scholarly journals Spontaneous Septic Embolic Encephalitis and Endophthalmitis in a Recovering Polytrauma Patient: A Case Report

2020 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Hashim Mohammad ◽  
Ankit Agarwal ◽  
Sonu Sama ◽  
Sana Kausar
Keyword(s):  
Chest Tube ◽  
Thoracic Injury ◽  
Fistula Formation ◽  
Endogenous Endophthalmitis ◽  
Systemic Embolism ◽  
Arteriovenous Fistulas ◽  
The Right ◽  
Polytrauma Patient ◽  
Chest Tube Drain ◽  
Pulmonary Arteriovenous Fistulas

In polytrauma cases with thoracic injury and long-term chest tube drain, there is a risk of pulmonary arteriovenous fistula formation, which mostly remains undiagnosed. The pulmonary arteriovenous fistulas lead to the right to left shunt and could be a potential source of systemic septic embolism. Here, we describe a recovering polytrauma patient, who spontaneously developed septic embolic encephalitis and endogenous endophthalmitis, with no evident source of septic systemic embolism. We suspect the pulmonary arteriovenous fistulas due to thoracic injury or chest tube drain could be the possible source of septic systemic embolism, which needs to be evaluated in such cases after excluding common causes.

Contrast echocardiography for diagnosis of pulmonary arteriovenous fistulas late after construction of a Glenn anastomosis

1998 ◽  
Vol 8 (2) ◽  
pp. 228-236
Author(s):  
Gül Sagin-Saylam ◽  
Jane Somerville
Keyword(s):  
Right Atrium ◽  
Contrast Echocardiography ◽  
Cardiac Catheterisation ◽  
Arterial Oxygen ◽  
Caval Vein ◽  
Glenn Shunt ◽  
Arteriovenous Fistulas ◽  
Superior Caval Vein ◽  
The Right ◽  
Pulmonary Arteriovenous Fistulas

AbstractTo demonstrate the use of transthoracic contrast echocardiography in the detection of pulmonary arteriovenous fistulas in patients with a previously constructed anastomosis between the superior caval vein and the right pulmonary artery (Glenn shunt), and to examine their prevalence in this special population, we evaluated prospectively all patients followed up in the Grown-Up Congenital Heart Unit subsequent to construction of a classical or bi-directional Glenn shunt. We studied 12 patients, aged from 21 to 38 (mean 28 ± 4.8) years who had had a previous cavopulmonary shunt in place for a period of 4 to 33 years (mean 24±9 years). All were examined with cross-sectional contrast echocardiography, 11 patients had cardiac catheterisation and angiography, and 6 patients had magnetic resonance imaging. Systemic arterial oxygen saturations at rest, and during exercise using the modified Bruce protocol, were measured in all patients. Contrast echocardiography showed evidence of pulmonary arteriovenous fistulas in 7 of the 12 patients, with appearance of echo contrast in the left atrium 1–8 seconds after peripheral venous injection in the arm. Simultaneous appearance of microbubbles in the right atrium revealed a residual communication between the superior caval vein and the right atrium in 2 patients, and presence of collaterals between the superior and inferior caval veins in one. Cardiac catheterisation and angiography showed obvious fistulas in 4 patients, and revealed suggestive findings in 2. In patients deemed to have pulmonary arteriovenous fistulas on contrast echocardiography, arterial oxygen saturations at rest (51–94%, mean 75±15.3%) and on exercise (23–91%, mean 53±24.2%) were significantly lower compared to patients judged to be without fistulas (p<0.005). Pulmonary hypertension in the contralateral lung was more common in patients with fistulas (mean left pulmonary arterial pressure 22–110 mm Hg, p=0.014). In patients with cavopulmonary anastomoses, pulmonary arteriovenous fistulas occur frequently in the long term (10–33, mean 25.7±8 years), and are associated with worsening systemic arterial desaturation. Contrast echocardiography should be included in the regular evaluation of these patients as a simple and sensitive technique for the detection of pulmonary arteriovenous fistulas, particularly with the devel opment of increasing cyanosis.

scholarly journals Airway Foreign Body Mimicking an Endobronchial Tumor Presenting with Pneumothorax in an Adult: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (1) ◽  
pp. 50
Author(s):  
Jun-Ho Ha ◽  
Byeong-Ho Jeong
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Chest Tube ◽  
Biopsy Forceps ◽  
Chest Computed Tomography ◽  
Contrast Enhanced ◽  
Lobar Bronchus ◽  
Green Pea ◽  
Airway Foreign Body ◽  
The Right

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.

scholarly journals PULMONARY ARTERIOVENOUS FISTULAS IN SISTERS

1956 ◽  
Vol 31 (3) ◽  
pp. 286-297
Author(s):  
Thomas J.E. O'Neill ◽  
Herbert Fisher ◽  
Donald E. McDowell ◽  
Vincent W. Lauby
Keyword(s):  
Arteriovenous Fistulas ◽  
Pulmonary Arteriovenous Fistulas

scholarly journals Lung autotransplantation for bronchial necrosis after radiotherapy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuya Nobori ◽  
Masaaki Sato ◽  
Mizuki Morota ◽  
Yoshikazu Shinohara ◽  
Daisuke Yoshida ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pulmonary Function ◽  
Treatment Success ◽  
Locally Advanced ◽  
Fistula Formation ◽  
Bronchial Anastomosis ◽  
Silicone Stent ◽  
Feasible Option ◽  
Malignant Germ Cell Tumor ◽  
The Right

Abstract Background Bronchial necrosis is a rare but fatal complication after radiation therapy. Because of the anatomical complexity and rarity of this condition, determining the most appropriate management for individual patients is extremely challenging. Lung autotransplantation is a surgical technique that has been applied to hilar neoplastic lesions to preserve pulmonary function and avoid pneumonectomy. We herein report a case of bronchial necrosis secondary to radiotherapy that was treated with lung autotransplantation. Case presentation A 46-year-old man developed broad necrosis and infection of the right bronchus secondary to previous stereotactic body-radiation therapy. This treatment was supplied close to a right hilar metastatic pulmonary tumor derived from a mediastinal malignant germ cell tumor that had been surgically resected with the left phrenic nerve. The bronchial necrosis accompanied by infection with Aspergillus fumigatus was progressive despite antibiotics and repetitive bronchoscopic debridement. Because of the patient’s critical condition and limited pulmonary function, right lung autotransplantation with preservation of the right basal segment was selected. An omental flap was placed around the bronchial anastomosis to prevent later complications. The postoperative course involved multiple complications including contralateral pneumonia and delayed wound healing at the bronchial anastomosis with resultant stenosis, the latter of which was overcome by placement of a silicone stent. The patient was discharged 5 months postoperatively. Three months after discharge, however, the patient developed hemoptysis and died of bronchopulmonary arterial fistula formation. Conclusions We experienced an extremely challenging case of bronchial necrosis secondary to radiotherapy. The condition was managed with lung autotransplantation and omental wrapping; however, the treatment success was temporary and the patient eventually died of bronchopulmonary arterial fistula formation. This technique seems to be a feasible option for locally advanced refractory bronchial necrosis, although later complications can still be fatal.

scholarly journals Tractotomy using the Penrose drain guide for deep lung injury caused by chest drainage: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hironori Oyamatsu ◽  
Hideki Tsubouchi ◽  
Kunio Narita
Keyword(s):  
Lung Injury ◽  
Chest Tube ◽  
Drain Tube ◽  
Chest Drainage ◽  
Respiratory Condition ◽  
Penrose Drain ◽  
Multiple Rib Fractures ◽  
Lung Injuries ◽  
The Right ◽  
Damaged Vessel

Abstract Background Pulmonary tractotomy effectively treats deep pulmonary penetrating injuries; however, it requires the accurate insertion of forceps or a stapler into the wound tract. This report describes a case of tractotomy using the Penrose drain guide for a deep lung injury caused by chest drainage. Case presentation A 75-year-old man suffered multiple rib fractures and hemothorax. After admission, chest tube drainage was performed because the patient’s respiratory condition deteriorated due to increased right pleural effusion. However, as the chest tube was stabbing into the right upper lobe, a pulmonary tractotomy was performed to treat the injury. Cutting the visceral pleura just over the tip of the chest tube caused the tube to completely penetrate the lung. A Penrose drain tube was fixed to the chest tube, which was then removed. The Penrose drain tube completely penetrated the lung and was coupled to the anvil side of the stapler to guide it smoothly into the wound tract. After stapling left the wound tract open, selective suture ligation of the damaged vessel and bronchioles was performed. Conclusions Although the indications for tractotomy using the Penrose drain guide are limited, we believe that this technique can be useful in patients with deep stabbing or penetrating lung injuries with rod- or tube-shaped foreign body remnants.

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