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Environ Int 2019 Apr 3;127:317-323. Epub 2019 Apr 3.

Emergency Department, CHU de Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Laboratory Chrono-environnement, UMR 6249 Centre National de la Recherche Scientifique, 16 route de Gray, 25000 Besançon, France; Université Bourgogne Franche-Comté, 32 avenue de l'Observatoire, 25000 Besançon, France.

Rationale: A link is established between air pollution and respiratory diseases. Very few studies evaluated this link with primary spontaneous pneumothorax (PSP). Contrasted results, low statistical power and methodological limits of these studies brought us to evaluate in a more thorough way this link. Read More

Medicine (Baltimore) 2019 Apr;98(14):e14993

Department of Thoracic Surgery.

Thoracic trauma in China was scarcely reported. This study aimed to summarize the clinical profiles and to analyze the management approaches of patients with traumatic thoracic injury.Data for consecutive patients with thoracic trauma from January 2003 to January 2018 were retrospectively collected and analyzed. Read More

Trauma Surg Acute Care Open 2019 18;4(1):e000288. Epub 2019 Feb 18.

Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.

Background: Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients.

Methods: This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018. Read More

J Gynecol Obstet Hum Reprod 2019 Mar 18. Epub 2019 Mar 18.

Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, INSERM U1086 BioTICLA, Department of Obstetrics and Gynecology, Avenue Côte de Nacre, 14000 Caen, France.

A 35 year old woman with chronic pelvic endometriosis suffered from right scapular pain. MRI imaging showed a right diaphragmatic rupture with liver herniation. Surgical procedure was performed by thoracotomy. Read More

Case Rep Emerg Med 2018 19;2018:4328704. Epub 2018 Dec 19.

General Physician, Pontifical Xavierian University, Bogotá, Colombia.

Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. Read More

Am J Respir Crit Care Med 2019 Jan 25. Epub 2019 Jan 25.

Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States ;

A genetic influence on spontaneous pneumothoraces - those occurring without a traumatic or iatrogenic cause - is supported by several lines of evidence: 1) Pneumothorax can cluster in families (i.e. familial spontaneous pneumothorax); 2) Mutations in the FLCN gene have been found in both familial and sporadic cases; and 3) Pneumothorax is a known complication of several genetic syndromes. Read More

Turk Thorac J 2019 Jan 1;20(1):25-29. Epub 2019 Jan 1.

Clinic of Emergency, Edirne I. Sultan Murat State Hospital, Edirne, Turkey.

Objectives: The aim of this study was to determine the demographic and clinical characteristics of patients who underwent tube thoracostomy in the emergency department (ED). The secondary aim of the study was to evaluate parameters such as the diagnosis for which the patients underwent tube thoracostomy, the imaging techniques used during diagnosis, and complications related to the procedure.

Materials And Methods: This prospective study was conducted in the ED between June 1, 2015 and May 31, 2016. Read More

Laeknabladid 2019 Jan;105(1):19-21

Cardiothoracic Surgery, Landspitali University Hospital.

A woman in her thirties, 15 weeks pregnant, underwent acupuncture therapy because of pregnancy-related nausea and vomiting. Several hours later she experienced shortness of breath and therefore came to the emergency room. Physical examination revealed tachypnea and reduced breath sounds bilaterally but normal oxygen saturation and blood pressure. Read More

Case Rep Med 2018 25;2018:3103061. Epub 2018 Nov 25.

Cumming School of Medicine, University of Calgary, Alberta Health Services, Department of Surgery, South Health Campus, 4448 Front St SE, Calgary, AB T3M1M4, Canada.

In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Read More

J Spec Oper Med Winter 2018;18(4):37-55

TCCC has previously recommended interventions that can effectively prevent 4 of the top 5 causes of prehospital preventable death in combat casualties-extremity hemorrhage, junctional hemorrhage, airway obstruction, and tension pneumothorax- and deaths from these causes have been markedly reduced in US combat casualties. Noncompressible torso hemorrhage (NCTH) is the last remaining major cause of preventable death on the battlefield and often causes death within 30 minutes of wounding. Increased use of whole blood, including the capability for massive transfusion, if indicated, has the potential to increase survival in casualties with either thoracic and/or abdominopelvic hemorrhage. Read More

Curr Probl Diagn Radiol 2018 Oct 29. Epub 2018 Oct 29.

Department of Radiology and Department of Surgery, JPN Apex trauma Center, All India Institute of Medical Sciences, New Delhi, India.

Airway Injuries are rare but often immediately life threatening. Incidence ranges from 0.5-2 % in blunt and 1-6 % in penetrating trauma. Read More

Int J Surg Case Rep 2018 25;53:154-156. Epub 2018 Oct 25.

College of Medicine, James Cook University, Townsville, Queensland, Australia; Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.

Introduction: Acquired diaphragmatic hernias are most commonly associated with traumatic thoracic injury and rarely heal spontaneously. Conditions that promote peritoneal seeding, such as endometriosis, are associated with spontaneous acquired diaphragmatic hernia formation. Non-traumatic acquired diaphragmatic herniation has previously been described in the context of catamenial pneumothorax, however post-menopausal endometriotic diaphragmatic herniation has not been previously reported. Read More

Cureus 2018 Aug 23;10(8):e3194. Epub 2018 Aug 23.

Department of Emergency Medicine, National University Health System, Singapore, SGP.

Acupuncture is a common form of therapy involving insertion of fine needles to alleviate nausea and various forms of pain. We describe a case of pneumothorax secondary to acupuncture. A 50-year-old woman presented to the emergency department with right-sided pleuritic chest pain. Read More

J Vet Emerg Crit Care (San Antonio) 2018 Nov 9;28(6):591-595. Epub 2018 Oct 9.

Department of Diagnostic Imaging, University of Glasgow Veterinary School, Glasgow, Scotland.

Objective: To describe the nonsurgical management of a cat with traumatic pneumoperitoneum.

Case Series Summary: A 4-year-old cat was presented following vehicular polytrauma. Thoracic radiographs revealed 4 rib fractures, a scapular fracture, and pneumothorax. Read More

Niger J Clin Pract 2018 Oct;21(10):1323-1329

Department of Emergency Medicine, University of Health Sciences, Van Training and Research Hospital, Van, Turkey.

Introduction: Computed tomography (CT) interpretation in the emergency department is one of the vital issues that should be carried out rapidly and accurately. The objective of this study was to examine the interpretation accuracy of emergency physicians (EPs) regarding CT scans at the emergency department for traumatic and nontraumatic purposes.

Materials And Methods: The study that was carried out as a prospective, observational study was completed at four centers during 1 year. Read More

Respir Med Case Rep 2018 20;25:235-238. Epub 2018 Sep 20.

Neurological Surgery, University of Maryland Community Medical Group, Easton, MD, USA.

Background: Syringomyelia is an unusual accumulation of fluid within the spinal cord that may be associated with significant neurologic symptoms. Surgical drainage using various techniques is often required to reduce the intraparenchymal pressure and to alleviate symptoms. Syringopleural shunting seems to produce best results. Read More

Am J Emerg Med 2018 Aug 3. Epub 2018 Aug 3.

University of Health Sciences Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.

Objective: In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma.

Methods: Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Read More

J Pediatr Surg 2018 Sep 8. Epub 2018 Sep 8.

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine; Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.

Background/purpose: Sternal fractures are rare in children. The purpose of this series is to document traumatic findings in pediatric patients with sternal fractures at a Level 1 trauma center.

Study Design: We reviewed the charts of patients with radiologically confirmed sternal fractures from a trauma database at a pediatric Level 1 trauma center between January 1, 2000 and December 31, 2015. Read More

Int J Surg Case Rep 2018 21;51:368-371. Epub 2018 Sep 21.

Japanese Red Cross Kyoto Daini Hospital, Japan. Electronic address:

Introduction: Systemic arterial air embolism (SAAE) is a rare but fatal condition, with only a few cases reported, and the detailed etiology underlying SAAE remains unknown. We report a first case of massive SAAE after blunt chest injury, wherein the presence of traumatic air shunt was confirmed by direct observation during surgery. We also summarize our experience with six other SAAE cases. Read More

Data Brief 2018 Oct 28;20:1053-1056. Epub 2018 Aug 28.

Inflammatory Lung Disease Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran.

This data was acquired using a cross-sectional design in which medical records of patients admitted at Arya and Razi Hospitals of Rasht from 2006 to 2015 were examined. The patients' demographic data, history of smoking and opium, underlying disease, clinical symptoms at admission, the utilized diagnostic method, duration of hospitalization, findings of chest CT scan, type of pneumothorax, and therapeutic technique were collected through a questionnaire. The collected data were encoded and analyzed using SPSS 21. Read More

Forensic Sci Med Pathol 2018 12 10;14(4):515-525. Epub 2018 Sep 10.

Emergency Department, Heinrich Heine University, University Hospital, Duesseldorf, Germany.

The aim of this autopsy study was to investigate chest-compression associated injuries to the trunk in out-of-hospital and in-hospital non-traumatic cardiac arrest patients treated with automated external chest compression devices (ACCD; all with LUCAS II devices) versus exclusive manual chest compressions (mCC). In this retrospective single-center study, all forensic autopsies between 2011 and 2017 were included. Injuries following cardiopulmonary resuscitation (CPR) in patients treated with mCC or ACCD were investigated and statistically compared using a bivariate logistic regression. Read More

Turk J Emerg Med 2018 Sep 24;18(3):105-110. Epub 2018 May 24.

Kocaeli University, Faculty of Medicine, Department of Thoracic Surgery, Kocaeli, Turkey.

Objectives: Traumatic iatrogenic pneumothorax occurs most often after a transthoracic needle biopsy. Since this procedure has become a common outpatient intervention, emergency department admissions of post-biopsy pneumothorax patients have increased. The aim of this study was to determine the factors that predict the need for tube thoracostomy in patients with post-biopsy pneumothorax in the emergency department. Read More

Am Surg 2018 Aug;84(8):1355-1362

The intent of this study was to characterize the management and subsequent complications of combat injury tube thoracostomies and to determine risk factors for the development of pneumonia (PNA) and retained hemothorax (RH). One hundred fifteen patients with 173 tube thoracostomies met the inclusion criteria and were analyzed. The mean injury severity score was 30. Read More

J Belg Soc Radiol 2018 Jan 4;102(1). Epub 2018 Jan 4.

UZ Brussel, BE.

We report the case of a 41-year-old male with traumatic coronary artery dissection after a high-speed motor vehicle collision. Computed tomography imaging revealed multiple intracranial subdural and subarachnoid bleedings, a skull base fracture and multiple bilateral rib fractures. There was no pericardial hemorrhage, haemothorax or pneumothorax. Read More

Chin J Traumatol 2018 Aug 28;21(4):246-248. Epub 2018 Jun 28.

Department of Physiotherapy, National Heart Institute, New Delhi, India. Electronic address:

This case report reveals the implementation of sensorimotor adaptation and learning process for rehabilitation in a patient with traumatic brain injury to achieve optimum recovery which is permanent in nature in compliance to the disability rating scale. A twenty two year old gentleman who had a history of fall was diagnosed as having subarachnoid hemorrhage along with diffuse axonal injury of the brain and bilateral lung contusion with pneumothorax. He underwent a total of ten months of sensorimotor adaptation and learning process for rehabilitation, which achieved functional mobility with a walker. Read More

Praxis (Bern 1994) 2018 Jul;107(14):773-776

1 Interdisziplinäre Notfallstation, Kantonsspital Olten.

A Rare Cause of an Angioedema-Like Habitus Abstract. We report about a 69-year-old patient arriving at the emergency room with suspected allergic reaction grade III due to a pronounced facial swelling, dyspnea and dizziness. However, the cause was a bilateral pneumothorax with massive soft-tissue emphysema. Read More

Int J Surg Case Rep 2018 27;49:78-80. Epub 2018 Jun 27.

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan. Electronic address:

Introduction: Pneumoperitoneum (PP), or air within the abdominal cavity, is frequently a harbinger of serious abdominal pathology and often represents visceral perforation. We herein report a case of combined massive intraperitoneal free air, pneumothorax and pneumomediastinum but emergency laparotomy was negative.

Presentation Of Case: A sixty-seven-year-old man was found unconscious on a road after being hit by a car. Read More

Am Surg 2018 May;84(5):680-683

Department of Trauma Surgery and Critical Care, The Medical Center, Navicent Health, Mercer University School of Medicine, Macon, Georgia, USA.

Rib fixation has become a strategy for patients with displaced rib fractures and hemo/pneumothoraces (HTX/PTX). Rib plating improves pain control and respiratory mechanics, thereby reducing recovery times and morbidity/mortality. Current treatment consists of chest tube placement, pain control, and pulmonary toilet. Read More

J Emerg Med 2018 09 28;55(3):366-371. Epub 2018 Jun 28.

Montgomery County Hospital District Emergency Medical Services, Houston, Texas.

Background: Tube thoracostomy has long been the standard of care for treatment of tension pneumothorax in the hospital setting yet is uncommon in prehospital care apart from helicopter emergency medical services.

Objective: We aimed to evaluate the performance of simple thoracostomy (ST) for patients with traumatic cardiac arrest and suspected tension pneumothorax.

Methods: We conducted a retrospective case series of consecutive patients with traumatic cardiac arrest where simple thoracostomy was used during the resuscitation effort. Read More

Ann R Coll Surg Engl 2018 Sep 18;100(7):520-528. Epub 2018 Jun 18.

Royal London Hospital, Barts Health NHS Trust , London , UK.

Introduction This study presents an extensive retrospective database of patients with polytrauma following train-related injuries and highlights the key lessons learnt in this rare clinical presentation. Materials and methods We retrospectively collected data from 127 patients who presented to Royal London Hospital after sustaining train related trauma. We analysed demographics, accident report data, aetiologies and clinical management interventions. Read More

J Spec Oper Med Summer 2018;18(2):19-35

This change to the Tactical Combat Casualty Care (TCCC) Guidelines that updates the recommendations for management of suspected tension pneumothorax for combat casualties in the prehospital setting does the following things: (1) Continues the aggressive approach to suspecting and treating tension pneumothorax based on mechanism of injury and respiratory distress that TCCC has advocated for in the past, as opposed to waiting until shock develops as a result of the tension pneumothorax before treating. The new wording does, however, emphasize that shock and cardiac arrest may ensue if the tension pneumothorax is not treated promptly. (2) Adds additional emphasis to the importance of the current TCCC recommendation to perform needle decompression (NDC) on both sides of the chest on a combat casualty with torso trauma who suffers a traumatic cardiac arrest before reaching a medical treatment facility. Read More

AJR Am J Roentgenol 2018 Aug 29;211(2):321-326. Epub 2018 May 29.

4 Department of Internal Medicine, Memorial Hermann Hospital, Houston, TX.

Objective: The purposes of this study were to determine the incidence of pneumorrhachis among patients with pneumomediastinum, determine whether its proportion correlates with the extent of pneumomediastinum, and ascertain its clinical relevance.

Materials And Methods: The radiologic database was searched for CT reports between January 2009 and September 2013 containing the term "pneumomediastinum" or "mediastinal air." Scans were examined for pneumomediastinum, pneumorrhachis, pneumothorax, sternotomy, and distribution of pneumomediastinum. Read More

Emerg Med Int 2018 1;2018:7307154. Epub 2018 Apr 1.

Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.

Background: Traumatic Pneumothorax (PTX) is a potentially life-threatening injury. It requires a fast and accurate diagnosis and treatment, but diagnostic tools are limited. A new point-of-care device (PneumoScan) based on micropower impulse radar (MIR) promises to diagnose a PTX within seconds. Read More

J Trauma Acute Care Surg 2018 09;85(3):491-494

From the Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon (D.Z.); US Air Force School of Aerospace Medicine (D.Z.); C-STARS University of Cincinnati, Cincinnati, Ohio (J.E.); Walter Reed Medical Center, Bethesda, Maryland (C.B., J.O.); Department of Trauma and Critical Care, Landstuhl Regional Medical Center, Landstuhl, Kaiserslautern (D.Z., J.E.); Department of Radiology, Landstuhl Regional Medical Center, Landstuhl, Kaiserslautern (V.P.); Uniformed Services Univerisity of the Health Sciences, Bethesda, Maryland (J.C.); and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (J.C.).

Background: Current recommendations for safe air travel following traumatic pneumothorax are 2 to 3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus, which cite a theoretical risk of recurrence and hypoxia because of decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel. Read More

Forensic Sci Med Pathol 2018 06 3;14(2):188-193. Epub 2018 May 3.

Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.

Pneumopericardium (PPC) describes the collection of gas in the pericardial sac. In tension Pneumopericardium (tPPC), this collection of gas may lead to cardiac tamponade. PPC following blunt trauma is considered a rare finding, as reflected by the low number of case reports on the topic. Read More

J Ultrasound Med 2018 Nov 24;37(11):2681-2687. Epub 2018 Apr 24.

Department of Emergency Medicine, University of Kentucky, Lexington, Kentucky, USA.

Objectives: It is unknown whether the addition of M-mode to B-mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels.

Methods: One hundred forty emergency physicians were randomized via online software to receive a quiz with B-mode clips alone or B-mode with corresponding M-mode images and asked to identify the presence or absence of lung sliding. Read More

Surg Case Rep 2018 Apr 20;4(1):37. Epub 2018 Apr 20.

Department of Surgery, Wollongong Hospital, Locked Bag 8808, South Coast Mail Centre, NSW, 2521, Australia.

Background: Traumatic diaphragmatic injuries from blunt or penetrating trauma are difficult to detect in the acute setting and, if missed, can result in significant morbidity and mortality in the future. We present a case demonstrating the natural progression of this resulting in faecopneumothorax, which is a rare but serious presentation.

Case Presentation: A 22-year-old young man presented with left upper quadrant and chest pain, nausea, vomiting, and intermittent obstipation with a background of previous lower chest wall stabbings. Read More

Trauma Case Rep 2018 Feb 15;13:42-45. Epub 2017 Dec 15.

Department of Anaesthesiology and Intensive Medicine, Zadar General Hospital, Zadar, Croatia.

Subcutaneous emphysema may aggravate traumatic pneumothorax treatment, especially when mechanical ventilation is required. Expectative management usually suffices, but when respiratory function is impaired surgical treatment might be indicated. Historically relevant methods are blowhole incisions and placement of various drains, often with related wound complications. Read More

Am Surg 2018 Feb;84(2):220-224

The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultrasonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical "real-life" application is yet to be investigated. Read More

Ann Thorac Cardiovasc Surg 2018 Jun 16;24(3):127-130. Epub 2018 Mar 16.

Emergency Department, Manisa Celal Bayar University, School of Medicine, Manisa, Turkey.

Purpose: To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients.

Methods: In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. Read More

Curr Sports Med Rep 2018 Mar;17(3):90-96

Samaritan Athletic Medicine at Oregon State University, Samaritan Health Services, Corvallis, OR.

While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Read More

Kyobu Geka 2018 Feb;71(2):149-151

Department of General Thoracic Surgery, Sakaide City Hospital, Sakaide, Japan.

A 73-year-old man was injured after crashing his automobile into a concrete wall, and was admitted to our hospital with breathing difficulties. Chest computed tomography showed extensive mediastinal emphysema, right traumatic pneumothorax, and a suspected tracheal injury at the membranous region. Because of the associated tracheomalacia, the site of the tracheal injury was difficult to find by bronchoscopy. Read More

Turk J Med Sci 2018 Feb 23;48(1):24-27. Epub 2018 Feb 23.

Background/aim: This study aimed to evaluate traumatic thorax complications in post-CPR patients and to investigate whether or not there has been a decrease in these complications since the adoption of current chest compression recommendations. Materials and methods: Post-CPR patients with return of spontaneous circulation (ROSC) were admitted between January 2014 and January 2016 were analyzed retrospectively. Patients admitted to the ED in 2014 were resuscitated according to 2010 AHA CPR guidelines, while those admitted to the ED in 2015 were resuscitated according to current ERC CPR guidelines. Read More

Injury 2018 Mar 8;49(3):457-466. Epub 2018 Feb 8.

Department of Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Objective: To assess the accuracy of the chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax in adults.

Study Design: Systematic review and meta-analysis.

Methods: PubMed, EMBASE, Scopus, Web of Science and LILACS (up to 2016) were systematically searched for prospective studies on the diagnostic accuracy of ultrasonography for pneumothorax and haemothorax in adult trauma patients. Read More

World J Surg 2018 08;42(8):2687-2688

Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA.