acute coronary syndrome ruled in or out expediently and additional comorbidities addressed before discharge. Patients at low risk also need to be evaluated, and once the likelihood of an unstable acute coronary syndrome is eliminated, they can be discharged with further evaluation performed as outpatients. Subsequent evaluation should attempt to assign a definitive diagnosis while also addressing issues specific to risk reduction, such as cholesterol lowering and smoking cessation. It is well documented that 4% to 5% of patients with MIs are inadvertently missed during the initial evaluation. This number is surprisingly consistent among many studies using various protocols and suggests that an initial evaluation limited to the history, physical examination, and ECG will fail to identify the small number of these patients who otherwise appear at low risk. The solution is to improve the sensitivity of the evaluation process to identify these patients. It appears that more than simple observation is required, and at the present time, no simple laboratory test can meet this need. However, success has been reported with a number of strategies including emergency imaging with either radionuclides such as

  5. Physical Trauma and Amyotrophic Lateral Sclerosis: A Population-Based Study Using Danish National Registries.

    Science.gov (United States)

    Seals, Ryan M; Hansen, Johnni; Gredal, Ole; Weisskopf, Marc G

    2016-02-15

    Prior studies have suggested that physical trauma might be associated with the development of amyotrophic lateral sclerosis (ALS). We conducted a population-based, individually matched case-control study in Denmark to assess whether hospitalization for trauma is associated with a higher risk of developing ALS. There were 3,650 incident cases of ALS in the Danish National Patient Register from 1982 to 2009. We used risk-set sampling to match each case to 100 age- and sex-matched population controls alive on the date of the case's diagnosis. Odds ratios and 95% confidence intervals were calculated using a conditional logistic regression model. History of trauma diagnosis was also obtained from the Danish Patient Register. When traumas in the 5 years prior to the index date were excluded, there was a borderline association between any trauma and ALS (odds ratio (OR) = 1.09, 95% confidence interval (CI): 0.99, 1.19). A first trauma before age 55 years was associated with ALS (OR = 1.22, 95% CI: 1.08, 1.37), whereas first traumas at older ages were not (OR = 0.97, 95% CI: 0.85, 1.10). Our data suggest that physical trauma at earlier ages is associated with ALS risk. Age at first trauma could help explain discrepancies in results of past studies of trauma and ALS. PMID:26825926

  6. Association of pneumonia and lung cancer: the value of convalescent chest radiography and follow-up

    International Nuclear Information System (INIS)

    A retrospective study of 1011 hospitalized patients with pneumonia was undertaken to assess the value of routine convalescent chest radiography for detection of underlying lung cancer. To investigate the mode of clinical onset of pulmonary carcinoma, 232 inpatients with this diagnosis were also studied. The findings may be summarized as follows: 1. 13/1011 pneumonia patients were found to have previously undiagnosed pulmonary carcinoma; 2. many of these carcinomas (8/13) were disclosed by an acute chest X-ray; 3. pulmonary carcinoma was found by convalescent chest X-ray in 2/88 patients not feeling well and in 2/524 patients feeling well at follow-up, and non of these 4 patients benefitted from the carcinoma diagnosis; 4. ESR was of no value in detecting underlying pulmonary carcinoma at follow-up in patients with pneumonia; 5. of the 232 patients with pulmonary carcinoma, 29 (12.5%) presented with an acute respiratory tract infection; 6. most of these latter patients did not recover as expected and their correct diagnosis was made based on a chest X-ray performed because of persistent symptoms. We suggest that patients with radiologically verified pneumonia undergo clinical examination or are interviewed 4-5 weeks after the onset. If signs or symptoms of respiratory disease persist, chest X-ray should be performed. We consider, however, that routine convalescent chest radiography with the aim of detecting any underlying pulmonary tumour could be omitted if the patient has completely recovered 1 month after the acute onset of illness. (9 refs.)

  7. Ecopsychology: A Perspective on Trauma

    OpenAIRE

    Milton, MJ; Corbett, L

    2011-01-01

    Literature has suggested that the cyclical nature of psychological trauma can cause enduring long-term effects on individuals and those around them. This review examines the effects of psychological trauma and its relationship to ecopsychology to provoke questions about integration and stimulate debate pertinent to trauma therapy. While being relatively unexplored with regards to psychological trauma, empirical evidence is beginning to amass to suggest that ecopsychology could be incorporated...

  8. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  9. Trauma and the endocrine system.

    Science.gov (United States)

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.

  10. Common Acupoints in Chest and Abdomen

    Institute of Scientific and Technical Information of China (English)

    Journal of Acupuncture and Tuina Science Editor; CUI Xue-jun

    2003-01-01

    @@ Tiantu (CV 21) Location: In the center of the suprasternal fossa(Fig. l ). Indications: Cough, dyspnea, chest pain, pharyngolaryngeal swelling and pains, sudden hoarseness of the voice, goiter, globus hystericus, and dysphagia.

  11. Tuberculosis, advanced - chest x-rays (image)

    Science.gov (United States)

    Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, ... death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying ...

  12. Aspergillosis - chest x-ray (image)

    Science.gov (United States)

    ... usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung ... are usually seen as black areas on an x-ray. The cloudiness on the left side of this ...

  13. Angina - when you have chest pain

    Science.gov (United States)

    ... or having sex. How to treat your chest pain Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity. If you are lying down, sit up in bed. Try deep breathing to ...

  14. Open-Chest Management after Heart Transplantation

    OpenAIRE

    Takayama, Hiroo; Leone, Richard J.; Aldea, Gabriel S.; Fishbein, Daniel P.; Verrier, Edward D.; Salerno, Christopher T.

    2006-01-01

    Postcardiotomy open-chest management has been widely used in cardiac surgery. Although this strategy can be applied to heart transplantation, the use of immunosuppressants in transplant recipients raises particular concerns about sternal wound infection and impaired healing.

  15. [Dedifferentiated Chondrosarcoma of the Chest Wall].

    Science.gov (United States)

    Saitoh, Genkichi; Yoneshima, Yasuto; Nakamura, Toshihiko; Kitagawa, Dai; Kinjo, Nao; Ohgaki, Kippei; Maehara, Shinichiro; Teramoto, Seiichi; Adachi, Eisuke; Ikeda, Yoichi; Mine, Mari

    2016-08-01

    A 79-year-old man complaining of an anterior chest mass with pain had an abnormal shadow on chest X-ray. A mass, 7 cm in size, with destruction of the right 4th rib was found on chest computed tomography. A F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) corresponding to the lesion showed an abnormal accumulation of FDG with the standardized uptake value(SUV) max=16.19. A malignant tumor of the chest wall origin was suspected and the tumor was resected with the 3th, 4th, and 5th ribs. Histologically, the tumor was diagnosed as dedifferentiated chondrosarcoma. He died of local recurrence about 5 months after the operation. PMID:27476566

  16. Early Childhood Trauma

    Science.gov (United States)

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  17. Trauma and Symbolic Violence

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    2011-01-01

    Our understanding of 'reactions to trauma' is dominated by concepts like Post-Traumatic Stress Disorder. The use of such concepts has been criticised but simultaneously integrated in folk-psychology. Connecting emotional and cognitive processes as well as acts - such as in gendered practices...

  18. Scapular dislocation from trivial trauma: a rare case

    Institute of Scientific and Technical Information of China (English)

    Landge Vikrant; Vaishya Raju; Aggarwal Anurag

    2012-01-01

    Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event.Scapulothoracic dissociation though has been reported,usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury,etc.Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition.Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature.It is a distinct clinical entity and needs to be differentiated from other similar conditions.Here,we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a l0 years old girl.The patient had a recurrence of the dislocation before presenting to us.But she did not have any pre-existing condition for scapular dislocation.

  19. Scapular dislocation from trivial trauma: a rare case.

    Science.gov (United States)

    Landge, Vikrant; Vaishya, Raju; Aggarwal, Anurag

    2012-01-01

    Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event. Scapulothoracic dissociation though has been reported, usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury, etc. Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition. Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature. It is a distinct clinical entity and needs to be differentiated from other similar conditions. Here, we present a case of painless scapular dislocation associated with trivial trauma followed by spontaneous reduction in a 10 years old girl. The patient had a recurrence of the dislocation before presenting to us. But she did not have any pre-existing condition for scapular dislocation.

  20. Scapular dislocation from trivial trauma: a rare case

    Directory of Open Access Journals (Sweden)

    Landge Vikrant

    2012-04-01

    Full Text Available 【Abstract】Dislocation of the scapula between the ribs and into the thoracic cage is a very rare event. Scapulothoracic dissociation though has been reported, usually occurs after a severe injury and is often associated with other serious injuries like brachial plexus or chest injury, etc. Ainscow has described a rare type that may occur due to slight violence with a pre-existing condition. Cases of isolated scapular dislocation after minor trauma have not been reported frequently in the literature. It is a distinct clinical entity and needs to be differentiated from other similar conditions. Here, we present a case of painless scapular dislocation associated with trivial trauma followed by spon-taneous reduction in a 10 years old girl. The patient had a recurrence of the dislocation before presenting to us. But she did not have any pre-existing condition for scapular dislocation. Key words: Scapula; Thorax; Shoulder dislocation

  1. Surface Chest Motion Decomposition for Cardiovascular Monitoring

    OpenAIRE

    Ghufran Shafiq; Kalyana C. Veluvolu

    2014-01-01

    Surface chest motion can be easily monitored with a wide variety of sensors such as pressure belts, fiber Bragg gratings and inertial sensors, etc. The current applications of these sensors are mainly restricted to respiratory motion monitoring/analysis due to the technical challenges involved in separation of the cardiac motion from the dominant respiratory motion. The contribution of heart to the surface chest motion is relatively very small as compared to the respiratory motion. Further, t...

  2. Necrotizing fasciitis involving the chest and abdominal wall caused by Raoultella planticola

    Directory of Open Access Journals (Sweden)

    Kim Si-Hyun

    2012-03-01

    Full Text Available Abstract Background Raoultella planticola was originally considered to be a member of environmental Klebsiella. The clinical significance of R. planticola is still not well known. Case presentation We describe the first case of necrotizing fasciitis involving the chest and abdominal wall caused by R. planticola. The identity of the organism was confirmed using 16S rRNA sequencing. The patient was successfully treated with the appropriate antibiotics combined with operative drainage and debridement. Conclusions R. planticola had been described as environmental species, but should be suspected in extensive necrotizing fasciitis after minor trauma in mild to moderate immunocompromised patients.

  3. Foreign bodies in the chest: how come they are seen in adults?

    International Nuclear Information System (INIS)

    The radiologic and clinical findings of foreign bodies in the chest of children are well recognized. Foreign bodies in adults are infrequent, however, and the radiologic findings of these unusual circumstances have rarely been described. We classified various thoracic foreign bodies into three types according to their cause: Type I, Aspiration, Type II, Trauma or Accident; Type III, Iatrogenic. This pictorial essay will illustrate the radiologic findings and consequences of thoracic foreign bodies in adults, which have rarely been described in the radiologic literature. The clinical significance of thoracic foreign bodies will be also be discussed

  4. Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report.

    Science.gov (United States)

    Rad, Mohammad Ghasemi; Mahmodlou, Rahim; Mohammadi, Afshin; Mladkova, Nikol; Noorozinia, Farahnaz

    2011-01-01

    We present the case of a 30-year-old man with no past history of disease or recent trauma, who was seen in the emergency room after developing sharp pain in the left hemithorax. Chest roentgenogram showed costopherenic angle blunting and an oval mass in the left mediastinum. A computed tomographic scan showed extrapleural mass with coarse calcifications and pleural effusion, confirmed by magnetic resonance imaging. The tumor was biopsied and removed during thoracotomy. The pathology reported revealed chondrosarcoma, which is a rare cause for a spontaneous massive hemothorax. Invasion of the intercostals vessels by the tumor was the probable cause of hemothorax in this patient. PMID:21740393

  5. Paediatric trauma care

    Directory of Open Access Journals (Sweden)

    Sebastian van As A

    2010-01-01

    Full Text Available Background: Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO that by 2020 it will be the number 1 disease globally. The WHO and UNICEF have published their third World Report on Child Injury Prevention in December 2008. Materials and Methods: A systematic review was performed on the history and magnitude of paediatric trauma worldwide. Additionally exciting developments and new trends were assessed and summarized. Results: Paediatric trauma is a growing field of clinical expertise. New developments include total body digital imaging of children presenting with polytrauma; targeted management of head injuries; conservative management of abdominal injuries in children and diagnostic laparoscopy, including the laparoscopic management of complications following the conservative management of solid organ injuries. Conclusion: Paediatric trauma has long been neglected by the medical profession. In order to deal with it appropriately, it makes sense to adopt the public health approach, requiring that we view child injuries similarly to any other disease or health problem. The greatest gain in our clinical practice with dealing with child injuries will result from a strong focus on primary (preventing the injury, secondary (dealing with the injury in the most efficient manner as well as tertiary prevention (making sure that children treated for trauma will be appropriately reintegrated within our society. By actively promoting child safety we will not only achieve a most welcome reduction in medical cost and disability, but also the ever-so-much desired decline of avoidable childhood misery and suffering.

  6. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  7. MANAGEMENT OF LIVER TRAUMA

    Directory of Open Access Journals (Sweden)

    Dova Subba

    2016-03-01

    Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.

  8. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  9. Gênero e trauma Gender and trauma

    OpenAIRE

    Gláucio Ary Dillon Soares; Dayse Miranda

    2005-01-01

    As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes) são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se de...

  10. Isolated Pediatric Pancreatic Transection Secondary to Ocean-Related Trauma

    Directory of Open Access Journals (Sweden)

    Afif N Kulaylat

    2013-03-01

    Full Text Available Context Isolated pancreatic transection is a rare but well-recognized complication following blunt trauma of the abdomen. Diagnosis at presentation may be difficult and delayed due to subtle initial symptoms and evolving nature of the injury. Case report We describe an isolated complete pancreatic transection in a 14-year-old female secondary to a previously unreported and highly unusual mechanism (being tossed by a wave. Diagnosis was obtained by computed tomography scan 24 hours following initial trauma. She was managed operatively with an open distal pancreatectomy with splenic preservation and no subsequent complications. Conclusions The force sustained from the blunt abdominal trauma of being tossed by a wave can be significant. The management of pancreatic injuries in children, particularly in the context of ductal transection, is controversial. Timely recognition and management is critical to optimal outcomes. Early operative intervention may help to avoid complications such as abscess or pseudocyst formation.

  11. Study on pathogenesis, clinical diagnosis and treatment of cerebral infarction after craniocerebral trauma operation%探究颅脑外伤手术后并发脑梗死的发病机制、临床诊断及治疗方法

    Institute of Scientific and Technical Information of China (English)

    龙翔

    2016-01-01

    目的:探讨颅脑外伤手术后并发脑梗死的发病机制、临床诊断及治疗方法。方法收集我院在1年之内收治的颅脑外伤术后并发脑梗死患者100例,对其临床资料和病历进行收集,并分析颅脑外伤术后并发脑梗死的相关发病机制。结果所有患者在治疗后其昏迷GCS评分、水肿体积以及颅内压均明显的优于治疗前,差异均明显(P<0.05)并有统计学意义。另本次研究中的残疾率为37%,无任何患者死亡。结论颅脑外伤术后并发脑梗死患者在实际治疗过程中需要做好早期预防和检查工作,并对患者实施针对性治疗。%Objective to investigate pathogenesis, clinical diagnosis and treatment of cerebral infarction after craniocerebral trauma operation.Methods collect clinical data and medical records of 100 patients with cerebral infarction after craniocerebral trauma operation received in our hospital during 1 year, and analyze related pathogenesis of cerebral infarction after craniocerebral trauma operation.Results GCS scores, edema volume and intracranial pressure of all patients after treatment were significantly better than that before treatment, difference showed statistical significance(P<0.05). Disability rate in this study was 37%, and there was no mortality. Conclusion in actual treatment process, early prevention and inspection should be done for patients with cerebral infarction complicated after craniocerebral trauma operation with targeted therapy.

  12. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Orkun Özkurtul

    2015-09-01

    Conclusion: This case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion.

  13. Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

    OpenAIRE

    Magu, Sarita; Agarwal, Shalini; Singla, Sham

    2012-01-01

    Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients ...

  14. Prehospital care for multiple trauma patients in Germany

    Institute of Scientific and Technical Information of China (English)

    Marc Maegele

    2015-01-01

    For the German speaking countries,Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid.The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care.The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system.The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept.The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first").If no immediate treatment is necessary,a "Secondary Survey" follows with careful and structured body examination and detailed assessment of the trauma mechanism.Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme.Critical trauma patients should be referred without any delay ("work and go") to TR-DGU(R) certified trauma centers of the local trauma networks.Due to the difficult prehospital environment the number of quality studies in the field is low and,as consequence,the level of evidence for most recommendations is also low.Much information has been obtained from different care systems and the interchangeability of results is limited.The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung",the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  15. The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department.

    Science.gov (United States)

    Pesch, Megan H; Bradin, Stuart

    2014-11-01

    Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.

  16. Chest pain, panic disorder and coronary artery disease: a systematic review.

    Science.gov (United States)

    Soares-Filho, Gastão L F; Arias-Carrión, Oscar; Santulli, Gaetano; Silva, Adriana C; Machado, Sergio; Valenca, Alexandre M; Nardi, Antonio E

    2014-01-01

    Chest pain may be due benign diseases but often suggests an association with coronary artery disease, which justifies a quick search for medical care. However, some people have anxiety disorder with symptoms that resemble clearly an acute coronary syndrome. More specifically, during a panic attack an abrupt feeling of fear accompanied by symptoms such as breathlessness, palpitations and chest pain, makes patients believe they have a heart attack and confuse physicians about the diagnosis. The association between panic disorder and coronary artery disease has been extensively studied in recent years and, although some studies have shown anxiety disorders coexisting or increasing the risk of heart disease, one causal hypothesis is still missing. The aim of this systematic review is to present the various ways in which the scientific community has been investigating the relation between chest pain, panic disorder and coronary artery disease. PMID:24923348

  17. Radioisotope lung scanning and the chest radiograph in pulmonary disease. Chapter 12

    International Nuclear Information System (INIS)

    The relationship between the chest radiograph and images of regional ventilation and perfusion is considered. Procedures using radioactive tracers for regional pulmonary blood flow and ventilation studies are reviewed. The normal perfusion scan used injected particles labelled with sup(99m)Tc. Ventilation scans use inhaled 133Xe or sup(81m)Kr. Chest radiographs are compared with perfusion and ventilation scans in the diagnosis of pulmonary embolic disease, chronic obstructive lung disease, emphysema, chronic bronchitis, asthma, carcinoma of the bronchus, pneumonia, collapse and acute bronchitis. It is concluded that the regional physiology as complementary information to the chest radiograph would greatly enhance the diagnostic skill of the radiologist and should therefore be more readily available to him. (author)

  18. Imaging of non-cardiac, non-traumatic causes of acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

    2012-12-15

    Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

  19. Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest

    Directory of Open Access Journals (Sweden)

    Praveen K. Jinnur

    2016-03-01

    Full Text Available A diagnosis of ‘chronic cough’ (CC requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported.

  20. Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest

    Science.gov (United States)

    Jinnur, Praveen K.; Pannu, Bibek S.; Boland, Jennifer M.; Iyer, Vivek N.

    2016-01-01

    A diagnosis of ‘chronic cough’ (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported. PMID:26958342

  1. Endovascular interventions for multiple trauma; Endovaskulaere Interventionen beim Polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Kinstner, C.; Funovics, M. [Klinik fuer Radiologie und Nuklearmedizin, Medizinische Universitaet Wien, Klinische Abteilung fuer Kardiovaskulaere und Interventionelle Radiologie, Wien (Austria)

    2014-09-15

    In recent years interventional radiology has significantly changed the management of injured patients with multiple trauma. Currently nearly all vessels can be reached within a reasonably short time with the help of specially preshaped catheters and guide wires to achieve bleeding control of arterial und venous bleeding. Whereas bleeding control formerly required extensive open surgery, current interventional methods allow temporary vessel occlusion (occlusion balloons), permanent embolization and stenting. In injured patients with multiple trauma preinterventional procedural planning is performed with the help of multidetector computed tomography whenever possible. Interventional radiology not only allows minimization of therapeutic trauma but also a considerably shorter treatment time. Interventional bleeding control has developed into a standard method in the management of vascular trauma of the chest and abdomen as well as in vascular injuries of the upper and lower extremities when open surgical access is associated with increased risk. Additionally, pelvic trauma, vascular trauma of the superior thoracic aperture and parenchymal arterial lacerations of organs that can be at least partially preserved are primarily managed by interventional methods. In an interdisciplinary setting interventional radiology provides a safe and efficient means of rapid bleeding control in nearly all vascular territories in addition to open surgical access. (orig.) [German] Innerhalb der letzten Jahre hat die interventionelle Radiologie das Management des Polytraumas massiv beeinflusst. Um eine Kontrolle einer arteriellen oder venoesen Blutung zu erreichen, koennen heute nahezu alle Gefaesse mithilfe spezieller Katheter und Draehte in kuerzester Zeit erreicht werden. Waehrend frueher eine Blutung nur in einem aufwendigen operativen Eingriff kontrolliert werden konnte, stehen heute Methoden zur Verfuegung, die Gefaesse temporaer zu okkludieren (Okklusionsballon), zu embolisieren

  2. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  3. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

    Science.gov (United States)

    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf

    2015-01-01

    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  4. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  5. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  6. Anatomical decomposition in dual energy chest digital tomosynthesis

    Science.gov (United States)

    Lee, Donghoon; Kim, Ye-seul; Choi, Sunghoon; Lee, Haenghwa; Choi, Seungyeon; Kim, Hee-Joung

    2016-03-01

    Lung cancer is the leading cause of cancer death worldwide and the early diagnosis of lung cancer has recently become more important. For early screening lung cancer, computed tomography (CT) has been used as a gold standard for early diagnosis of lung cancer [1]. The major advantage of CT is that it is not susceptible to the problem of misdiagnosis caused by anatomical overlapping while CT has extremely high radiation dose and cost compared to chest radiography. Chest digital tomosynthesis (CDT) is a recently introduced new modality for lung cancer screening with relatively low radiation dose compared to CT [2] and also showing high sensitivity and specificity to prevent anatomical overlapping occurred in chest radiography. Dual energy material decomposition method has been proposed for better detection of pulmonary nodules as means of reducing the anatomical noise [3]. In this study, possibility of material decomposition in CDT was tested by simulation study and actual experiment using prototype CDT. Furthermore organ absorbed dose and effective dose were compared with single energy CDT. The Gate v6 (Geant4 application for tomographic emission), and TASMIP (Tungsten anode spectral model using the interpolating polynomial) code were used for simulation study and simulated cylinder shape phantom consisted of 4 inner beads which were filled with spine, rib, muscle and lung equivalent materials. The patient dose was estimated by PCXMC 1.5 Monte Carlo simulation tool [4]. The tomosynthesis scan was performed with a linear movement and 21 projection images were obtained over 30 degree of angular range with 1.5° degree of angular interval. The proto type CDT system has same geometry with simulation study and composed of E7869X (Toshiba, Japan) x-ray tube and FDX3543RPW (Toshiba, Japan) detector. The result images showed that reconstructed with dual energy clearly visualize lung filed by removing unnecessary bony structure. Furthermore, dual energy CDT could enhance

  7. CT of blunt hepatic trauma in children

    International Nuclear Information System (INIS)

    CT findings of blunt hepatic trauma were studied in 27 children. Liver injury was classified into 3 types from mild to severe. Liver contusion was observed in 1, liver laceration in 21, and liver rupture in 5. Only 2 patients (7.4%) required surgery, and the others could be managed by conservative therapy. CT, which accurately reveals not only the severity of liver injury but also injuries of other abdominal organs and intraperitoneal bleeding, is important for the diagnosis of liver injury and determination of its treatment. (author)

  8. Substance Abuse and Trauma.

    Science.gov (United States)

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD. PMID:27613348

  9. Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma.

    Science.gov (United States)

    Ilker Oz, Ibrahim; Bozay Oz, Evrim; Şerifoğlu, Ismail; Kaya, Nurullah; Erdem, Oktay

    2016-01-01

    Objective Cerebellar ischemic infarction is a rare complication of minor head trauma. Vertebral artery dissection, vasospasm or systemic hypo perfusion can cause infarct. However, underlying causes of the ischemic infarct cannot be explained in nearly half of cases. The accurate diagnosis is essential to ensure appropriate treatment. Here we report a five yr old boy patient of cerebellar infraction after minor head trauma, admitted to emergency serves of BulentEcevit University, Turkey in 2013. We aimed to remind minor head trauma that causes cerebellar infarction during childhood, and to review the important points of the diagnosis, which should be keep in mind. PMID:27375760

  10. Fluid resuscitation in trauma

    Directory of Open Access Journals (Sweden)

    Rudra A

    2006-01-01

    Full Text Available Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics,and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

  11. Trauma is danger

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    Porterfield Nancy

    2011-06-01

    Full Text Available Abstract Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusions Our knowledge of Danger signals in relation to traumatic injury is still limited. Danger/alarmin signals are the most proximal molecules in the immune response that have many possibilities for effector function in the innate and acquired immune systems. Having a full understanding of these molecules and their pathways would give us the ability to intervene at such an early stage and may prove to be more effective in blunting the post-injury inflammatory response unlike previously failed cytokine experiments.

  12. Rib Tuberculosis Treatment By Steel Greft which has Fractured after a Thoracic Trauma: 10-year Follow up Case

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    Murat Oncel

    2013-04-01

    Full Text Available Rib tuberculosis is an uncommon form of osteoarticular tuberculosis. The physical and radiological examination can often mimic other conditions ,including primary and metastatic chest wall tumors . A 60 year-old male patient had a mass in the chest wall. Surgery aiming diagnosis and treatment based on physical and radiological findings were performed. Histopathological examination of the mass specimen revealed tuberculosis. The chest wall defect was supported with a stell greft after the six month . The patient had fallen from stairs and hit his chest six year after . The case had a significant fracture in the steel graft . This is unusual manifestation of chest wall grefts . This, chest wall, showing a softer steel materials should be used in grafts that would break a long-term follow-up is presented [Cukurova Med J 2013; 38(2.000: 295-298

  13. Radiation induced osteosarcoma of the chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, Tsutomu; Yuki, Yoshihiro; Oizumi, Hiroyuki; Iijima, Yoshiyuki; Fujishima, Tsukasa; Shimazaki, Yasuhisa [Yamagata Univ. (Japan). School of Medicine

    1996-11-01

    We report a successful resection of an osteosarcoma in the chest wall developed 25 years after irradiation. A 74-year-old woman was admitted to our hospital for her swelling in the left chest wall at August 24, 1995. At 49-year-old, she had undergone an operation and postoperative irradiation for left breast cancer. A computed tomography demonstrated a mass in the left chest wall that destructed the first rib, extending into the pleural space and invaded into the left common carotid and subclavian arteries. We planned a radical resection of the mass after repeated CT scannings, since it was histopathologically diagnosed as a chondrosarcoma and showed a rapid growth. The tumor was completely removed with radical transmediastinal forequarter amputation of the partial chest wall and total left upper extremity. The left common carotid artery was partially replaced with 6 mm EPTFE vascular prosthesis. The chest wall was reconstructed with Marlex-mesh prosthesis and a myocutaneous flap. She was discharged uneventfully and has not shown any evidence of recurrence. (author)

  14. Interventional procedures in the chest.

    Science.gov (United States)

    Vollmer Torrubiano, I; Sánchez González, M

    2016-05-01

    Many thoracic conditions will require an interventional procedure for diagnosis and/or treatment. For this reason, radiologists need to know the indications and the technique for each procedure. In this article, we review the various interventional procedures that radiologists should know and the indications for each procedure. We place special emphasis on the potential differences in the diagnostic results and complications between fine-needle aspiration and biopsy. We also discuss the indications for radiofrequency ablation of lung tumors and review the concepts related to the drainage of pulmonary abscesses. We devote special attention to the management of pleural effusion, covering the indications for thoracocentesis and when to use imaging guidance, and to the protocol for pleural drainage. We also discuss the indications for percutaneous treatment of pericardial effusion and the possible complications of this treatment. Finally, we discuss the interventional management of mediastinal lesions and provide practical advice about how to approach these lesions to avoid serious complications.

  15. Cardiac pathologies incidentally detected with non-gated chest CT; Inzidentelle Pathologien des Herzens im Thorax-CT

    Energy Technology Data Exchange (ETDEWEB)

    Scherer, Axel; Kroepil, P.; Lanzman, R.S.; Moedder, U. [Inst. fuer Radiologie, Universitaetsklinikum Duesseldorf, Heinrich-Heine-Univ. (Germany); Choy, G.; Abbara, S. [Cardiovascular Imaging Section, Massachusetts General Hospital, Harvard Medical School (United States)

    2009-12-15

    Cardiac imaging using electrocardiogram-gated multi-detector computed tomography (MDCT) permits noninvasive diagnosis of congenital and acquired cardiac pathologies and has thus become increasingly important in the last years. Several studies investigated the incidence and relevance of incidental extracardiac structures within the lungs, mediastinum, chest wall, and abdomen with gated coronary CT. This resulted in the general acceptance of the review of extracardiac structures as a routine component of coronary CT interpretation. On the other hand radiologists tend to neglect pericardial and cardiac pathologies in non-gated chest CT, which is primarily performed for the evaluation of the respiratory system or for tumor staging. Since the introduction of multi-detector spiral CT technology, the incidental detection of cardiac and pericardial findings has become possible using non-gated chest CT. This article reviews the imaging appearances and differential diagnostic considerations of incidental cardiac entities that may be encountered in non-gated chest CT. (orig.)

  16. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Science.gov (United States)

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa; Guerra, Vinicius André; Seligman, Renato; Knorst, Marli Maria

    2016-01-01

    Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients. PMID:26982039

  17. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Eleci Vaz Ferreira

    2016-02-01

    Full Text Available Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA in patients with suspected pulmonary thromboembolism (PTE who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%. Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%. Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%. Among those 75 cases, there were only 39 (20.4% in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases. Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001. Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

  18. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Seligman, Renato; Knorst, Marli Maria, E-mail: mknorst@gmail.com [Hospital de Clinicas de Porto Alegre, Porto Alegre, RS (Brazil); Guerra, Vinicius Andre [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS (Brazil). Faculdade de Medicina. Programa de Pos-Graduacao em Ciencias Pneumologicas; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa [Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre (Brazil). Faculdade de Medicina

    2016-01-15

    Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients. (author)

  19. Early trauma and mood disorders in youngsters

    Directory of Open Access Journals (Sweden)

    Caroline Elizabeth Konradt

    2013-01-01

    Full Text Available OBJECTIVE: To verify early experiences of childhood abuse and neglect among young with bipolar disorder (BD, major depression (MDD, and controls. METHOD: Case-control study nested to a population-based cross-sectional study. The diagnosis was performed via the structured clinical interview for DSM-IV Axis I Disorders (SCID. Traumatic events were analyzed using the Portuguese version - Questionário sobre Traumas na Infância (CTQ - based on the Childhood Trauma Questionnaire. RESULTS: The sample comprised 231 adolescents with 95 individuals in the control group, 82 with MDD and 54 with BD (32 of type I and 22 type II. The prevalence of trauma or violence in childhood was 42.2%; among those, 54.7% had BD, 62.2% had MDD and 18.1% were in the control group. Young people with BD or MDD obtained higher means in total CTQ and among their components when compared with those in the control group. DISCUSSION: Reports on early traumatic experiences were more frequent among young people with mood disorders than in the general population, corroborating the literature on the subject. In this sense, the traumatic experiences during childhood seemed to contribute to the onset of the disorder.

  20. Blunt pancreatic trauma. Role of CT

    Energy Technology Data Exchange (ETDEWEB)

    Procacci, C. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Graziani, R. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bicego, E. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Mainardi, P. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bassi, C. [Dept. of Surgery, Univ. Hospital, Verona (Italy); Bergamo Andreis, I.A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Valdo, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Guarise, A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Girelli, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy)

    1997-07-01

    Purpose: To define the evolution patterns of blunt pancreatic trauma, and to point out the CT features most significant for the diagnosis. Material and Methods: Ten cases of pancreatic trauma, observed over a period of about 10 years, were analyzed in retrospect. The cases were divided into 3 groups according to the time that had elapsed between trauma and first CT: Early phase (within 72 h: n=3/10); late phase (after 10 days: n=3/10); and following pancreatic drainage (n=4/10). Results: In the early phase, one case showed a blood collection surrounding the pancreatic head and duodenum, and displacing the mesenteric vessels to the left. In the 2 other cases it was possible to demonstrate a tear in the pancreas at the neck, perpendicular to the main pancreatic axis. In the late phase in all 3 cases, one cystic lesion was present at the site of the tear, either surrounding the gland or embedded - more or less deeply - within the parenchyma. One of the lesions subsided spontaneously; the 2 others required surgery. In the postoperative phase, an external fistula was demonstrated in 2 cases following percutaneous drainage of pancreatic cysts; the fistula was fed by a cystic lesion in the pancreatic neck. In the 2 other cases a pseudocyst developed. (orig.).

  1. A case of trauma related Acanthamoeba keratitis.

    Science.gov (United States)

    Kamel, A G M; Faridah, H; Yusof, S; Norazah, A; Nakisah, M A

    2004-12-01

    Acanthamoeba is an uncommon cause of keratitis but one of the most severe because of the prolonged and painful course of the disease and poor visual outcome. Although contact lens use is the principal risk factor, about 10% of cases occur following trauma and exposure to contaminated soil or water. Two cases of Acanthamoeba keratitis involving women contact lens wearers have previously been reported in Malaysia but this is the first time, a non contact lens related Acanthamoeba keratitis is reported. The case involved a 28 year old Indonesian male construction worker who had a trauma of the right eye during work. His eye was struck by sand and dust particles after which he quickly washed with water from an open tank at the construction site. He experienced pain, redness, glaring and blurring of vision of the right eye three days later. The diagnosis was missed at initial presentation but culture of the corneal scraping had proven Acanthamoeba as the aetiological agent. The history and clinical findings of this trauma related Acanthamoeba keratitis are briefly discussed.

  2. Pediatric pancreatic trauma: trending toward nonoperative management?

    Science.gov (United States)

    Cuenca, Alex G; Islam, Saleem

    2012-11-01

    Pancreatic trauma is rare in children and optimal care has not been defined. We undertook this study to review the cumulative experience from three centers. After obtaining Institutional Review Board approval at each site, the trauma registries of three institutions were searched for pancreatic injuries. The charts were reviewed and data pertaining to demographics, hospital course, and outcome were obtained and analyzed. During the study period, a total of 79 pancreatic injuries were noted. The most common mechanism of injury was motor vehicle crash (44%) followed by child abuse (11%) and bicycle crashes (11%). Computed tomographic (CT) scans were obtained in 95 per cent with peripancreatic fluid the most common finding. Median Injury Severity Score (ISS) was 9, whereas median organ injury score was 2, and a higher grade correlated with need for operation (P = 0.001). Pancreatic operations were performed in 32 patients, whereas nonoperative management was noted in 47 cases. We noted no differences in length of stay, age, ISS, or initial blood pressure in operative versus nonoperatively managed cases. Pancreatic injuries were rare in children with trauma. CT scans were the most common method of diagnosis. Nonoperative management appeared to be safe and was more common, especially for the lower grade injuries.

  3. Uso da cintilografia miocárdica em repouso durante dor torácica para descartar infarto agudo do miocárdio Utilización de la centellografía miocárdica en reposo durante dolor torácico para descartar infarto agudo de miocardio Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Gustavo Borges Barbirato

    2009-04-01

    miocardio. MÉTODOS: Un total de 108 pacientes ingresados con dolor torácico, o hasta tras 4 horas del término de los síntomas, con electrocardiograma no diagnostico, realizaron centellografía en reposo y dosificaciones de troponina I. No se excluyeron a los pacientes con pasado de infarto de miocardio (IM (24 pacientes. Se dosificó troponina I al ingreso y tras 6 horas del ingreso. Médicos nucleares realizaron análisis ciego de las imágenes. Se confirmó infarto de miocardio, con elevación de la troponina I mayor que tres veces el control. RESULTADOS: La imagen de perfusión en reposo se mostró anormal en todos los seis pacientes con IM. Sólo un paciente presentó imagen normal y elevación de la troponina. Otros 55 pacientes obtuvieron imagen positiva sin IM y 46 pacientes presentaron imágenes y troponinas normales. La prevalencia de la enfermedad fue de un 6,5%. Fue de un 85,7% la sensibilidad de la imagen de reposo durante dolor torácico para la evidencia de IM, y la especificidad de un 45,5%. El valor predictivo negativo fue de un 97,7%. CONCLUSIÓN: Pacientes sometidos al protocolo de dolor torácico con centellografía de perfusión miocárdica demostraron un excelente valor predictivo negativo para la exclusión del diagnóstico de infarto de miocardio. Estos resultados sugieren que la imagen de perfusión en reposo es una herramienta importante en la unidad de dolor torácico.BACKGROUND: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. OBJECTIVE: To evaluate the operating characteristics of 99mTc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of acute myocardial infarction. METHODS: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and nondiagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial

  4. Psychological trauma exposure and co-morbid psychopathologies in HIV+Men and Women.

    Science.gov (United States)

    Fellows, Robert P; Spahr, Nayeli A; Byrd, Desiree A; Mindt, Monica Rivera; Morgello, Susan

    2015-12-30

    This study examined the association between trauma exposure, PTSD, suicide attempts, and other psychopathology among 316 racially/ethnically diverse HIV-infected men and women who underwent semi-structured psychiatric assessment. In addition, the role of psychological resilience in trauma exposure was examined in the context of neurological symptoms and functional status. Nearly half (47.8%; 151/316) of the participants reported trauma exposure, of which 47.0% (71/151) developed PTSD. Among trauma-exposed individuals, those with a current psychiatric diagnosis reported more neurological symptoms and lower functional status. Trauma exposure without PTSD was associated with a higher rate of panic disorder and substance-induced mental disorders. Trauma-exposed individuals who did not develop PTSD were less likely than those who reported no trauma exposure to meet criteria for major depressive disorder (MDD). Trauma exposure, MDD, borderline personality disorder, and substance-induced mental disorders were independently associated with increased odds of suicide attempt. These results indicate that co-morbid psychiatric disorders are common among trauma exposed individuals with a history of PTSD, but those with trauma exposure who do not develop PTSD are less likely to experience MDD. The role of other co-morbid psychopathologies in the genesis of suicidal behavior among individuals living with HIV deserves further study. PMID:26599389

  5. 心型脂肪酸结合蛋白在胸痛6h内诊断急性心肌梗死的meta分析%heart-type fatty acid binding for diagnosis of acute myocardial infarction with chest pain within 6h:meta-analysis

    Institute of Scientific and Technical Information of China (English)

    刘延青; 冯长州; 孙淑艳

    2015-01-01

    目的:采用meta 分析的方法评价血清心型脂肪酸结合蛋白检测在胸痛发生6 h内的急性心肌梗死诊断中的应用价值。方法通过计算机检索 Medline、Pubmed、EMBASE、OVID、中国期刊全文数据库(CNKI)等,收集发表2006年1月至2013年1月的关于hFABP检测诊断AMI的横断面研究或病例对照研究,并应用Meta-DiSc统计软件进行分析。结果7个研究,共2338例受试者纳入 meta 分析。结果显示血清 hFABP 检测诊断 AMI的灵敏度为63%(95% CI:60%-66%),特异度为90%(95% CI:88%-91%),阳性似然比为4.48(95% CI:2.06-9.75),阴性似然比为0.42(95% CI:0.25-0.69),诊断比数比为10.97(95% CI:3.51-34.31),SROC曲线下的面积(the area under curve, AUC)为0.8859。结论 hFABP 在胸痛发生6 h内对 AMI有较高的诊断效能,可作为临床上诊断 AMI的有效方法。%Objective To evaluate the diagnostic value of heart-type fatty acid-binding protein (hFABP)for early de-tection of subjects entering the hospital with chest pain within 6h suggestive of acute myocardial infarction (AMI)by meta-analysis.Methods By searching Medline,Pubmed,EMBASE,OVID,CNKI et al datebase from January 2006 to January 2013,all the cross-sectional and case-control studies about hFABP in the diagnosis of AMI were collected to calculate the pooled results by using statistic software Meta-DiSc.Results seven trials with 2338 subjects were includ-ed in this meta-analysis.The pooled sensitivity(SEN),specificity(SPE),positive likelihood ratio(+LR),Negative like-lihood ratio(-LR),diagnostic odds ratio(DOR)were 63%(95% CI:60%-66%),90% (95% CI:88%-91%),4.48 (95%CI:2.06-9.75),0.42(95% CI:0.25-0.69),10.97(95% CI:3.51-34.31)respectively.And the SROC AUC was 0.8859.Conclusion HFABP plays an excellent diagnostic performance of AMI within 6 h after symptom onset.

  6. Global trauma: the great divide

    OpenAIRE

    Paniker Jayanth; Graham Simon Matthew; Harrison James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in deal...

  7. Trauma Studies: prospettive e problemi

    Directory of Open Access Journals (Sweden)

    Rachele Branchini

    2013-12-01

    Full Text Available The trauma paradigm pervades contemporary life. In newspapers, on television, on the web, even in ordinary conversation, experiences of every kind (both figurative and positive ones are described as “traumatic”. Thus the very meaning of the term is often overturned. This article seeks to reshape the limits of the concept of trauma by tracing its evolution from the psychological debate of the early nineteenth century to the recent setting up of the specific discipline of Trauma Studies.

  8. The epidemiology of renal trauma

    OpenAIRE

    Voelzke, Bryan B.; Leddy, Laura

    2014-01-01

    Introduction Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades. We sought to examine the modern epidemiology of renal trauma over the past decade. Methods A systematic review of PubMed from the past decade was conducted to examine adult and pediatric renal trauma. A total of 605 articles were identified. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. Results Th...

  9. PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

    Directory of Open Access Journals (Sweden)

    Jeffrey Guina

    2016-08-01

    Full Text Available Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472, we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis, as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs, DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs, most PTSSs (especially negative beliefs, recklessness, and avoidance, and interpersonal traumas (e.g., assaults and child abuse. Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment.

  10. PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

    Science.gov (United States)

    Guina, Jeffrey; Nahhas, Ramzi W.; Goldberg, Adam J.; Farnsworth, Seth

    2016-01-01

    Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse). Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment. PMID:27517964

  11. Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma.

    Science.gov (United States)

    Miyazawa, Masahisa; Yoshida, Kazuo; Komatsu, Kazunori; Kobayashi, Nobutaka; Haba, Yoshiaki

    2012-03-01

    We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

  12. Added diagnostic benefit of 16-row whole-body spiral CT in patients with multiple trauma differentiated by region and injury severity according to the ATLS {sup registered} concept; Diagnostischer Zugewinn der 16-Zeilen-Ganzkoerper-Spiral-CT bei polytraumatisierten Patienten differenziert nach Koerperregion und Verletzungsschwere gemaess ATLS {sup registered} -Konzept

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Knopke, S.; Schroeder, R.J. [Klinik fuer diagnostische und interventionelle Radiologie, Charite-Universitaetsmedizin Berlin (Germany)

    2008-12-15

    Purpose: to determine the added diagnostic benefit of using MS-CT in multiple trauma patients differentiated by severity of injury and affected body region. Materials and methods: a retrospective analysis was performed of the 16-row whole-body spiral CT findings in 275 multiple trauma patients (73% men, 27% women; age 39.6 {+-} 18.9 years) with regard to additional findings and new findings obtained with CT compared to the findings obtained by conventional projection radiography and abdominal ultrasound in the emergency room. The additional and new findings were differentiated by body region (head, face, chest, pelvis, abdomen, spine) and the degree of severity according to the three classes of injuries distinguished by the ATLS {sup registered} concept (class 1: simple injury, class 2: potentially life threatening, class 3: immediately life threatening). Results: a total of 921 additional findings (= findings potentially relevant for further diagnosis and therapy in addition to the findings obtained by conventional radiography or ultrasound) were obtained by MS-CT in all patients. The distribution by number of patients and body region was as follows: 22 neck, 76 face, 125 chest, 112 abdomen, 50 pelvis, and 91 spine. Most additional findings were categorized as potentially life threatening (ATLS class 2). In addition, there were 439 completely new findings, involving the head in 128 patients (mostly ATLS class 3), the face in 18, the chest in 47, the abdomen in 26, and the spine in 9 patients. Most new findings involving the face, abdomen, and spine were ATLS class 2 injuries. (orig.)

  13. The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants

    Energy Technology Data Exchange (ETDEWEB)

    Dietz, Kelly R. [University of Minnesota, Department of Radiology, Minneapolis, MN (United States); Zhang, Lei [University of Minnesota, Biostatistical Design and Analysis Center, Minneapolis, MN (United States); Seidel, Frank G. [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States)

    2015-08-15

    Prior to digital radiography it was possible for a radiologist to easily estimate the size of a patient on an analog film. Because variable magnification may be applied at the time of processing an image, it is now more difficult to visually estimate an infant's size on the monitor. Since gestational age and weight significantly impact the differential diagnosis of neonatal diseases and determine the expected size of kidneys or appearance of the brain by MRI or US, this information is useful to a pediatric radiologist. Although this information may be present in the electronic medical record, it is frequently not readily available to the pediatric radiologist at the time of image interpretation. To determine if there was a correlation between gestational age and weight of a premature infant with their transverse chest diameter (rib to rib) on admission chest radiographs. This retrospective study was approved by the institutional review board, which waived informed consent. The maximum transverse chest diameter outer rib to outer rib was measured on admission portable chest radiographs of 464 patients admitted to the neonatal intensive care unit (NICU) during the 2010 calendar year. Regression analysis was used to investigate the association between chest diameter and gestational age/birth weight. Quadratic term of chest diameter was used in the regression model. Chest diameter was statistically significantly associated with both gestational age (P < 0.0001) and birth weight (P < 0.0001). An infant's gestational age and birth weight can be reliably estimated by comparing a simple measurement of the transverse chest diameter on digital chest radiograph with the tables and graphs in our study. (orig.)

  14. The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants

    International Nuclear Information System (INIS)

    Prior to digital radiography it was possible for a radiologist to easily estimate the size of a patient on an analog film. Because variable magnification may be applied at the time of processing an image, it is now more difficult to visually estimate an infant's size on the monitor. Since gestational age and weight significantly impact the differential diagnosis of neonatal diseases and determine the expected size of kidneys or appearance of the brain by MRI or US, this information is useful to a pediatric radiologist. Although this information may be present in the electronic medical record, it is frequently not readily available to the pediatric radiologist at the time of image interpretation. To determine if there was a correlation between gestational age and weight of a premature infant with their transverse chest diameter (rib to rib) on admission chest radiographs. This retrospective study was approved by the institutional review board, which waived informed consent. The maximum transverse chest diameter outer rib to outer rib was measured on admission portable chest radiographs of 464 patients admitted to the neonatal intensive care unit (NICU) during the 2010 calendar year. Regression analysis was used to investigate the association between chest diameter and gestational age/birth weight. Quadratic term of chest diameter was used in the regression model. Chest diameter was statistically significantly associated with both gestational age (P < 0.0001) and birth weight (P < 0.0001). An infant's gestational age and birth weight can be reliably estimated by comparing a simple measurement of the transverse chest diameter on digital chest radiograph with the tables and graphs in our study. (orig.)

  15. Inter-observer variation of chest radiography for pneumoconiosis

    International Nuclear Information System (INIS)

    In order to assess the inter-obeserver variability in the interpretation of chest radiographs for the diagnosis of pneumoconiosis, 1040 radiographs were re-read simultaneously by four radiologists. The radiographs had been performed previously by 8 different radiology services on workers exposed to low silica content dust (<5%). Assessment of variability by pairs of readers was performed by calculating the ''k'' coefficient, as proposed by fleiss, which permits measurement of agreement of diagnosis, escluding any change agreement. Agreement of diagnosis for profusion of lung opacities was satisfactory (k 0.39 -0.68) for all the categories considered as a whole, but some categories (0/1 in particular), coefficients were recorded that were significantly lower than 0.4 (the value taken as the minimum agreement limit). The percentage of ''negative'' radiological pictures (0/0 in this case and the technical quality of radiographs did not affect agreement. There was substantial variability of interpretation particulary between one radiologist and the other three, but agreement between radiologist with greater experience was very good (k=0.6). An attempt is made to explain the greater variability observed in classifying category 0/1, which could depend on the definition of the category itself or on its interpretation

  16. Global trauma: the great divide.

    Science.gov (United States)

    Paniker, Jayanth; Graham, Simon Matthew; Harrison, James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

  17. Global trauma: the great divide

    Directory of Open Access Journals (Sweden)

    Paniker Jayanth

    2015-01-01

    Full Text Available Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

  18. CT of blunt trauma to the bowel and mesentery.

    Science.gov (United States)

    Nghiem, H V; Jeffrey, R B; Mindelzun, R E

    1993-01-01

    The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. CT has been shown to be accurate for detecting bowel and mesenteric injuries caused by blunt trauma and may be useful in predicting the need for either surgical repair or conservative management. However, many major gastrointestinal injuries have subtle CT findings. In this pictorial essay, we illustrate the broad spectrum of gastrointestinal abnormalities that can be shown by CT in patients with blunt abdominal trauma.

  19. Usefulness of ultrasound examination in larynx traumas in children

    International Nuclear Information System (INIS)

    Background: The aim of the paper was to evaluate the usefulness of ultrasonographic examination in diagnosing laryngeal traumas, and monitoring the progress or complications in its treatment. Material/Method: In the years 2004 - 2009, 12 children, including 5 girls and 7 boys with laryngeal injuries, aged 5 - 12 years, were diagnosed and treated. In all the children, US examination of the neck and larynx, using a high-frequency linear transducer, as well as laryngoscopy and radiological examination of the cervical spine and chest were performed. Results: Blunt injury of the larynx was found in 12 children; in 9 children, the injury had been caused by hitting the neck against an obtuse object, 1 child had been kicked in the neck, and in one there had been an attempt of strangling. One of the children had sustained blunt injuries of the neck and chest in a traffic accident. In US examinations, the findings included: unilateral lack of vocal cord mobility in 5 children, asymmetry in vocal cord mobility in 1 child, fractured thyroid cartilage with local hematoma in the affected area in 2 children, and thickened vocal cords in 5 children. In radiological examination, the findings included: subcutaneous emphysema in the cervical area of the chest in 4 children, and mediastinal emphysema in 2 children with traumatic rupture of the trachea shown in laryngoscopy. Conclusions: US examination is helpful in the assessment of the extensiveness of laryngeal trauma, especially in the evaluation of vocal cord mobility, cervical cartilage and the soft tissues of the neck. A high level of conformity was demonstrated between the results of cervical US and the respective laryngoscopic findings. US examination does not allow to differentiate between vocal cord paralysis and their immobilization. (authors)

  20. Diagnosis and treatment of the cerebral infarcts within large area after head trauma%颅脑损伤后大面积脑梗塞的诊治体会

    Institute of Scientific and Technical Information of China (English)

    李前国; 牛洪泉; 陈劲草

    2004-01-01

    颅脑损伤后大面积脑梗塞(large cerebral infarcts after head trauma)是指颅脑损伤所致大动脉痉挛、变窄、乃至闭塞,引起该动脉供应区的脑组织缺血、缺氧,最终导致功能丧失。其致死率和致残率极高,是重型颅脑损伤预后不良的一个重要因素。但如果诊断及时、治疗得当,仍有一部分患者恢复良好。现就我院近年来收治的12例颅脑损伤后大面积梗塞作回顾性分析,总结诊治体会,报告如下: