Abstract text (incl. references and figure legends)
Case history
A fit-and-well 46-year-old male patient presented in our emergency room with increasing pain and swelling of his left thoracic wall after falling down an entire staircase around 11 hours previously.
Clinical findings
In the emergency room the patient presented in full consciousness, spontaneously breathing and hemodynamically stable. Swelling of the neck, chest, scrotum and left upper leg were found upon physical examination with crackling skin as found in emphysema. The airway was not compromised, but there was a B problem detected, as the patient presented with left chest hypoventilation. There were no C, D or E problems present.
Investigations/Results
A trauma CT scan was performed, which revealed a massive pneumothorax on the left side as well as massive subcutaneous emphysema. Fractures of the sixth and seventh left rib as well as of the left scapula were detected.
Diagnosis
The patient suffered a pneumothorax with massive subcutaneous emphysema as well as fractures of the sixth and seventh left rib and scapula after falling down the stairs eleven hours previously.
Therapy and Progressions
Immediately after performing the CT scan a chest drain was placed in the left chest. X-ray was performed to control the correct position of the tube, in which the massive emphysema was still visible(Figure 1). Afterwards, the patient was transferred to the intensive care unit. A few days later, pneumothorax as well as the emphysema had completely resolved, and the chest drain was removed.
Comments
This case study presents the story of a patient, who suffered a severe trauma resulting in a potentially life-threatening injury. As the pneumothorax was not treated immediately after trauma, subcutaneous emphysema could develop, with swelling of the neck, chest and even lower body including the scrotum. If this swelling due to emphysema had continued, airway obstruction or obstruction of blood vessels could have resulted, potentially leading to death.
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