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J Radiol Case Rep 2021 Aug 1;15(8):1-7. Epub 2021 Aug 1.

Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Tension gastrothorax is a rare, life-threatening clinical condition caused by intrathoracic herniation of the stomach through a diaphragmatic defect which becomes increasingly distended over time. If not recognized promptly, this can rapidly progress to respiratory distress, mediastinal shift, and hemodynamic compromise. Initial clinical presentation and imaging findings closely mirror those of tension pneumothorax, confounding diagnosis and potentially leading to unnecessary interventions with increased risk of morbidity and mortality. Read More

BMJ Mil Health 2022 May 18. Epub 2022 May 18.

Emergency Department, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK.

Background: Tension pneumothorax following trauma is a life-threatening emergency and radiological investigation is normally discouraged prior to treatment in traditional trauma doctrines such as ATLS. Some trauma patients may be physiologically stable enough for diagnostic imaging and occult tension pneumothorax is discovered radiologically. We assessed the outcomes of these patients and compared them with those with clinical diagnosis of tension pneumothorax prior to imaging. Read More

Acute Crit Care 2022 Apr 13. Epub 2022 Apr 13.

Dubai Medical College, Dubai, UAE.

Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can produce a life-threatening condition comparable to tension pneumothorax, which is termed tension pneumocephalus. We report a case of tension pneumocephalus after drainage of a cerebrospinal fluid hygroma. Read More

J Family Med Prim Care 2022 Apr 18;11(4):1564-1567. Epub 2022 Mar 18.

Department of General Medicine, Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India.

Cavitation and pneumothorax are independently associated with high morbidity and mortality in coronavirus disease-2019 (COVID-19). While spontaneous (non-traumatic) pneumothorax formation has commonly been observed among mechanically ventilated COVID-19 patients, there are few rare reports of COVID-19 associated pneumothorax without any history of barotrauma and other conventional risk factors. Here, we report a unique case of post-COVID-19 cavitation and tension pneumothorax which was further complicated by hydropneumothorax formation in a young patient who suffered severe COVID-19 pneumonia 4 weeks back. Read More

Radiology 2022 May;303(2):480-484

From the Departments of Radiology (V.P., D.V.K., S.J., S.K.D., R.H.) and Community Medicine (N.S.), JSS Medical College, JSS AHER, 1st Main, Yadavagiri, Mysore 570020, India.

History: A 38-year-old man who had been in a motor vehicle collision was referred to our institute. He was suspected of having left-sided pneumothorax. This necessitated intercostal drainage with a chest tube, which had been placed elsewhere prior to his arrival. Read More

Emerg Med Pract 2022 Apr 15;25(5, Suppl 1):1-28. Epub 2022 Apr 15.

Duke University School of Medicine, Durham, NC.

Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. Findings associated with pneumothorax include dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation. Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. Read More

Am Surg 2022 Apr 21:31348221086799. Epub 2022 Apr 21.

12343Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Rural patients have fewer complications and deaths, shorter hospital stay, and less resource utilization than their urban counterparts. They also tend to have fewer chronic illnesses; this reflects a system working as intended, with high-risk patients transferred to better-resourced institutions, while others receive surgical care closer to home. Deciding which operations a modern rural surgeon should-and shouldn't-perform starts with the question "Who decides?" Government, insurers, hospitals, surgeons, and patients are all stakeholders, with a vested interest in the answer. Read More

Med Ultrason 2022 Mar 9. Epub 2022 Mar 9.

Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

Aim: To assess chest ultrasound (US) diagnostic accuracy in pneumothorax diagnosing.

Material And Methods: Prospec-tive studies related to the US pneumothorax diagnostic accuracy in trauma patients were extensively searched from 2000 up to November 2020. The studies features and findings were gathered using a standardised form and the methodological quality of the investigations was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Read More

Am Surg 2022 Apr 17:31348221087926. Epub 2022 Apr 17.

Department of Emergency Medicine, 12279Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Background: Traumatic pneumothorax (PTX) can be deadly, and rapid diagnosis is vital. Ultrasound (US) is rapidly gaining acceptance as an accurate bedside diagnostic tool. While making the diagnosis is important, not all PTX require tube thoracostomy. Read More

Front Vet Sci 2022 31;9:818055. Epub 2022 Mar 31.

Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.

Background: Small-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in small animals for management of pleural space disease. We aimed to evaluate the indications, placement locations, types of complications, and complication rate of small-bore wire-guided thoracostomy tube placements in dogs and cats in a university setting.

Methods: Electronic medical records of patients that underwent SBWGTT placement were reviewed. Read More

Trauma Surg Acute Care Open 2022 25;7(1):e000874. Epub 2022 Mar 25.

Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco.

J Trauma Acute Care Surg 2022 Apr 1. Epub 2022 Apr 1.

Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California.

J Trauma Acute Care Surg 2022 Apr 1. Epub 2022 Apr 1.

Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California.

Cureus 2022 Feb 21;14(2):e22457. Epub 2022 Feb 21.

Anesthesiology and Critical Care, Saint Louis University School of Medicine, Saint Louis, USA.

Early diagnosis of brachial plexus injuries is crucial to prevent long-term morbidity and improve outcomes. We present a unique case of delayed onset of brachial plexus compression two months following a traumatic gunshot injury causing multiple injuries including a T1 vertebral body comminuted fracture and pneumothorax. The patient experienced significant pain and progressive neurological examination changes during follow-up visits, and thus duplex ultrasound and computed tomography (CT) angiography were performed, which demonstrated a left subclavian artery pseudoaneurysm. Read More

J Trauma Acute Care Surg 2022 Mar 14. Epub 2022 Mar 14.

Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego School of Medicine, San Diego, California.

J Trauma Acute Care Surg 2022 Mar 14. Epub 2022 Mar 14.

Department of Emergency Medicine, University of British Columbia & Vancouver General Hospital, Vancouver, British Columbia, Canada Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Br J Radiol 2022 Jun 24;95(1134):20210979. Epub 2022 Mar 24.

Department of Radiology, Alfred Health, Melbourne, Victoria, Australia.

Objectives: Trauma chest radiographs may contain subtle and time-critical pathology. Artificial intelligence (AI) may aid in accurate reporting, timely identification and worklist prioritisation. However, few AI programs have been externally validated. Read More

Trauma Case Rep 2022 Apr 22;38:100623. Epub 2022 Feb 22.

Anesthesia and Intensive Care Unit, AUSL Romagna - Bufalini Hospital, Cesena, FC, Italy.

Introduction: The management of complex trauma patient with concomitant brain injury and extra-cranial lesions is challenging since the requirement of a low pressure to limit the bleeding clashes with the need to maintain an adequate cerebral perfusion and to obtain a brain CT-scan.Here we present the use of REBOA as a bridge to CT scan in complex head and torso trauma.

Case Presentation: A 59 years old male patient involved in a road traffic crash was admitted to our hospital after a car accident. Read More

Lakartidningen 2022 02 25;119. Epub 2022 Feb 25.

överläkare, akutkliniken, Skånes universitetssjukhus Lund.

A couple of decades ago, most large pneumothoraces were managed initially through the insertion of large-bore chest tubes, active suction and in hospital admission. Mounting evidence has since established that the patient's symptoms, not the size of the pneumothorax, should guide whether invasive management is required for spontaneous pneumothoraces. There is also mounting evidence that small traumatic and iatrogenic pneumothoraces can be managed conservatively. Read More

J Vet Emerg Crit Care (San Antonio) 2022 May 24;32(3):334-340. Epub 2022 Feb 24.

Department of Emergency and Critical Care, The Animal Medical Center, New York, New York, USA.

Objective: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT.

Design: Prospective, observational study. Read More

Ann Med Surg (Lond) 2022 Feb 5;74:103349. Epub 2022 Feb 5.

Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.

Introduction: Pneumorachis, air in the spinal canal, is very rare and its association with pneumocephalus following blunt thoracic trauma remains exceptionally uncommon.

Case Presentation: We present the case of a 65-year-old patient, a pedestrian hit by a car driving at very high speed. The lesion assessment on admission showed a bilateral hemothorax of moderate abundance, a right pneumothorax of low abundance and a left pneumothorax of moderate abundance, subcutaneous cervico-dorsal emphysema, pneumocephalus and significant pneumorachis at the cervico-dorsal level without fracture of the base of the skull, sinuses or the spine. Read More

Eur J Trauma Emerg Surg 2022 Feb 15. Epub 2022 Feb 15.

Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Min-Chun E. Rd., Sec. 6, Neihu, Taipei 114, Taiwan, ROC.

Purpose: To determine if an electrocardiogram-based artificial intelligence system can identify pneumothorax prior to radiological examination.

Methods: This is a single-center, retrospective, electrocardiogram-based artificial intelligence (AI) system study that included 107 ECGs from 98 pneumothorax patients. Seven patients received needle decompression due to tension pneumothorax, and the others received thoracostomy due to instability (respiratory rate ≥ 24 breaths/min; heart rate, < 60 beats/min or > 120 beats/min; hypotension; room air O saturation, < 90%; and patient could not speak in whole sentences between breaths). Read More

S Afr Med J 2022 02 1;112(2):13499. Epub 2022 Feb 1.

Ndlovu Laboratories, Elandsdoorn, Limpopo Province, South Africa; Ndlovu Research Consortium, Elandsdoorn, Limpopo Province, South Africa.

We describe a case of prolonged SARS-CoV-2 RNA shedding in an HIV-negative 21-year-old man recovering from abdominal and thoracic trauma. Nasopharyngeal (NP) swabs collected at 12 time points over a 95-day span all tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Genotyping revealed canonical beta-variant E484K and N501Y mutations at earlier time points. Read More

Eur J Trauma Emerg Surg 2022 Feb 7. Epub 2022 Feb 7.

Department of Thoracic Surgery, Magdeburg University Medicine, Leipziger Strasse 44, 39120, Magdeburg, Germany.

Purpose: To evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures.

Methods: Retrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Read More

J Trauma Acute Care Surg 2022 Feb 4. Epub 2022 Feb 4.

Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Introduction: Axial imaging has allowed for more precise measurement and, in-turn, more objective guidelines related to the management of traumatic pneumothoraces (PTXs) In 2017, our trauma center used a guideline to observe any PTX ≤ 35 mm in stable patients. We hypothesize that this guideline would decrease unnecessary chest tubes without affecting failure rates.

Methods: This is a single-center, retrospective review of all adult trauma patients who had a PTX diagnosed on computed tomography (CT) before (2015-2016) and after (2018-2019) guideline implementation. Read More

Int J Emerg Med 2022 Feb 4;15(1). Epub 2022 Feb 4.

Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.

Background: Leriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT). Read More

Cureus 2021 Dec 27;13(12):e20762. Epub 2021 Dec 27.

Cardiology, Al Jufairi Diagnostic and Therapeutic Hospital, Doha, QAT.

A tracheostomy tube (TT) is usually taken out in a well-planned and coordinated manner after the underlying condition that necessitated the procedure is resolved. The inadvertent removal or dislodgement of the TT from the stroma is known as accidental extubation or decannulation. This event may prove fatal in a stable patient. Read More

Eur Respir Rev 2022 Mar 25;31(163). Epub 2022 Jan 25.

Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Dept of Pulmonary Medicine and Oncology, Nice, France.

Tracheobronchial injury is a heterogeneous entity comprising multiple rare and potentially life-threatening scenarios. We performed a systematic literature review focusing on post-intubation tracheal injuries (PiTIs) and post-traumatic tracheobronchial injuries (PTTBIs).PiTIs are often longitudinal lacerations of the middle third of the membranous trachea. Read More

Mil Med 2022 Jan 17. Epub 2022 Jan 17.

Introduction: To date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Read More