Pulmonary puzzle: a precordial crunch.
نویسندگان
چکیده
To cite: Barnard EBG, Rimmer J, McD Johnston A. Thorax 2013;68:794–795. Three patients with unusual additional sounds heard on auscultation of the precordium were admitted to a military hospital in Afghanistan. Patient 1: A male in his 20s was shot in his left flank. Injuries included a left haemothorax and visceral injuries. An intercostal drain (ICD) was inserted. After surgery, he was admitted to the intensive care unit (ICU) where a ‘click’ was heard on auscultation of the precordium just after the second heart sound, loudest in expiration. A chest radiograph was taken (figure 1). Patient 2: A male in his 20s was very close to an explosion. He had fragmentation wounds to his chest, abdomen and limbs. Initial CT scan demonstrated a right-side haemopneumothorax and fragmentation within his pleural space. Intraoperatively, a right-sided ICD was inserted. In the ICU, a ‘crunch’ was heard over the precordium loudest in expiration and synchronous with the heart sounds. A second CTwas performed (figure 2). Patient 3: A male in his 30s was close to an explosion. He sustained facial fractures and fragmentation injuries. Initial CT demonstrated multiple fractures and soft tissue injuries to the face, but a normal mediastinum, heart and lungs. Following surgery he was transferred to the ICU. Two days later, a systolic ‘click’ was heard on auscultation of the precordium. Cardiac ultrasound showed no mediastinal or pericardial abnormality. A chest radiograph was taken (figure 3).
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عنوان ژورنال:
- Thorax
دوره 68 8 شماره
صفحات -
تاریخ انتشار 2013