[abstract] IMAGING: CT (COMPUTED TOMOGRAPHY) THORAX VS. CHEST X-RAY TO RULE-OUT PNEUMOTHORAX PRIOR TO HYPERBARIC OXYGEN THERAPY (HBOT)

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[abstract] IMAGING: CT (COMPUTED TOMOGRAPHY) THORAX VS. CHEST X-RAY TO RULE-OUT PNEUMOTHORAX PRIOR TO HYPERBARIC OXYGEN THERAPY (HBOT)

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Title: [abstract] IMAGING: CT (COMPUTED TOMOGRAPHY) THORAX VS. CHEST X-RAY TO RULE-OUT PNEUMOTHORAX PRIOR TO HYPERBARIC OXYGEN THERAPY (HBOT)
Author: Cooney, N; Heyboer, M; Cooney, D
Abstract: Introduction: Pneumothorax s/p transthoracic percutaneous needle biopsy is a known complication. It is the most frequent complication associated with this procedure, occurring 26.6% of the time and 14.2% requiring thoracostomy. The management and detection of a pneumothorax prior to HBOT is important to ensure patient safety and avoid a life-threatening tension pneumothorax. A 68-year old male with a history of interstitial fibrosis had a pulmonary nodule biopsied by interventional radiology under CT guidance. Immediately post-procedure, the patient became unresponsive. He was intubated. CT head showed pneumocephalus. Hyperbaric medicine was consulted for treatment of an air gas embolism (AGE). Materials and Methods: On exam, the patient had stable vital signs. He was intubated and sedated. Cardiac exam was normal. Lungs had diffuse rhonchi throughout. Neurologically, he had equal, round, and reactive pupils. Off sedation, he had spontaneous movement to the right upper and lower extremity. Movement was not on command and was not in reference to noxious stimuli. Results: A chest x-ray was obtained prior to HBOT and showed fibrotic changes with no pneumothorax. Due to high suspicion for a pneumothorax, a CT thorax was done and showed a small right pneumothorax. The decision was made to place a chest tube prior to HBOT. Conclusion: Prior to HBOT, placement of a chest tube for a known pneumothorax is required. Prophylactic chest tube placement is indicated when suspicion is high despite negative findings. Detection is typically done with a chest x-ray. However, the gold standard to diagnose a pneumothorax is CT thorax. In this case, the pneumothorax was not detected on chest x-ray but with a CT thorax. With the timeliness of obtaining a CT and the risk to benefit ratio, CT thorax should be highly considered prior to HBOT in the setting of post-transthoracic procedures.
Description: Abstract of the Undersea and Hyperbaric Medical Society, Inc. Annual Scientific Meeting, St Pete Beach, Florida, USA. (http://www.uhms.org)
URI: http://archive.rubicon-foundation.org/9276
Date: 2010

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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