Stuart A. Groskin

Pneumorachis and pneumocephalus caused by pneumothorax and multiple thoracic vertebral fractures

Pneumorachis, or air within the spinal canal, has rarely been described, particularly in conjunction with thoracic trauma. We report a case of pneumorachis and pneumocephalus in a patient with a tension pneumothorax and multiple closed thoracic spinal fractures.

PLEUROPULMONARY BLASTOMA SIMULATING AN EMPYEMA IN A YOUNG CHILD

Pleuropulmonary blastoma is a rare childhood malignancy that may simulate an empyema both clinically and radiographically. A 3-year-old boy with fever, cough, and abdominal pain developed complete opacification of the left hemithorax with contralateral mediastinal shift over the course of several weeks. At thoracotomy, a pleuropulmonary blastoma was discovered. The radiology, pathology, and clinical course of this rare neoplasm are discussed.

Pulmonary artery laceration and tension pneumothorax in blunt chest trauma.

Traumatic laceration of the pulmonary artery is rare and is associated with a high mortality rate. The article describes a patient with pulmonary artery laceration from blunt chest trauma who presented with tension pneumothorax. Potentially life-threatening intrathoracic bleeding was not apparent until the pneumothorax was decompressed.

Barotrauma and Decompression Sickness

Divers are candidates for three types of thoracic trauma: drowning/near drowning, pulmonary barotrauma, and decompression sickness. The clinical and radiographic manifestations of drowning/near-drowning have already been discussed. In this chapter, the pulmonary abnormalities associated with barotrauma and decompression sickness will be presented.

Air-fluid level in axillary vein simulating abscess

Demonstration of an air-fluid level in the body wall on a computed tomography examination usually suggests the presence of an abscess or a postoperative fluid collection. However, the small amount of air that frequently is injected during intravenous contrast administration may result in a similar computed tomography appearance.

An 81-year-old woman with a cystic pancreatic mass

An 81-year old woman presented to her internist with a lo-pound weight loss and a 8-month history of intermittent nausea, vomiting, and diarrhea. Her past medical history was unremarkable, other than a prior cholecystectomy. Specifically, there was no history of pancreatitis or alcoholism. Her physical examination was unrevealing, and complete blood count, serum electrolytes, amylase, and lipase were normal. A computed tomography (CT) scan of the abdomen and pelvis was performed. A 4.5 x 4.0 x 4.0-cm lobulated mass was visualized in the pancreatic head, which extended into the pancreatic body (Figure 1). The mass contained multiple low-attenuation cystic areas, each measuring about 1 cm. The tail of the pancreas was atrophic. There was no evidence of pancreatic duct dilatation or local invasion of adjacent structures by the mass. The liver appeared normal, and there was no evidence of lymphadenopathy. The patient was admitted to University Hospital, State University of New York Health Science Center at Syracuse for further evaluation.

Pseudometastasis of the chest wall resulting from a Hickman catheter

A 21-year-old woman with a high-grade soft-tissue sarcoma developed a lesion in the soft tissues of her chest wall at the same time that she developed pulmonary metastases from her primary neoplasm. The chest wall lesion diminished in size on sequential computed tomography (CT) scans, indicating that it was a pseudometastasis caused by removal of the patients indwelling Hickman catheter. Awareness that removal of tunneled central venous catheters can produce soft-tissue masses in the chest wall that may mimic metastases may prevent inappropriate staging and treatment of these patients.

Fire-Related Pulmonary Damage

“Victims of conflagrations frequently sustain pulmonary injuries that are of equal or greater importance to survival than are the burns received on the surface of the body. In some instances the changes are confined to the upper air passages with little or no damage to the lungs. In some the larynx and trachea show little or no evidence of injury and profound pulmonary damage is sustained. In still others the entire tract is affected” [211].

Inhalational Injuries (Excluding Smoke Inhalation)

Toxic gas inhalation injuries occur as the result of occupational or domestic accidents, smoke inhalation, or military exposure. Most noxious inhalants directly irritate or damage the mucosa of the pharynx and tracheobronchial tree, producing erythema, edema, laryngospasm, and bronchospasm [272]. On occasion, mucosal ulceration and sloughing also occur. If the dose and the toxicity of the inhaled agent is great enough (ammonia, chlorine, hydrogen, sulfide, nitrogen dioxide, phosgene, sulfur dioxide), the alveolocapillary barrier can be disrupted, causing noncardiogenic pulmonary edema [29, 128, 313, 320].

Fat Embolism Syndrome

The traumatic fat embolism syndrome is throught to be caused by the embolization of fat from traumatized tissues to the pulmonary microvasculature or by the precipitation of stress-mobilized serum lipids within the pulmonary vascular tree. Nontraumatic causes of fat embolism syndrome have been documented and include pancreatitis, diabetes mellitus, alcoholic liver disease, corticosteroid use, bone marrow transplantation, and osteomyelitis [261]. Release and embolization of marrow fat is presumed to occur primarily as a result of bone infarction or of marrow necrosis or replacement in these conditions.