Pulmonary Rib Research Articles

Characterization of all-terrain vehicle-related chest injury patterns in children.

To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents. Retrospective review of patients 0-18years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. Chest injury was present in 102 (22%) of total 455 patients. The most common chest injuries were pulmonary contusion (61%), pneumothorax (45%), and rib fracture (34%). There were no cardiac, esophageal, or tracheobronchial injuries. Pulmonary lacerations, hemothoraces, and scapular fractures were predominantly not detected on radiography and recognized on CT only (86-92%). Patients with chest injury had longer median hospital stays (3days vs 2days, p = 0.0054). There was no significant difference in admission to intensive care after controlling for injury severity scores in patients with chest injury compared to those without (17 vs 9). Eight patients with chest injury died (8%) compared to 2 patients without chest injury (0.6%) (p = 0.0002). Chest injuries are common in children following ATV accidents and may be a marker of more severe trauma. Increased public awareness of these potentially devastating injuries and continuing safety efforts are needed.

Clinical characteristics of adrenal gland trauma

To explore the clinical characteristics of adrenal gland trauma. A retrospective review was performed for 17 patients presenting with adrenal gland injury diagnosed by computed tomography (CT). There were 11 males and 6 females with an average age of 14-60 (38 ± 12) years. The injuries occurred as the consequence of motor vehicle crash (n = 13) and secondarily to a fall (n = 4). The average time from accident to admission was 5.0 ± 4.1 hours and the average injury severity score (ISS) 31.5 ± 10.3. Among 9 patients with throat injuries, there were pulmonary contusion, hematopneumothrax and rib fracture, followed by extremity fracture (n = 8) and pelvis fracture (n = 7). Additionally, 3 patients had injuries to vertebral column and 4 suffered closed cranial injury. There were 3 patients with liver injury, including subcapsular hematoma (n = 2) and laceration (n = 1). The urinary related injuries included renal contusion and laceration (n = 5) and urethral injury (n = 1). Among them, 15 had injuries to right adrenal glands and 2 to left ones. The CT findings of adrenal trauma were adrenal contusion and focal hematoma. All patients received conservative treatment. No patient died. The complications of urinary tract infection (n = 6) , deep vein thrombosis (n = 3), pneumonia (n = 3) and gastrointestinal ulceration (n = 2) improved with conservative treatment.Vital signs were all stable after 1 week treatment except for 1 patient operated for intracranial hematoma. The average follow-up period was 2.0- 12.0 (5.5 ± 2.7) weeks for 11 patients. The re-examination of CT showed a absorption of hematoma. And 2 cases had a complete absorption. Adrenal gland injury is rare and there is a right-sided preponderance.It is associated with high injury severity.For a lack of obvious clinical manifestations, missed diagnosis is frequently made. CT scan is the first-choice diagnostic tool for adrenal gland injury. Conservative treatment is often satisfactory and hormonal supplement unnecessary.

Formation of a parenchymal pseudocyst following a blunt thoracic trauma

Introduction Pulmonary pseudocyst is an uncommon condition that may occur after blunt thoracic trauma. Traumatic pulmonary pseudocysts develop in less than 3% of patients after blunt thoracic trauma. In this study we share a “formation of a pulmonary pseudocyst following a blunt thoracic trauma” case. Case presentation A 34-year-old male patient suffering from a motor vehicle accident, who had admitted to another medical unit, was referred to our ED for advanced treatment after the first intervention. Due to wide hemopneumothorax, bilateral tube thoracostomy had been performed when patient arrived. Thorax CT revealed a pulmonary pseudocyst in the right lung beside diffuse bilateral pulmonary contusions, hemopneumothorax and rib fracture. Following necessary medical treatments, patient was admitted to the intensive care unit. After three months with clinical and radiological follow-up, traumatic pulmonary pseudocyst in the right lung was fully healed. Discussion and Conclusion Pulmonary pseudocysts are air cysts that may occur in the lung parenchyma after blunt thoracic trauma. Around 85% of cases reported in the literature involved young and male patients. Tears occurring in the lung parenchyma are one of the underlying mechanisms of pseudocyst formation. In these cases there is no need for further treatment of these cysts which are known to recede spontaneously unless no complication occurs.

Eosinophilic Granuloma of the Lung and Rib

Langerhans-cell histiocytosis is characterized by abnormal proliferation of Langerhans cells, and frequently associated with cigarette smoking. A 24-year-old man who underwent excisional biopsy of a pulmonary nodule and segmental rib resection was found to have the eosinophilic granuloma variation of Langerhans-cell histiocytosis.

Penicillium piceuminfection: diagnosis and successful treatment in chronic granulomatous disease

Infections due to Penicillium species other than P.marneffei are rare. We identified a boy with X-linked chronic granulomatous disease (X-CGD) with a pulmonary nodule and adjacent rib osteomyelitis caused by Penicillium piceum. The only sign of infection was an elevated sedimentation rate. P. piceum was isolated by fine needle aspirate and from excised infected tissues. Surgical removal and one year of voriconazole treatment were very well tolerated and led to complete recovery. Microbiological, microscopic and molecular studies support the fungal diagnosis. P. piceum should be considered as a relevant pathogen in immunocompromised patients.

Seat belt-related chondrosternal disruption with lung herniation

A case of blunt chest trauma resulting in anterior chondrosternal separation with right lung herniation and hemothorax is presented. The injury is related to the use of a seat belt restraint. The patient underwent surgical repair with polytetrafluoroethylene chest wall reconstruction. Postoperative recovery was complicated by respiratory insufficiency due to underlying pulmonary contusion and multiple rib fractures.

Epidural analgesia or mechanical ventilation for multiple Rib fractures?

A protocol for treating thoracic trauma is proposed. Severe pulmonary lesion with increased venous admixture (e.g. contusio, atelectasis, aspiration) is treated by mechanical ventilation. Rib fractures with minor pulmonary lesion and therefore with only moderately abnormal gas exchange but with remarkably reduced vital capacity (even with flail chest) are controlled by thoracic epidural analgesia following vital capacity, tidal volume and respiratory rate. If both a severe pulmonary lesion and serial rib fractures are present, the patient is ventilated for 2-3 days and then extubated to breath spontaneously with epidural analgesia. The indication for a mechanical ventilation or for spontaneous breathing with thoracic epidural analgesia is therefore deducted more from functional variables than from morphological facts. The course of a consecutive series of 283 patients is presented. 155 patients were treated with primary ventilation and 112 patients with primary epidural analgesia, while 16 patients could be managed with general analgesia. The duration of treatment morbidity and mortality show this protocol to be very useful.