Peer Reviewed

radiology quiz

Post-Traumatic Abnormal Breathing Pattern

Alexandra Close, BS1 • Maaria Chaudhry, MS32 • Kirill Alekseyev, MD3 • Bilal Chaudhry, MD4

  • AFFILIATIONS:
    1University of Maryland College Park, MD 
    2Saint Louis University School of Medicine, St. Louis, MO 
    3Post Acute Medical, Dover, DE 

    4ChristianaCare Christiana Hospital, Newark, DE 

    CITATION:
    Close A, Chaudhry M, Alekseyev K, Chaudhry B. Post-traumatic abnormal breathing pattern. Consultant. 2023;63(7):e3. doi:10.25270/con.2023.07.000001.


    Received October 26, 2022. Accepted February 3, 2023. Published online July 13, 2023.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    ACKNOWLEDGEMENTS
    None.

    CORRESPONDENCE:
    Alexandra Close, University of Maryland College Park, 4816 Waltonshire Circle, Olney, MD 20832 (a1tara2c@gmail.com)


    A 60-year-old woman presented to the emergency department with blunt thoracic trauma after a head-on motor vehicle accident.

    History. The patient had a past medical history significant for obesity, hyperlipidemia, and degenerative disc disease. An initial examination revealed fractures of the manubrium, ribs, femur, and scaphoid, along with abnormal chest wall movement and shortness of breath. On evaluation, all other vitals were stable. After a brief discharge of 3 days, she was readmitted due to progressive dyspnea. She did not appear to be in pain and was placed on 5 L of supplementary oxygen.

    Diagnostic testing. An X-ray revealed an irregularity on the right 1st to 3rd ribs and a large right hemopneumothorax as a cause of the abnormal chest wall movement (Video 1). To relieve pressure in the thoracic cavity, a 12 French pigtail catheter was inserted under computed tomography (CT) guidance (Figure 1) and drained a total of 4.4 L of blood. Oxygen was then consistently lowered over the course of 3 days to a minimum of 2 L.

    Video 1. The patient’s abnormal chest wall movement resulting from the blunt thoracic trauma.

    Image 1

    Figure 1. The additional CT image of the irregularity.

     

References

1. Morel-Lavallée A. Hernies du poumon. Bull Soc Chir Paris. 1845–1847;1:75–195. 

2.  Knoef RJH, Wemeijer TM, Steenvoorde P, de Groot R. Spontaneous lung herniation after coughing: a case series. Trauma Cases Rev. 2020;6:083. doi:10.23937/2469-5777/1510083

3. Masmoudi S, Ghemissou N, Abid M, et al. Hernie pulmonaire traumatique chez un enfant [Traumatic lung herniation in a child]. Arch Pediatr. 2003;10(5):436-438. doi:10.1016/s0929-693x(03)00092-7.

4. Detorakis EE, Androulidakis E. Intercostal lung herniation--the role of imaging. J Radiol Case Rep. 2014;8(4):16-24. doi:10.3941/jrcr.v8i4.1606.

5. Rugg AL, Lee JJ. Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery. Radiol Case Rep. 2022;17(3):798-801. doi:10.1016/j.radcr.2021.12.017.

6. Hazebroek EJ, Boxma H, De Rooij PD. Traumatic intercostal pulmonary herniation: a case report. Ulus Travma Acil Cerrahi Derg. 2008;14(2):154-157. https://pubmed.ncbi.nlm.nih.gov/18523908/

7. Perera TB, King KC. Flail chest. StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK534090/

8. Kukuruza K, Aboeed A. Subcutaneous emphysema. StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK542192/