Monday, May 18, 2009

An Agricultural Tool for Threshing

This is the CXR of an unidentified male patient, a passenger of a high speed motor vehicle accident. As you do your primary survey (ABC's!) you notice that his right chest moves in the opposite direction of his left chest with breathing. That is, a part of his chest retracts with inspiration and bulges with expiration. You look closer at that part of the X-ray.

Challenge: What's the diagnosis?

Both images shown under fair use.

3 comments:

Yahya said...

Multiple Traume+Paradoxical chest wall motion.The primary diagnosis which comes to mind is Flail Chest.Doesn't It?

Stephanie said...

flail chest (ribs broken in two places)

Craig Chen said...

Exactly!
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An Agricultural Tool for Threshing

This is flail chest when three or more adjacent ribs are fractured in two places creating one floating segment comprised of several rib sections and the soft tissues between them. This unstable section has paradoxical movement with breathing and is associated with pulmonary contusion. Treatment is with oxygen, close monitoring, and stabilization of the segment with pressure to restrict chest expansion.

Sources: UpToDate; trauma.org.