RESUMO
Se describe el caso clínico de un paciente de 45 años de edad, blanco, quien fue atendido en el cuerpo de guardia médica del Hospital Universitario Dr. Antonio Luaces Iraola, provincia de Ciego de Ávila, por presentar trauma facial, debido a caída por un resbalón y golpe en la cara con el borde de cemento de una piscina. Al realizar el examen físico se halló un enfisema cervicofacial. Se indicó tomografía axial computarizada, la cual mostró fractura de las paredes medial y lateral del seno maxilar izquierdo. Se decidió utilizar la técnica conservadora para extracción de aire mediante la colocación de agujas. El paciente evolucionó favorablemente y no tuvo recidivas.
The case report of a 45 years white patient is described who was assisted in the emergency department of Dr. Antonio Luaces Iraola University Hospital, Ciego de Ávila province, presenting a facial trauma, due to a fall by a slip and hit in the face with a swimming pool cement border. A cervicofacial emphysema was found when the physical exam was carried out. Computerized axial tomography was indicated, which showed fracture of the medial and lateral walls of the left maxillary sinus. It was decided to use the conservative technique for air extraction by means of the needles placement. The patient had a favorable clinical course and he didn't have relapses.
Assuntos
Enfisema Subcutâneo/diagnóstico , Adulto , Enfisema Subcutâneo/terapia , Enfisema Subcutâneo/diagnóstico por imagemRESUMO
INTRODUCTION: Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. OBJECTIVE: To describe a new way to diagnose subcutaneous emphysema. METHOD: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. RESULTS: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. CONCLUSION: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.
Assuntos
Auscultação/métodos , Enfisema Subcutâneo/diagnóstico , Auscultação/instrumentação , Diagnóstico Diferencial , Humanos , RuídoRESUMO
Summary Introduction: Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. Objective: To describe a new way to diagnose subcutaneous emphysema. Method: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. Results: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. Conclusion: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.
Resumo Introdução: O enfisema subcutâneo é uma condição clínica que ocorre quando o ar entra nos tecidos sob a pele. Isso pode ocorrer em qualquer parte do corpo, dependendo do tipo de patologia. O local mais comum é sob a pele que cobre a parede torácica ou o pescoço. É caracterizado por inchaço indolor de tecidos. O sinal clínico clássico é a sensação de crepitação quando se toca a região afetada, assemelhando-se à sensação de se tocar uma esponja. Objetivo: Descrever uma nova maneira de diagnosticar enfisema subcutâneo. Método: Este achado foi uma serendipidade, caracterizada por inspeção clínica de pacientes com enfisema subcutâneo com uso de estetoscópio. Além da auscultação do tórax do paciente, o estetoscópio foi suavemente pressionado contra a pele com enfisema subcutâneo, sendo possível detectar um ruído diferente. Resultados: Essa nova maneira de diagnosticar enfisema subcutâneo consiste em pressionar o diafragma do estetoscópio contra a pele do paciente supostamente afetada por enfisema subcutâneo, sendo possível ouvir o ruído de pequenas bolhas estourando. O ruído de crepitações tem uma energia de emissão acústica que varia de 750-1.200 Hz, considerada alta frequência. Conclusão: Atualmente, o uso de métodos de imagem é generalizado em todo o mundo, mas gostaríamos de fortalecer o valor do exame clínico. Embora a ausculta seja um método de diagnóstico essencial, foi subestimado à medida que os cuidados de saúde e os medicamentos avançaram. Propomos uma maneira diferente de diagnosticar enfisema subcutâneo.
Assuntos
Humanos , Auscultação/métodos , Enfisema Subcutâneo/diagnóstico , Auscultação/instrumentação , Diagnóstico Diferencial , RuídoRESUMO
Spontaneous pneumomediastinum is the presence of free air contained within the mediastinum, frequently associated with subcutaneous emphysema and of atraumatic origin. Frequency during childbirth is 1 in 100,000. We report the case of a 19 year old woman without respiratory disease history, in her first pregnancy with 39.5 weeks of gestation patient had, prolonged latent phase and sudden postpartum onset of dyspnea, thoracic pain and subcutaneous emphysema. Simple X ray film and thoracic tomography revealed the presence of free air in the mediastinum. The association of pneumomediastinum during delivery is an uncommon event.
Assuntos
Enfisema Mediastínico/etiologia , Período Pós-Parto , Enfisema Subcutâneo/etiologia , Feminino , Humanos , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/patologia , Gravidez , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/patologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Introduction: Endoscopic submucosal dissection (ESD) is an already established procedure in the treatment of gastric and esophageal cancer in its early stages. Colorectal lesions, initially approached by endoscopic mucosal resection en bloc or in fragments, are the current focus for submucosal approach, especially for superficial lateral spreading tumor of 20 mm-diameter. The experience of Japanese centers, which are reference in therapeutic endoscopy, demonstrates reduction in the rate of disease recurrence with this approach and, according to specific histopathological criteria, may avoid colectomy in some cases of malignant neoplasia. Case report: The patient was 50-year-old female. She underwent endoscopic submucosal dissection of a rectal lateral spreading tumor measuring 50 mm, located 8 cm from the anal margin. The procedure was performed without major complications, with just two points for muscle layer detachment, without gross perforation and closed with metal clips. However, the patient developed air leakage to the peritoneum, retroperitoneum, mediastinum and subcutaneous tissue, being only treated with clinical procedures and without additional intervention. Conclusion: It is vital to know and be able to apply the technique of ESD, in addition to addressing its complications, since despite the numerous benefits compared to surgery, ESD can result in serious outcomes. (AU)
Introdução: A dissecção endoscópica da submucosa (ESD) já é procedimento consagrado no tratamento do câncer gástrico e esofagiano em suas fases precoces. As lesões colorre-tais, inicialmente abordadas por mucossectomia, em bloco ou em fragmentos, são o foco atual para a abordagem submucosa, principalmente para os tumores de crescimento lateral superficial a partir de 20 mm de diâmetro. A experiência de centros japoneses, referências em endoscopia terapêutica, demonstram redução no índice de recidiva da doença com esta abordagem e, segundo critérios histopatológicos específicos, podem evitar uma colectomia em alguns casos de neoplasia maligna. Relato de caso: Trata-se de paciente de 50 anos, submetida à dissecção endoscópica da submucosa de lesão de crescimento lateral, com 50 mm, localizada no reto, a 8 cm da margem anal. O procedimento foi realizado sem maiores intercorrências, com apenas dois pontos de afastamento da muscular, sem perfuração grosseira, fechados com clipe. Entretanto, a paciente evoluiu com escape aéreo para peritônio, retroperitônio, mediastino e subcútis, sendo tratada sem intervenção adicional, apenas com manejo clínico. Conclusão: É de fundamental importância conhecer e saber aplicar a técnica da ESD, além de abordar suas complicações, uma vez que, mesmo repleta de benefícios em relação à cirurgia, ela pode apresentar desfechos graves. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Retropneumoperitônio/diagnóstico , Enfisema Subcutâneo/diagnóstico , Ressecção Endoscópica de Mucosa/efeitos adversos , Enfisema Mediastínico/diagnóstico , ColonoscopiaRESUMO
In this article, the authors present a case of postrhinoplasty periorbital subcutaneous emphysema in a 35-year-old woman. This is an uncommon and benign rhinoplasty complication that can sometimes result from other pathologies such as barotrauma, hematoma, and allergic reaction. This patient's symptoms appeared to be a result of postanesthesia agitation. The patient's symptoms resolved after 1 week.
Assuntos
Rinoplastia/efeitos adversos , Enfisema Subcutâneo/etiologia , Adulto , Olho , Feminino , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Endoscopic retrograde cholangiopancreatography (ERCP) has become an essential procedure in the diagnosis and treatment of biliopancreatic diseases. Complications of this procedure are potentially serious, being necessary to know how to recognize them for the application of the appropriate treatment. We report the case of a 79-year-old woman who developed a massive subcutaneous emphysema, bilateral pneumothorax, retropneumomediastinum, retropneumoperitoneum and pneumoperitoneum due to iatrogenic duodenal injury secondary to ERCP. The clinical suspicion for early diagnosis of iatrogenic injury after ERCP will determine the correct treatment of this complication and will achieve better outcomes.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Duodeno/lesões , Enfisema Mediastínico/diagnóstico , Pneumoperitônio/diagnóstico , Pneumotórax/diagnóstico , Retropneumoperitônio/diagnóstico , Enfisema Subcutâneo/diagnóstico , Idoso , Feminino , Humanos , Enfisema Mediastínico/etiologia , Pneumoperitônio/etiologia , Pneumotórax/etiologia , Retropneumoperitônio/etiologia , Enfisema Subcutâneo/etiologiaRESUMO
El neumomediastino espontáneo o enfisema mediastinal es una condición rara en niños, generalmente benigna y autolimitada, causada por la ruptura alveolar y disección de aire al espacio mediastinal. Es más común en niños asmáticos, pero puede ocurrir en cualquier paciente que induzca una maniobra de Valsalva. Los signos clínicos son disnea, dolor torácico y enfisema subcutáneo. Su diagnóstico se realiza por sospecha clínica y se confirma con los rayos X de tórax. El tratamiento es sintomático y conservador. Este artículo le permitirá al clínico familiarizarse con los síntomas clínicos específicos y los signos radiológicos asociados. Se presenta el caso de una paciente de 12 años de edad que consulta al servicio de urgencias por dolor torácico y disnea luego de haber realizado un esfuerzo excesivo. Al examen físico se encontró enfisema subcutáneo y se diagnostica neumomediastino espontáneo con la ayuda de los rayos X de tórax. Se hace manejo de soporte y resuelve a los 15 días.
Spontaneous pneumomediatinum is a rare, generally benign and self-limited condition in children, caused by alveolar rupture and dissection of air into the mediastinum. In children, is seen most commonly in asthmatics but may also occur in any patient who induces a Valsalva maneuver. Clinical signs may include dyspnea, chest pain and subcutaneous emphysema. Diagnosis is made upon clinical suspicion and confirmed by chest x-rays. Treatment is symptomatic and conservative. This article will allow the clinician to become familiar with the specific clinical and radiological signs of this disease. We report a case of a 12 year-old girl who developed spontaneous neumomediastinum and subcutaneous emphysema after lifting heavy weight. The patient presented to the emergency department with chest pain and dyspnea. The initial physical exam was positive for subcutaneous emphysema. The chest x-rays confirmed the clinical suspicion of spontaneous pneumomediatinum. The patients symptoms were completely resolved after two weeks of supportive management.
Assuntos
Humanos , Diagnóstico de Pneumomediastino , Enfisema Subcutâneo/diagnóstico , Enfisema Mediastínico , Dor no Peito , PediatriaRESUMO
El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.