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Necrotising Fasciitis
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
The benefit of imaging versus the delay in treatment means that it is generally not used in the diagnosis of NF. Subcutaneous emphysema may be seen on X-ray. CT and MRI can aid diagnosis of early NF but can create an unacceptable delay in treatment [x].
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The plain chest radiograph has a number of significant disadvantages, some of which relate to the fact that it is most often performed with the patient in the supine position. Small pneumo- and haemothoraces may be missed due to the air or blood being evenly distributed throughout the hemithorax; the mediastinum usually appears widened, leading to false-positive diagnoses of traumatic aortic disruption; and air under the diaphragm suggestive of a hollow viscus perforation may not be evident. Subcutaneous emphysema may further complicate interpretation. Multiple rib fractures, fractures of the first or second ribs or scapular fractures indicate that severe force has been delivered to the chest, highlighting the need for careful assessment for further unsuspected injuries. Pneumomediastinum, pneumopericardium or air beneath the deep cervical fascia suggests tracheobronchial disruption. Surgical emphysema of the chest wall with haemopneumothorax is generally indicative of pulmonary laceration following rib fractures.
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Patients typically present following heavy drinking or eating episodes, with some form of forceful action such as vomiting. Retrosternal or upper abdominal pain and shortness of breath are most often associated, although the patient may also complain of odynophagia and shoulder pain. Examination findings are usually limited but subcutaneous emphysema is an important associated finding. Auscultation may also reveal a crunching sound synchronous with the heart beat, known as Hamman's sign. The triad of chest pain, vomiting and subcutaneous emphysema is known as Mackler's triad.
Update on the diagnosis and management of pediatric laryngotracheal stenosis
Published in Expert Review of Respiratory Medicine, 2022
Matthew M Smith, Lauren S Buck
Tracheal A-frame, a known consequence of tracheostomy, can be a cause of obstruction after decannulation. While this can be treated with open procedures, endoscopic resection tracheoplasty with a CO2 laser can be an option for appropriate patients. The patient is placed into suspension with an appropriate laryngoscope and spontaneous ventilation is maintained. The CO2 laser is then used to excise the prolapsed cartilaginous ring in a staged fashion. Due to the risk of circumferential scarring, this should be only performed on one side. If the other side eventually needs to be addressed, sufficient time should be given (at least 1 month) between procedures. Bergeron et al reported their results out of our institution (Cincinnati Children’s Medical Center) on 8 patients treated with this technique. Five had resolution of their symptoms with a unilateral tracheoplasty, two underwent bilateral endoscopic resection tracheoplasty (staged procedure) with resolution of symptoms, and one patient did not have complete resolution of symptoms due to multilevel airway obstruction [21]. Caution should be taken to avoid perforating the trachea causing subcutaneous emphysema. Platform suctions are useful to help avoid this by judging the caliber of the otherwise normal airway and leaving a rim of lateral cartilage support.
Pneumorrhachis and asthma exacerbation in young people
Published in Journal of Asthma, 2020
Brazilian authors described an 18-year-old woman, asthmatic since infancy, with conspicuous SPM and pneumorrhachis during an exacerbation of bronchial asthma (2). Her respiratory rate was 22/min, with room-air pulse oximetry of 93%, and the chest CT images revealed discrete pneumorrhachis. After 5 days of conservative management (including O2 inhalation, corticosteroids and antibiotics) the subcutaneous emphysema and respiratory symptoms improved. Similar to the Mexican case study, the incidental diagnosis of pneumorrhachis was established by CT images during the evaluation of SPM and subcutaneous emphysema (2).
Hamman’s syndrome – a rare entity
Published in Journal of Obstetrics and Gynaecology, 2020
Nikit D. Kadam, Joana Almeida, Manju Singh, Sadashiv Kamath
The diagnosis of subcutaneous emphysema is self-explanatory. Crepitus, palpable at the base of the neck, is emblematic of subcutaneous emphysema. Other symptoms include substernal pain, mild dyspnoea, and difficulty in swallowing, tachycardia. The important differentials to be excluded are oesophageal rupture, aortic dissection, amniotic fluid embolism, myocardial infarction. An absolute diagnosis is done by radiology. A chest X-Ray, being the primary diagnostic modality, should be followed by a CT scan, which offers confirmation about extension of subcutaneous emphysema.