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Current Cardiology Reports Nov 2023The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current... (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to serve as a practical guide to computed tomography (CT)-guided pericardiocentesis and to discuss the role of this approach in current clinical practice. An overview of indications, technique, advantages, and limitations specific to CT-guided pericardiocentesis will be provided. The reader will have an enhanced understanding of the use of this imaging modality to guide pericardial drainage.
RECENT FINDINGS
Use of CT guidance to drain the pericardial space is safe, especially when adequate echocardiographic evaluation is precluded and when echocardiography-guided pericardiocentesis is deemed unsafe and or not feasible. Our review and experience indicate that CT-guided pericardiocentesis is technically successful in more than 94% of patients, with a low risk (<1%) of significant complications. CT-guided pericardiocentesis is therefore a viable alternative when echocardiographic guidance is insufficient and can obviate the need for surgery in most patients.
Topics: Humans; Pericardiocentesis; Pericardial Effusion; Echocardiography; Drainage; Tomography, X-Ray Computed
PubMed: 37856032
DOI: 10.1007/s11886-023-01965-9 -
Forensic Science, Medicine, and... Oct 2023The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem...
The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem computed tomography (PMCT) visualization techniques and discusses the potential cause of death of this individual. A dead-stranded adult male East Asian finless porpoise was recovered from the Northern coast of Jeju Island, Republic of Korea. The carcass was frozen in Jeju National University within 2 h upon first reported. The PMCT examinations were performed at 120 kVp, 200 mAs with a section thickness of 1 mm. The scan field of view (sFOV) was set to 400 mm. Four image rendering techniques, including multi-planar reconstruction, three-dimensional volume rendering, perspective volume rendering, and minimum intensity projection technique, were used to aid the diagnosis of upper aerodigestive tract obstruction in the stranded finless porpoise. Conventional necropsy was performed to provide a complete necropsy report. Using PMCT, a Sebastidae of 24 cm measured length was found to be lodged in the left pharyngeal food channel and esophagus of the finless porpoise. Hard rays of the pectoral fin of the lodged fish have impaled the esophageal mucosa. Fishing gear was found to embed at the dorsal side of the lodged fish. The trachea was compressed ventrally and the arytenoepiglottic tube opening has been narrowed, which may precipitate to the finless porpoise difficult breathing. Pulmonary hyperinflation, pulmonary edema, pneumothorax, pneumopericardium, and pneumorrhachis were observed. This case report represents the first documentation of potential radiological indicators of upper aerodigestive tract obstruction in the East Asian finless porpoise using PMCT. Spatial location of the lodged item could be rendered in situ as the time of death. It has demonstrated that PMCT could provide objective measurements to adjunct the necropsy findings in diagnosis of fatal aerodigestive tract obstruction in stranded cetaceans.
PubMed: 37831312
DOI: 10.1007/s12024-023-00732-0 -
BMJ Case Reports Oct 2023A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and...
A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and deep inspiration accompanied by dysphonia and odynophagia in the last 1 day. He had a notable history of viral fever with non-productive cough 2 weeks prior, which resolved spontaneously. Examination revealed stable haemodynamic parameters. Palpable non-tender crepitus was felt in left anterior chest wall, axilla and both sides of the neck. Auscultation revealed Hamman's sign. ECG showed high voltage complexes and 2-dimensional echocardiogram (2D ECHO) showed normal biventricular function. CXR was evident of subcutaneous emphysema, pneumopericardium and Naclerio's sign clinching the diagnosis of pneumomediastinum. CT findings were consistent with a diagnosis of Hamman's syndrome. Patient was admitted for observation and treated with high-flow oxygen. He improved symptomatically and was discharged on the fourth day of admission.
Topics: Male; Adolescent; Humans; Auscultation; Mediastinal Emphysema; Dyspnea; Pneumopericardium; Diagnosis, Differential; Syndrome; Subcutaneous Emphysema
PubMed: 37798040
DOI: 10.1136/bcr-2022-253248 -
Wiener Medizinische Wochenschrift (1946) Sep 2023This report highlights the early and unusual detection of a pneumopericardium by echocardiography prior to potential development of cardiocirculatory compromise. It is...
This report highlights the early and unusual detection of a pneumopericardium by echocardiography prior to potential development of cardiocirculatory compromise. It is important to consider pneumopericardium into the differential diagnosis when difficulties arise in the visualization of the heart by conventional echocardiography. Pneumopericardium is associated with a high mortality rate and may be effectively treated by immediate insertion of a pericardial catheter.
PubMed: 37750989
DOI: 10.1007/s10354-023-01021-9 -
HeartRhythm Case Reports Sep 2023
Risk for contralateral pneumothorax, pneumopericardium, and pneumomediastinum in the elderly patient receiving a dual-chamber pacemaker-A case report of 2 patients with acute and chronic atrial lead perforation.
PubMed: 37746575
DOI: 10.1016/j.hrcr.2023.07.004 -
Cureus Aug 2023Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal,...
Spontaneous Subcutaneous Emphysema in a Teenage Male Extending As Pneumomediastinum, Pneumothorax, Pneumopericardium, and Epidural Pneumatosis: A Rare Combination of Anatomical Locations.
Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal, pericardial, and pleural space together is rare, while epidural pneumatosis is an even rarer entity. We report a previously healthy teenage male with sudden onset chest pain whose plain radiographs and high-resolution computed tomography (HRCT) showed extensive spread of air in the mediastinum, pericardial space, pleural space, and epidural space. He was hemodynamically stable and had a spontaneous recovery after one week. Follow-up radiological imaging showed complete radiological resolution of gas lucencies. It is quite important for clinicians to be aware of this condition, common and rare routes of extension, and possible complications. Clinical suspicion is vital to plan appropriate investigations especially radiological modalities such as chest X-ray and HRCT. This will help in evaluating the severity of the condition, exclude possible etiologies, and look for potential complications so that proper management and follow-up can be planned.
PubMed: 37711916
DOI: 10.7759/cureus.43462 -
Pediatric Pulmonology Nov 2023Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after...
BACKGROUND AND AIMS
Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome.
METHODS
We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome.
RESULTS
In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak.
CONCLUSIONS
Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.
Topics: Adolescent; Young Adult; Humans; Retrospective Studies; Pneumothorax; Graft vs Host Disease; Pleurodesis; Respiratory Insufficiency
PubMed: 37641438
DOI: 10.1002/ppul.26645 -
Forensic Science, Medicine, and... Aug 2023Fatal neonatal pneumothorax is often described in the literature as a consequence of prematurity and respiratory distress syndrome, pulmonary congenital anomalies,...
PURPOSE
Fatal neonatal pneumothorax is often described in the literature as a consequence of prematurity and respiratory distress syndrome, pulmonary congenital anomalies, artificial ventilation and cardiopulmonary resuscitation.
METHODS
Forensically clinical commentaries of the letal complications in perinatal malpractices.
RESULTS
After an orderly term delivery in a 31.- year old tercipara, the newborn developed a clinical sign of meconium aspiration syndrome, for which he was primarily resuscitated with an APGAR score of 3,5,6. In the neonatology department, one hour after delivery, severe generalized emphysema and massive air embolism developed with bilateral pneumothorax, pneumomediastinum, pneumopericardium and pneumoperitoneum, as well as cardiac arrest and death. A direct connection between the oxygen supply pipe and the endotracheal tube was found with the consequent continuous overpressure and hyperoxygenation as the cause of the above pathological conditions, which were confirmed by autopsy with a massive air embolism.
CONCLUSION
For a forensic-clinical discussion, I consider this rare presentation of a massive lethal air plurifocal embolism to be a necessary contribution to the understanding of professional, educational and organizational communication failure. Alveolar overdistension with hyperinflation of oxygen led to imposibility of spontaneous and assisted ventilation, massive air embolism and consequent complications that led to death without response to resuscitation measures.
PubMed: 37578625
DOI: 10.1007/s12024-023-00686-3 -
JACC. Case Reports Jul 2023Tension pneumopericardium is most commonly traumatic. Nontraumatic etiologies are rare, but have been reported with gastropericardial and esophagopericardial fistulas....
Tension pneumopericardium is most commonly traumatic. Nontraumatic etiologies are rare, but have been reported with gastropericardial and esophagopericardial fistulas. We present the case of a 54-year-old patient who developed a tension pneumopericardium with tamponade secondary to a perforated marginal ulcer in the proximal jejunum with an enteropericardial fistula. ().
PubMed: 37545683
DOI: 10.1016/j.jaccas.2023.101909 -
Medicine Aug 2023Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use...
Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory exchange technique during tracheostomy: A case report.
RATIONALE
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management.
PATIENT CONCERNS
A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%.
DIAGNOSIS
Endotracheal tube was directed toward the tracheal wall, causing airway obstruction.
INTERVENTIONS
THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation.
OUTCOMES
The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9.
LESSONS
THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.
Topics: Female; Humans; Middle Aged; Tracheostomy; Tracheal Stenosis; Insufflation; Administration, Intranasal; Apnea; Airway Obstruction
PubMed: 37543766
DOI: 10.1097/MD.0000000000034567