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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Roentgenography is the simplest and most reliable means to arrive at the diagnosis of chest injury. General roentgenograms are difficult to interpret as they tend to be technically imperfect. Fractures, emphysema, pneumothorax, accumulation of fluid can usually be ascertained directly; but the traumatic origin of changes in the pulmonary parenchyma or of an enlarged heart shadow cannot be reliably deduced from the X-ray appearance. It may provide some differential-diagnostic information but the correct interpretation of the findings depends on further observation. In 6-7% of severe chest trauma with vascular injuries and rupture of the diaphragm angiography is indicated. The evidence to be obtained from chest radiography should not be overestimated: fractures of ribs are sometimes overlocked, even by the expert; parenchymatous lesions may manifest themselves as shadows but their nature remains obscure until they have been related to the clinical and subsequent radiological findings. The same applies to rupture of the diaphragm, bronchi or vessels, if only the immediate posttraumatic roentgenographs are examined. A tent-shaped heart shadow is considered characteristic of the presence of fluid in the pericardium; this is valid only for chronic hydropericardium, but not for the potentially fatal cardiac tamponade; if the pericardium has lost its elasticity a haemorrhage of not more than 150 ml may prove fatal. Nor does the roentgenogram provide information about pulmonary function. Especially in cases of pulmonary shock minor changes in the chest roentgenogram may give a false sense of security when, in fact, blood gas analyses show that a life-endangering situation has developed. The radiologist who is aware of the limititations of the method will derive maximum diagnostic benefit from a chest angiography. No other method is capable of supplying information of such great importance in such a short time.
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PMID:[Diagnostic problems in chest injuries (angiography) (author's transl)]. 46 14

263 persons with chest injuries were treated over a period of 16 years. 47 had performating chest injuries, in the remaining cases it was a blunt trauma. Prompt recognition of a life-endangering situation (cardiac tamponade, tension pneumothorax, mediastinal emphysema, massive haemothorax) is essential; radiological and laboratory diagnostic methods play a secondary role. The most effective emergency treatment is intercostal continuous suction; in many cases it is the only one needed. A haemothorax must be evacuated completely because of the risk of complications and fibrin formation. Thoracotomy is rarely, and surgical removal of lung tissue hardly ever, indicated. 30 persons needed emergency thoracotomy. Accompanying intraabdominal injuries, mostly rupture of the diaphragm and spleen, were observed in 45 patients. Late sequels were lung abscesses, posttraumatic cysts, pleural empyema and adhesions, atelectases. Decortication, if indicated, should be performed at an early stage.
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PMID:[Surgical aspects of open and closed chest injuries (author's transl)]. 46 18

In order to be able to carry out effective emergency medicine outside the hospital, knowledge of some of the important puncture techniques is essential. Sometimes injection and infusion is required under difficult conditions, and sometimes decompression punctures are the vitally decisive interventions. Among these are central venous access via the subclavian vein, intracardial injection, decompression puncture in cardiac tamponade, relief of tension pneumothorax, cannulation of the trachea and relief of mediastinal emphysema. These interventions are outlined according to indication, technique and complications.
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PMID:[Puncture techniques in emergency medicine (author's transl)]. 81 32

Acquired calcified aortic stenosis in elderly patients successfully resolved after percutaneous aortic valvuloplasty (PAV) using the antegrade or retrograde method. The effectiveness and complications of these two methods were compared. A 79-year-old man who had acute myocardial infarction and pulmonary emphysema underwent aortic valvuloplasty using Medi-Tech balloons, 15 mm and 20 mm in diameter, via the brachial artery route. This caused a reduction of the peak and mean aortic valve pressure gradients, from 56 to 30 and from 59 to 35 mmHg, respectively and an increase in the valve area from 0.6 to 0.8 cm2. However, cardiac tamponade developed due to penetration of the left ventricular wall by the guide wire. A 73-year-old man who had transient cerebral ischemia and pulmonary emphysema underwent valvuloplasty by the Inoue's balloon technique (inflated up to 19 mm) via the saphenous vein. This resulted in a reduction of the peak and mean pressure gradients from 35 to 15 and from 39 to 15 mmHg respectively, a month thereafter. There were no complications. To our knowledge, these are the first two reported cases of acquired aortic stenosis which were relieved by percutaneous aortic valvuloplasty in Japan.
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PMID:[Percutaneous aortic valvuloplasty in the aged using the antegrade or retrograde method: a report of two cases]. 263 37

Pneumopericardium is a rare condition, most frequently reported in connection with prolonged artificial ventilation in infants with hyaline membrane disease. No reports of pneumopericardium after pulmonary surgery have been published. Two cases of pneumopericardium are reported, one of tension pneumopericardium after pneumonectomy and artificial ventilation and one that followed radical lobectomy and artificial ventilation. The radiographic findings included pneumopericardium and subcutaneous emphysema and the patient who had had a pneumonectomy had severe symptoms of cardiac tamponade. Prolonged artificial ventilation in patients after pulmonary surgery and in the presence of an intrathoracic air leak may be a hazard. The importance of prompt surgical intervention in cases of tension pneumopericardium is underlined; the treatment of choice is thoracotomy with pericardiotomy.
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PMID:Pneumopericardium after pneumonectomy and lobectomy. 301 Apr 83

Pneumopericardium, a complication of ventilatory management of neonatal respiratory distress syndrome, may result in cardiac tamponade. Pneumopericardium occurred in 47 premature infants (mean birth weight, 1,894 gm) at the University of Minnesota Hospital between July, 1972, and January, 1981. At the onset of pneumopericardium, 44 of 46 intubated patients were on positive end-expiratory pressure (PEEP) and 1 patient was ventilated using a mask. Five infants were asymptomatic, while 42 were seen with sudden hypotension, bradycardia, and hypoxia an average of 57 hours (range, 1 to 312 hours) after the commencement of ventilatory support. Pneumothorax (38 instances), pneumomediastinum (21), pulmonary interstitial emphysema (29), pneumoperitoneum (6), or a combination of these conditions was noted prior to or simultaneously with pneumopericardium in 46 infants. Pneumopericardium was not treated in 14 patients, 10 of whom were symptomatic and 4 asymptomatic; there were 5 deaths in this group. The group of 33 infants treated for this complication underwent either pericardial aspiration (2 patients), aspiration followed by pericardial tube placement (12 patients), or pericardial tube placement alone (19 patients). All 33 patients who underwent treatment had resolution of symptoms, but pneumopericardium recurred in 13 with 5 deaths. Causes of recurrence were tube or aspiration failure in 10 infants and tube removal prior to cessation of PEEP in the other 3. There were five complications related to tube placement, resulting in 2 deaths due to myocardial laceration following percutaneous insertion. Of 35 neonates surviving pneumopericardium, 12 were discharged from the hospital and 23 died of complications of respiratory distress syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Neonatal pneumopericardium: a surgical emergency. 669 45

Chest injuries have a high and steadily increasing incidence in western countries, but only some of the most common problems they create require an emergency thoracotomy or surgical video thoracoscopy. Flail chest, persistent pneumothorax, massive haemothorax, mediastinal emphysema, cardiac tamponade and intrathoracic foreign bodies can be identified as major surgical problems. Some of such patients (i.e. those with flail chest or foreign bodies) would be immediately candidates for major intervention. Other require fast but diagnostic procedures, because the choice of a therapy is dependent upon a precise identification of the damage. Injuries of trachea and primary bronchi, oesophagus, diaphragma, vena cava, great lung vessels, heart and aorta may represent important surgical emergencies; some leading rapidly to death. Fortunately, major surgical procedures are not really frequent in the management of thoracic traumas. Only 42 (3.5%) of nearly 2,000 patients with non-penetrating thoracic injuries had a thoracotomy or an surgical video thoracoscopy. The figure is far different for penetrating wounds; in fact 12 patients (41%) of 29 underwent mayor surgery.
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PMID:[Major surgery in thoracic injuries]. 1110 65

In spite of great advances in imaging and biochemistry, histological examination of tissues remains a vital part of the multidisciplinary approach to the prevention of the onset, morbidity and mortality of preterm birth. There has been increasing interest in the role of infection and inflammatory cytokines in causation both of early labour and the white matter damage in the brain of preterm infants. However, labour itself is associated with the build up of increased numbers of inflammatory cells in the uterine cervix and increased concentrations of inflammatory cytokines and positive microbiological cultures may reflect carriage or contamination. Confirmation of an infective aetiology in an individual case is best achieved by demonstration of a pathological inflammatory response in tissues, for example, by showing the presence of chorioamnionitis in the placenta. A proper understanding of the poor response to neonatal intensive care of some preterm babies often requires histological examination of the lungs after death, where unsuspected pneumonia, interstitial emphysema and/or pulmonary hypoplasia may help provide an explanation for the adverse outcome in individual cases. The pathophysiological mechanism of brain injury in preterm infants is undergoing re-evaluation, and the systemic study of brain tissue using the latest histological techniques may elucidate the importance of apoptosis in this situation and could point the way towards an effective preventative strategy. Paediatric pathology is also essential to explain many cases of sudden unexpected death in preterm infants, as demonstrated by the recent realisation that death may be caused by total parenteral nutrition fluid-associated myocardial necrosis, and acute cardiac tamponade.
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PMID:The critical role of perinatal pathology. 1276 30

The barotrauma cases related to childbirth are an uncommon event, especially the neumopericardium. This entity must be suspected in a patient with subcutaneuos emphysema and confirmed by chest X-ray. The management is based on closed observation, support measures and antibiotic to prevent infection. The radiological follow up is important to evaluate the resolution of this problem. The patient must be followed with caution if the neumopericardium increases because this could lead to a cardiac tamponade with fatal consequences. The description of a case diagnosed and managed in our hospital is done herein which evolution was satisfactory towards resolution of the pneumopericardium without the need of further intervention.
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PMID:[Neumopericardium and spontaneous post partum subcutaneus emphysema. A case report and literature review]. 1532 4

A 15 year old male was an unrestrained passenger in a high speed motor vehicle crash followed by ejection. The patient was noted to have evidence of bilateral pneumothorax upon arrival in the Emergency Department. Bilateral chest tubes were placed under sterile conditions; however, the left pneumothorax remained, and a second left chest tube was placed. Repeat chest radiographs revealed extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium. Needle aspiration of the pericardium returned significant quantities of air, an immediate improvement in blood pressures followed. An 18-gauge triple lumen catheter was placed into the pericardial space for additional withdrawal of air via syringe. Mechanisms have been proposed to explain the development of tension pneumopericardium after chest trauma. Early diagnosis is crucial, and may be found on initial chest radiographs. Computed tomography is also an effective method for evaluating the presence of air in the pericardial space and may assist in establishing the diagnosis. Tension pneumopericardium requires immediate recognition and decompression to prevent cardiac tamponade with a fatal circulation collapse, an entity that is as serious as the tamponade resulting from hemopericardium. Traumatic pneumopericardium is rare, but can be a complicated finding associated with high-speed blunt chest trauma. Patients with evidence of pneumopericardium should be closely monitored, particularly those supported by positive pressure ventilation.
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PMID:Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection. 1841 Aug 29


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