Latest news with #pneumothorax
Medscape
07-07-2025
- Health
- Medscape
Sudden Intense Chest Pain Unlike Prior Pneumothorax
Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians, but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please email us at ccsuggestions@ with the subject line "Case Challenge Suggestion." We look forward to hearing from you. Background and Initial Presentation A 35-year-old man with a history of two prior spontaneous pneumothoraxes — both managed conservatively — presents to the emergency department with new-onset chest pain and lightheadedness. The pain is described as sudden, intense, and exacerbated by deep breathing. He indicates that it is located in the center of the chest. He denies dyspnea or leg swelling and has no other complaints. When asked, he says this pain is different from his pneumothorax pain, mainly because it is in the center of his chest. Physical Examination and Workup Vital signs are within normal limits, except for a pulse > 120 bpm. Physical examination reveals diminished breath sounds on the left hemithorax. There are no rales or wheezes and no leg edema. Discussion Central pleuritic chest pain in a patient with a history of pneumothorax suggests a pulmonary etiology. A chest x-ray is the most appropriate investigation to promptly assess for recurrent pneumothorax, pleural effusion, structural abnormalities, or other intrathoracic pathology. ECG or cardiac biomarkers such as troponins are indicated primarily if myocardial ischemia or infarction is suspected. This suspicion would be raised if the patient described his chest pain as squeezing or pressure-like sensation radiating to the neck, jaw, or left arm. The patient's young age and lack of history of coronary artery disease also make acute coronary syndrome less likely. A CBC may provide supplementary information about signs of infection or inflammation, especially if the chest x-ray appears normal, but a CBC alone is unlikely to determine the cause of the patient's acute pleuritic chest pain. On initial testing, chest x-ray, metabolic panel, and troponin level were normal. CBC showed an elevated white blood cell count (16,200/μL). An ECG was also performed (Figure 1). Figure 1. ECG performed on patient in ED. Despite the central location of symptoms, the patient's young age, history of pneumothorax, and presence of pleuritic chest pain would have placed pneumothorax high on the initial differential diagnosis. After pneumothorax was ruled out with chest x-ray, PE should have become the leading consideration given the pleuritic pain and the patient's age group, in which PE is far more common than coronary artery disease. Although anxiety is also common in this age group — as it is in others — it should remain a diagnosis of exclusion, considered only after more serious conditions have been reasonably ruled out. While the ECG is not diagnostic of PE, it raises suspicion by demonstrating three supportive findings: tachycardia, incomplete right bundle branch block, and nonspecific ST-segment changes.[1] A subsequent D-dimer test was positive, and chest CT angiography showed extensive bilateral pulmonary emboli, more pronounced on the left side. PE typically presents as either unilateral pleuritic chest pain or as dyspnea with or without chest pain.[1] However, PE can present without the typical symptom of chest pain, sometimes being asymptomatic or discovered incidentally during diagnostic workup for other conditions.[1,2,3] Other symptoms of large pulmonary emboli may include syncope, diaphoresis, and cardiac arrest. Other symptoms of smaller emboli may include minor hemoptysis or cough.[1,3] Although most patients with PE have at least one identifiable risk factor, up to 20% of patients present without any known risk factor, so the absence of risk factors should not exclude the diagnosis.[1] Pain in patients with PE is believed to result from pulmonary infarction, which typically occurs when small to medium emboli lodge distally in the peripheral pulmonary arteries — areas with limited collateral circulation — making them more susceptible to infarction. The absence of chest pain does not exclude PE and may contribute to missed diagnoses, increasing the risk of patient morbidity and mortality. PE classically presents with pleuritic chest pain and dyspnea associated with known risk factors, tachycardia, and clear lungs both on auscultation and chest radiography. However, most patients with PE present with one or more atypical features, which may include the absence of pain or any known risk factors and/or normal or nonspecific ECG findings.[1] About 40% of patients with PE have tachycardia.[1] Scoring systems such as the PE Rule-out Criteria (PERC) can be useful in evaluating patients with suspected PE, but clinicians must be familiar with both the inclusion and exclusion criteria and should recognize that applying PERC requires a low pretest probability based on clinical judgment and the presence of a more likely alternate diagnosis with adequate supporting evidence. When PE cannot be excluded based on clinical assessment, diagnostic testing is warranted, typically beginning with a D-dimer assay. If the D-dimer is positive, imaging with CT pulmonary angiography or a or ventilation-perfusion scan should follow.[2,3] D-dimer should not be ordered reflexively or 'just in case,' as this often leads to unnecessary imaging. As Greg Henry advises, 'In medicine and life, don't ask questions you don't really want to know the answer to.' PE is typically treated with anticoagulants unless they are absolutely contraindicated, in which case a vena cava interruption filter may be used.[2,3,4] The treatment setting and choice of anticoagulant depend on various factors, including PE severity, comorbidities, and bleeding risk.[3] Most patients are admitted for treatment initiation, but some low-risk patients may be discharged with oral anticoagulants.[2] Patients with hypotension or right ventricular strain often require ICU admission for close monitoring and may be treated with thrombolytic therapy or, in some cases, surgical intervention.[1,2,3] The absolute contraindication to thrombolytic therapy is a history of intracranial hemorrhage, due to a significantly increased risk of catastrophic bleeding.[1,2,4] Thrombolytic agents can dissolve blood clots, but they also impair hemostasis. A history of pneumothorax episodes is not considered an absolute contraindication to thrombolytics in this patient.[1] Anemia is an important clinical factor that significantly increases the risk of bleeding during anticoagulation, but it does not preclude thrombolysis, if not caused by active bleeding or associated with a significant coagulopathy.[1,3,5] Hemodynamic instability is not a contraindication but rather an indication for thrombolytic therapy in patients with massive PE. The benefits of restoring circulation outweigh the bleeding risk associated with thrombolysis.[1,2,4] Hospital admission on intravenous heparin is reasonable. The patient could deteriorate if additional thrombi embolize. ICU admission is typically reserved for patients who remain unstable or require intravenous fibrinolytics. Discharge may be appropriate for stable patients who meet discharge criteria. For patients who are stable but do not qualify for discharge and have a low risk of decompensation, admission to a general medical floor may be considered. Because this patient's CT angiography showed extensive PE and his vital signs were concerning, thrombolytics were considered. However, after heparin was initiated, his vital signs normalized within a few hours, so he was able to be admitted to a telemetry bed. Although most patients with PE meet criteria for outpatient treatment,[3,4] a minority of eligible patients are actually discharged from the emergency department despite having an estimated mortality risk of less than 3%.[1,2] Risk stratification tools such as the Pulmonary Embolism Severity Index and the Hestia criteria can help identify candidates for outpatient treatment. Clinicians should also consider using an online calculator (eg, In addition to PE severity, clinicians should evaluate the patient's bleeding risk on anticoagulation when making disposition decisions.[1,2,3,4]
Yahoo
26-06-2025
- Health
- Yahoo
Lexi Held injury update: Latest news on Phoenix Mercury guard's collapsed lung
Phoenix Mercury guard Alexa Held, 25, suffered a scary injury against the New York Liberty on Thursday, June 19, ultimately leaving the game due to a partially collapsed lung. While the team would go on to Chicago to take on the Sky on June 21, Held had to remain under observation in New York, recovering from her collision with Breanna Stewart. Advertisement Even after she was cleared, she was not in any state to fly. So, how on Earth was Held supposed to get back home, back to Phoenix with her team? Well, as it turns out, when you're determined enough, nothing can stop you. Held embarked on a three-day train trip across the United States in order to reunite with her team ahead of their next home game against, coincidentally, the New York Liberty. Obviously, Held will not be playing in the game. In fact, her timeline for return has still yet to be determined. But her presence in Phoenix is an enormous lift for the organization, as evidenced by the number of Mercury staff to welcome her home. Phoenix Mercury guard Lexi Held dribbles the ball against the Connecticut Sun during the second half at Mohegan Sun Arena on June 18. WNBA News: Fever guard Caitlin Clark to miss Sparks game with injury Lexi Held's official diagnosis Held was diagnosed with pneumothorax on her right lung. Recovery times involving pneumothoraxes can vary wildly depending on the severity of the injury. Advertisement A small pneumothorax can heal naturally, but still needs a week or two to fully recover, per the National Library of Medicine. A larger one requires more medical attentiveness, needing multiple days just to reinflate the lung before recovery officially starts. For such injuries, recovery can take 4-6 weeks. The Mercury noted that Held is already "making good progress in her recovery." Mercury making moves in wake of Held's absence On Thursday, June 26, the Phoenix Mercury signed guard Kiana Williams. In the wake of Held's injury as well as Megan McConnell's tibial plateau fracture, the Mercury were in desperate need of guard help. Reports have also indicated that the Mercury are linked to former Indiana Fever guard/forward DeWanna Bonner, who was released by the Fever earlier this week. Phoenix is reportedly Bonner's preferred destination. This article originally appeared on USA TODAY: Lexi Held collapsed lung, latest news on Phoenix Mercury guard injury
The Sun
18-06-2025
- Health
- The Sun
Baby boy died just hours after being born when ‘doctors failed to carry out basic life-saving tests'
A BABY died just hours after birth when hospital staff missed signs of a collapsed lung, a coroner has ruled. Little Benjamin Finch Arnold was born prematurely at St James' Hospital in Leeds in 2022. 1 Soon after birth, he developed serious breathing problems, which is not uncommon among babies born early. But crucial, basic life-saving tests were not carried out in time, an inquest into his death has found. It heard Benjamin could have survived if doctors had acted sooner to diagnose and treat a pneumothorax - a condition where air leaks into the chest and causes the lung to collapse. Leeds Teaching Hospitals NHS Trust (LTHT), which runs the hospital, said it was "extremely sorry that Benjamin died whilst in our care". Last month, coroner Oliver Longstaff ruled Benjamin's death was avoidable. Around three hours after he was born, Benjamin underwent a procedure to help his underdeveloped lungs breathe, during which his lungs collapsed. Efforts to resuscitate him were unsuccessful and he was pronounced dead less than eight hours after he was born. Mr Longstaff said staff "missed opportunity to consider the possibility" of a pneumothorax as the cause of his breathing problems early on in the process. This is because procedure policy "did not mandate a chest X-ray", which he said would probably have revealed it, the BBC reports. A further opportunity was also missed when the medic performing the procedure did not discuss it with the neonatal consultant involved, the coroner added. One sip of my porn star martini and I was in utter agony – my lung collapsed and I was gasping for breath The consultant would likely have asked if a pneumothorax had been ruled out as a cause of Benjamin's condition, the conclusion read. Mr Longstaff said: "No thought was given to the pneumothorax being a potential, and potentially reversible, cause of the collapse. "If they had been treated he would have, on the balance of probabilities, survived." Mr Longstaff has since issued a Prevention of Future Deaths report, aiming to prevent similar tragedies. He sent this report to the Health Secretary, Leeds Teaching Hospitals NHS Trust, and other relevant bodies. He said maternity services in Leeds are dangerously split between two hospitals, with St James' lacking proper medical and paediatric support. Plans to bring all services under one roof have been delayed until at least 2030. There was also confusion over how the St James' unit is classified, with staff describing it as operating at a higher level than officially recognised. What is a collapsed lung? A pneumothorax - also known as a collapsed lung - happens when air has leaked out from the lung in to the chest cavity and chest wall. This causes the lung to collapse down and peel away from the inside of the chest. When someone who doesn't have any known lung problems develops a pneumothorax, this is called a primary pneumothorax. Usually the air has leaked from a blister on the surface of the lung which has been present from birth. A lung can also collapse as a result of conditions like chronic obstructive pulmonary disease or emphysema, as well as injuries to the chest wall that cause damage to lung surfaces. The condition most commonly occurs in smokers. The most common symptoms are sudden shortness of breath and chest pain, which may be sharp and worse with coughing and breathing. You may also experience a dry cough. If air has leaked out into the muscles and skin in your chest wall, you may notice a swelling and a 'bubble wrap' sensation if you press on your chest. Occasionally, if the leak of air has been very large, you may feel faint or light headed. A pneumothorax is usually diagnosed through an X-ray. Source: NHS The coroner warned that NHS guidelines for a breathing procedure called LISA are inconsistent, and questioned whether national rules for treating cardiac arrest in newborns are good enough. Finally, he said changes made by the Trust after Benjamin's death need to be properly explained. All organisations involved must respond by July 28. 'This cannot wait any longer' Earlier this year, Benjamin's parents described the care their son received as 'unacceptable'. "We are devastated by Benjamin's death," they said in a statement sent to the BBC. "The standard of care he received was unacceptable. "We urge Leeds Teaching Hospitals Trust to take the prevention of future deaths report seriously. "We ask the government to urgently provide the funding for the new hospital building in Leeds. "This would allow all maternity and neonatal care to be provided from a single site and improve patient safety. "This cannot wait any longer." Dr Magnus Harrison, Chief Medical Officer at Leeds Teaching Hospitals NHS Trust, said: 'I am extremely sorry that Benjamin died whilst in our care and I cannot imagine how difficult the last three years have been for his family. 'We have already made important changes, including ensuring a consultant neonatologist is available on each hospital site and involved earlier in complex procedures. 'While these changes do not undo the loss of Benjamin, we will continue to review and improve our services to provide the best possible care for our babies and their families. 'We appreciate the coroner's thorough investigation and are preparing a response to the recommendations to provide the assurances he is seeking.'
BBC News
30-05-2025
- General
- BBC News
Premature baby's care at Leeds hospital 'unacceptable'
The parents of a premature baby boy who died just hours after his birth have described the care he received in hospital as "unacceptable".Benjamin Arnold developed breathing difficulties shortly after being born just over five weeks before his due date at St James's Hospital in Leeds in "missed" opportunities to diagnose a pneumothorax, also known as a collapsed lung, and had this been treated he would likely have survived, area coroner Oliver Longstaff said at an Teaching Hospitals NHS Trust (LTHT), which runs the hospital, said it was "extremely sorry that Benjamin died whilst in our care". 'Missed opportunity' Mr Longstaff's narrative conclusion, following the inquest into Benjamin's death at Wakefield Coroner's Court last week, said the baby had "collapsed" during a procedure to help his underdeveloped lungs to breathe three hours after his to resuscitate him were ultimately unsuccessful and he was pronounced dead less than eight hours after he was Longstaff said there was a "missed opportunity to consider the possibility" of a pneumothorax early on in the process, because procedure policy "did not mandate a chest X-ray", which he said would probably have revealed it.A further opportunity was also missed when the medic performing the procedure did not discuss it with the neonatal consultant involved, the coroner added. The consultant would likely have asked if a pneumothorax had been ruled out as a cause of Benjamin's condition, the conclusion Longstaff said: "No thought was given to the pneumothorax being a potential, and potentially reversible, cause of the collapse."If they had been treated he would have, on the balance of probabilities, survived."The coroner said he was preparing a prevention of future deaths report, which would examine what lessons could be learned from the case and that would be published in due course. 'Important changes' In a statement to the BBC, Benjamin's parents said: "We are devastated by Benjamin's death."The standard of care he received was unacceptable."We urge Leeds Teaching Hospitals Trust to take the prevention of future deaths report seriously."We ask the government to urgently provide the funding for the new hospital building in Leeds. "This would allow all maternity and neonatal care to be provided from a single site and improve patient safety. This cannot wait any longer."In January, Health Secretary Wes Streeting announced the planned redevelopment of Leeds General Infirmary would not begin before 2030. At the time Professor Phil Wood, chief executive of Leeds Teaching Hospitals, said he was "extremely disappointed" by the the inquest, Dr Magnus Harrison, LTHT's medical director, said: "I am extremely sorry Benjamin died whilst in our care and I cannot imagine how difficult the last three years have been for his family."I want to reassure everyone that we have already made important changes to improve our neonatal service."These include changes to our policies to have a consultant neonatologist available on each hospital site and involving them earlier in the delivery of complex clinical procedures."While we recognise these do not undo the loss of Benjamin, we will continue to review our service and make improvements so we can deliver the best possible care for our babies and their families." Listen to highlights from West Yorkshire on BBC Sounds, catch up with the latest episode of Look North.
Reuters
28-05-2025
- Automotive
- Reuters
Honda's MotoGP rider Marini suffers severe injuries in crash while testing
May 28 (Reuters) - Honda rider Luca Marini suffered a nasty crash while testing in Japan, sustaining injuries to his hip, knee, chest and shoulder as well as a collapsed lung, the Japanese team said on Wednesday. Marini had travelled to the Suzuka Circuit after the British Grand Prix that was held over the weekend and the Italian was testing Honda's bike for the Suzuka 8-Hour endurance race when he crashed heavily on the second day of testing. "Suffering from a dislocated left hip, damage to the ligaments in his left knee, fractures in the sternum and left collarbone and a right-sided pneumothorax, Marini was transferred to local hospital and stabilised," Honda said. "Marini will remain under observation in Japan until he is deemed fit to travel." Honda did not give a timeline for Marini's return. The 27-year-old is 13th in the MotoGP riders' standings after seven rounds. The next MotoGP round is the Aragon Grand Prix in Spain on June 7-8.
