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Frontiers in Medicine 2023Tracheobronchial diverticulum (TBD) is an asymptomatic, benign cystic lesion outside the lumen of the trachea and bronchus. This is the first report case of a SCUBA...
Tracheobronchial diverticulum (TBD) is an asymptomatic, benign cystic lesion outside the lumen of the trachea and bronchus. This is the first report case of a SCUBA (self contained underwater breathing apparatus) diver diagnosed with TBD, which is a potential risk to diving. No literature or guideline is available so far on the diving fitness for patients with congenital or acquired TBD condition. A healthy 26-year-old male professional diver has records of SCUBA diving up to a depth of 40 meters sea water. He did not have any diving-related injuries or symptoms during his career and had no history of smoking, drinking, or other special illnesses except for a COVID-19 infection. A tracheal diverticulum was found accidentally by computed tomography (CT), but its communication with the trachea was not clear initially. Therefore, high-resolution CT and electronic bronchoscopy were done to clarify the situation of the diverticulum and identify the diving risk. High-resolution CT showed a possible opening in the diverticulum, but this was not seen under electronic bronchoscopy. Although a potential opening was shown in high-resolution CT, the lack of visual bronchoscopic evidence made it likely to be a dead cavity. As there is a higher theoretical risk of barotrauma during decompression, leading to pneumomediastinum, hemorrhage, or arterial gas embolism, the current clinical consensus is that air-containing tissue should be regarded as a relative contraindication for diving. Overall, it is recommended that the diver should dive carefully and avoid ascending too rapidly.
PubMed: 38274443
DOI: 10.3389/fmed.2023.1340974 -
Radiology Case Reports Mar 2024Air embolism is often an iatrogenic complication that may occur in venous or arterial circulation depending on the port of entry. We present a case of a 40-year-old...
Air embolism is often an iatrogenic complication that may occur in venous or arterial circulation depending on the port of entry. We present a case of a 40-year-old female who had a venous air embolism in the pulmonary artery as a consequence of the injection of a contrast agent. She experienced dyspnea and chest pain following a contrast-enhanced chest computed tomography imaging. She was successfully treated and discharged from our hospital. Early detection of this clinical condition is essential to prevent morbidity and mortality.
PubMed: 38204934
DOI: 10.1016/j.radcr.2023.11.058 -
BMC Pulmonary Medicine Jan 2024Pulmonary air embolism (AE) and thromboembolism lead to severe ventilation-perfusion defects. The spatial distribution of pulmonary perfusion dysfunctions differs...
BACKGROUND
Pulmonary air embolism (AE) and thromboembolism lead to severe ventilation-perfusion defects. The spatial distribution of pulmonary perfusion dysfunctions differs substantially in the two pulmonary embolism pathologies, and the effects on respiratory mechanics, gas exchange, and ventilation-perfusion match have not been compared within a study. Therefore, we compared changes in indices reflecting airway and respiratory tissue mechanics, gas exchange, and capnography when pulmonary embolism was induced by venous injection of air as a model of gas embolism or by clamping the main pulmonary artery to mimic severe thromboembolism.
METHODS
Anesthetized and mechanically ventilated rats (n = 9) were measured under baseline conditions after inducing pulmonary AE by injecting 0.1 mL air into the femoral vein and after occluding the left pulmonary artery (LPAO). Changes in mechanical parameters were assessed by forced oscillations to measure airway resistance, lung tissue damping, and elastance. The arterial partial pressures of oxygen (PaO) and carbon dioxide (PaCO) were determined by blood gas analyses. Gas exchange indices were also assessed by measuring end-tidal CO concentration (ETCO), shape factors, and dead space parameters by volumetric capnography.
RESULTS
In the presence of a uniform decrease in ETCO in the two embolism models, marked elevations in the bronchial tone and compromised lung tissue mechanics were noted after LPAO, whereas AE did not affect lung mechanics. Conversely, only AE deteriorated PaO, and PaCO, while LPAO did not affect these outcomes. Neither AE nor LPAO caused changes in the anatomical or physiological dead space, while both embolism models resulted in elevated alveolar dead space indices incorporating intrapulmonary shunting.
CONCLUSIONS
Our findings indicate that severe focal hypocapnia following LPAO triggers bronchoconstriction redirecting airflow to well-perfused lung areas, thereby maintaining normal oxygenation, and the CO elimination ability of the lungs. However, hypocapnia in diffuse pulmonary perfusion after AE may not reach the threshold level to induce lung mechanical changes; thus, the compensatory mechanisms to match ventilation to perfusion are activated less effectively.
Topics: Animals; Rats; Carbon Dioxide; Hypocapnia; Thromboembolism; Perfusion; Pulmonary Embolism; Bronchi; Embolism, Air; Bronchoconstriction
PubMed: 38200483
DOI: 10.1186/s12890-024-02842-z -
Journal of Orthopaedic Case Reports Dec 2023Bilateral bifocal femur fractures occur as a result of high-velocity trauma mainly road traffic accidents with dashboard injuries or fall from height. These fractures...
INTRODUCTION
Bilateral bifocal femur fractures occur as a result of high-velocity trauma mainly road traffic accidents with dashboard injuries or fall from height. These fractures can result in high morbidity or mortality as they are usually presented with hypovolemic shock or fatal fat embolism syndrome.
CASE REPORT
We present a 47-year-old male with a history of fall from 35 feet. He sustained a symmetrical intertrochanteric femur fracture with a diaphyseal femur fracture with a bilateral patella fracture. There was no evidence of any head injury or spinal fracture. The patient reached the emergency room in hypotension and was maintaining saturation on room air. The patient was admitted to the intensive care unit; hypotension was corrected overnight and was operated on after 24 h with bilateral intramedullary long proximal femoral nail and tension band wiring for the bilateral patella fractures. At 1-year follow-up, he was able to do his daily activities with minimal limitation.
CONCLUSION
Bilateral bifocal femur fractures result from a high-velocity trauma. In such injuries, careful evaluation of all the systems should be performed to find out concomitant injuries. Single-staged surgical intervention decreases the morbidities of the subsequent surgeries, helps in a rehabilitation hospital stay as well as financially suitable for the patient.
PubMed: 38162357
DOI: 10.13107/jocr.2023.v13.i12.4056 -
European Heart Journal. Acute... Mar 2024Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in...
Diagnosis and treatment of right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale): a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology.
Acute right ventricular failure secondary to acutely increased right ventricular afterload (acute cor pulmonale) is a life-threatening condition that may arise in different clinical settings. Patients at risk of developing or with manifest acute cor pulmonale usually present with an acute pulmonary disease (e.g. pulmonary embolism, pneumonia, and acute respiratory distress syndrome) and are managed initially in emergency departments and later in intensive care units. According to the clinical setting, other specialties are involved (cardiology, pneumology, internal medicine). As such, coordinated delivery of care is particularly challenging but, as shown during the COVID-19 pandemic, has a major impact on prognosis. A common framework for the management of acute cor pulmonale with inclusion of the perspectives of all involved disciplines is urgently needed.
Topics: Humans; Pulmonary Heart Disease; Pandemics; Heart Failure; Heart Ventricles; Cardiology
PubMed: 38135288
DOI: 10.1093/ehjacc/zuad157 -
International Journal of Surgery Case... Jan 2024Intravascular ballistic embolism is a rare and complex medical condition, posing diagnostic and management challenges. It involves the migration of ballistic materials...
INTRODUCTION AND IMPORTANCE
Intravascular ballistic embolism is a rare and complex medical condition, posing diagnostic and management challenges. It involves the migration of ballistic materials within the arterial system, often stemming from neck and chest injuries.
CASE PRESENTATION
A 13-year-old boy sustained a chest injury from an air rifle, leading to a pellet embolism in the right internal carotid artery, resulting in severe cerebral infarction. Despite intervention attempts, the lodged pellet left the patient with permanent hemiplegia.
CLINICAL DISCUSSION
Intravascular ballistic embolism, although infrequent, presents diagnostic and therapeutic complexities. Embolization can manifest after a delay, with neck and chest injuries serving as common entry points. This case raised potential embolization routes through the left ventricle or a chest wound to the aortic arch or right common carotid artery. Management strategies for intravascular ballistic embolism remain debated. Some cases are conservatively treated, while others undergo surgical or radiological procedures to remove the foreign body. These interventions carry risks, such as foreign body migration and reperfusion injury.
CONCLUSION
Effectively managing intravascular ballistic embolism necessitates a deep understanding of possible embolization routes and a careful evaluation of intervention risks. Collaborative research efforts are pivotal in establishing optimal management strategies for these intricate cases.
PubMed: 38100926
DOI: 10.1016/j.ijscr.2023.109112 -
Indian Journal of Pathology &... 2023Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this...
BACKGROUND
Non-thrombotic pulmonary embolism, an uncommon entity, is defined as the embolization of tissues, microorganisms, air, or foreign material. One subset in this non-thrombotic category is septic pulmonary embolism (SPE) that refers to embolism of microorganisms with or without a thrombotic mantle into the pulmonary vasculature. This condition is often recognized on the basis of imaging with a clinical correlation. Unfortunately, data regarding the pathological features are meager. This has prompted to review such cases at autopsy.
AIMS
To study the pathological features of SPE at autopsy.
MATERIALS AND METHODS
Ten-year (2012 to 2021) autopsy records of the hospital were retrospectively reviewed. The diagnosis was based on the identification of acute necrotizing pulmonary arteritis with peri-bronchoarterial consolidation. These cases were analyzed with reference to the demographics, clinical characteristics, and pulmonary/extrapulmonary findings at autopsy.
STATISTICAL ANALYSIS
Nil.
RESULTS
According to the inclusion criterion, 19 cases demonstrated the presence of SPE. There were 11 men and 8 women with a mean age of 32.1 years. The major source of infection included infection arising from skin and musculo-skeletal system (11 patients, 59.7%). The common clinical presentation included fever, dyspnea, chest pain, hemoptysis, and altered sensorium. The cause of death was mainly due to septicemia and/or confluent lung consolidations. A large number of bacterial colonies were seen in all; Candida species were also identified in two cases. Other lung findings included diffuse alveolar damage, fresh arterial thrombosis, infarction, arterial pseudo-aneurysms, abscess formation, and pyogenic pleuritis.
CONCLUSION
Presence of an extrapulmonary infection with persistent fever, bacteremia, and pulmonary complaints should raise suspicion for this entity, particularly in resource-poor settings, to prevent grave pulmonary complications.
Topics: Male; Humans; Female; Adult; Retrospective Studies; Sepsis; Pulmonary Embolism; Lung; Bacteremia
PubMed: 38084525
DOI: 10.4103/ijpm.ijpm_528_22 -
European Heart Journal. Case Reports Sep 2023Air emboli are a life-threatening diagnosis, which may form through a range of mechanisms. In this case, we describe the case of extensive multi-territory air emboli in...
BACKGROUND
Air emboli are a life-threatening diagnosis, which may form through a range of mechanisms. In this case, we describe the case of extensive multi-territory air emboli in a patient with a history of intravenous drug abuse.
CASE SUMMARY
This case describes a 41-year-old male who presented with confusion following fall with long lie. He was diagnosed with hyperkalaemia, renal failure, rhabdomyolysis, and compartment syndrome, and he developed extensive multi-territory air emboli. Air embolism was identified in arterial, venous, subcutaneous, and mediastinal territories. Echocardiography demonstrated right ventricular dilation and dysfunction, consistent with air visualized in the right coronary artery on computed tomography. The patient was transferred to the intensive care unit for close cardiac and neurological monitoring and supportive organ care, and ultimately made an uneventful recovery by 6 weeks without apparent complications from the air emboli.
DISCUSSION
The presence of multi-territory air emboli has previously been described in the setting of surgery, manipulation of intravascular catheters, pulmonary barotrauma, and in sepsis with gas-forming organisms. It has not previously been reported in intravenous drug use or sterile rhabdomyolysis. Computed tomography imaging and echocardiography are useful to diagnose air emboli and their haemodynamic impact. Our patient's case provides a novel example of multi-territory air emboli in a unique scenario.
PubMed: 38073677
DOI: 10.1093/ehjcr/ytad460 -
Scandinavian Journal of Trauma,... Dec 2023Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical... (Review)
Review
BACKGROUND
Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially.
AIMS
The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome.
METHODS
A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened.
RESULTS
The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work.
CONCLUSIONS
Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.
Topics: Humans; Iron-Dextran Complex; Mountaineering; Heart Arrest; Hypothermia; Emergency Medicine
PubMed: 38071341
DOI: 10.1186/s13049-023-01164-z