Misdiagnosed pneumothorax blainepollock.net

Undiagnosed Pneumothorax as the Cause for Emphysema

by / 0 Comments / 9 View / December 14, 2014

Misdiagnosed pneumothorax interpreted as necrotizing fasciitis of the chest wall: case report of a potentially preventable death

Background:
Subcutaneous emphysema is an uncommon clinical finding associated both with benign sources and potentially deadly necrotizing infections.  Wide ranges of causes exist including trauma, iatrogenic injuries, factitious disorders and necrotizing infections.
Case presentation:
A 49-year old male presented to the emergency room with extensive subcutaneous emphysema following blunt trauma. The orthopaedic  surgery service was consulted for treatment of suspected necrotizing fasciitis due to his subcutaneous emphysema. A careful patient history and  physical examination correlated with laboratory and radiographic findings revealed rib fractures and a long-standing, undiagnosed  pneumothorax as the cause for emphysema. Treatment of the underlying condition with chest tubes led to eventual resolution of the  emphysema, though multisystem organ failure ultimately resulted in patient death.
Conclusion:
This case illustrates the importance of rapidly and appropriately evaluating trauma patients, and in this case specifically diagnosing and  treating the underlying cause of subcutaneous emphysema. The late diagnosis of pneumothorax resulted in delayed definitive treatment, which  may have contributed to the patient’s ultimate demise. In acute and sub-acute trauma situations a high level of suspicion for life threatening  injuries must be maintained. Decision making for initial treatment should be based on the basic tenants of Advanced Trauma Life Support to primarily address these injuries and help prevent further disability or death.

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