Accreditation ; Chest Pain ; etiology ; China ; Humans ; Myocardial Infarction ; complications ; therapy ; Pain Clinics

We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term "Chilaiditi syndrome" is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.
Chest Pain ; Chilaiditi Syndrome ; complications ; diagnosis ; Dyspnea ; Humans ; Male ; Middle Aged ; Pneumothorax ; complications ; diagnosis

BACKGROUND: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. MATERIALS AND METHOD: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. RESULT: No significant differences were found in any of the factors studied in either group. CONCLUSION: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.
Analgesics ; Chest Pain ; Chest Tubes ; Follow-Up Studies ; Humans ; Length of Stay ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Talc ; Thoracoscopy* ; Thoracotomy

No abstract available.
Adolescence ; Adult ; Chest Pain/etiology* ; Female ; Fibromyalgia/complications* ; Human ; Middle Age

PURPOSE: To compare the results of the thoracoscopic approach and open thoracotomy retrospectively for scoliosis requiring anterior release and fusion followed by posterior correction. MATERIALS AND METHODS: Of 22 rigid scoliosis patients, 10 open thoracotomy cases (group I) were compared with 12 thoracoscopic cases (group II) in terms of blood loss, operation time, and chest pain (visual analogue scale, VAS), as checked 1 week after operation and final follow-up, correction ratio of major curve and complications. Posterior correction was performed 2 weeks after anterior release. Statistical analysis of group differences was performed using the t-test or the Mann-Whitney. RESULTS: Blood loss was higher in group I, 268.0 mL (200-530) than in group II, 195.0 mL (100-280) (p=0.047). The operation time was shorter in group I, 108.0 minutes (90-180) than in group II, 175.0 minutes (120-240) (p=0.001), and chest pain (visual analogue scale, VAS) which was checked at 1 week after operation and at final follow-up was milder in group II, 3.9 (3-6), 1.6 (0-3) than in group I, 5.8 (4-8), 3.1 (1-5) (p=0.005, p=0.013, respectively). The correction ratios of the major curve between two groups were similar. The cosmetic aspects of the thoracoscopic approach were favorable. The postoperative complications were 1 pneumothorax in each group and 3 chronic chest pain in group I. CONCLUSIONS: The results of thoracoscopic approach for anterior release were compared favorably with standard open thoracotomy in terms of blood loss, chest pain both postoperatively and at final follow-up, and cosmetics, but unfavorably for operation time.
Chest Pain ; Follow-Up Studies ; Humans ; Pneumothorax ; Postoperative Complications ; Retrospective Studies ; Scoliosis* ; Thoracoscopy ; Thoracotomy*

Chest pain is one of the most common complaints in the emergency department. Diseases of the heart, aorta, lungs, esophagus, stomach, mediastinum, pleura, and abdominal viscera can all cause chest discomfort (Gulati et al., 2021; Jiao et al., 2021; Lu et al., 2022). Clinicians in the emergency department are expected to immediately recognize life-threatening chest pain (Jiao et al., 2021). Delayed diagnosis further increases the risk of complications and mortality (Liu et al., 2021). In this case, we present an elderly Chinese female who had a history of myocardial infarction two years previously, with chest pain eventually found to be caused by ingestion of a duck bone.
Humans ; Female ; Aged ; Esophagus ; Foreign Bodies/diagnosis* ; Chest Pain/complications* ; Emergency Service, Hospital ; Heart

BACKGROUND: Minimally invasive surgery of pectus excavatum by Dr. Nuss is a new technique that allows the repair of this deformity without any cartilage resection or sternal osteotomy. We describe the early experiences with Nuss procedure. MATERIAL AND METHOD: From December 1999 to January 2001, twenty patients with pectus excavatum underwent repair by Nuss procedure. There were 14 males and 6 females whose mean age was 10.1 +/- 7.7 years, ranging from 1 to 33 years. Most patients(N=19) were below 20 years, except 33 years old female patient(N=1). RESULT: The severity of depression was assessed by computed tomography(CT). CT index was mean 4.9 +/- 5.7(ranged from 3.3 to 8). The average operating time was 85.8 +/- 23.7 minutes. The used metal bars were ranged in length from 8 inches to 16 inches(average 11.8 +/- 14.4 inches). Early postoperative complications were pneumothorax in three patients, paralytic ileus in one, and postoperative chest pain requiring analgesics in all patients. Epidural analgesia was used in one adult patient for control of postoperative pain. In our experiences, there were no serious complications posteoperatively. CONCLUSION: There were good early results with the Nuss procedure that we performed for repairing of pectus excavatum. However, we believe the procedure needs to be observed for the long term results for it to be broadly accepted.
Adult ; Analgesia, Epidural ; Analgesics ; Cartilage ; Chest Pain ; Congenital Abnormalities ; Depression ; Female ; Funnel Chest ; Humans ; Intestinal Pseudo-Obstruction ; Male ; Osteotomy ; Pain, Postoperative ; Pneumothorax ; Postoperative Complications ; Surgical Procedures, Minimally Invasive

Cardiovascular and noncardiovascular conditions are commonly encountered in the emergency department. While the majority of patients have underlying cardiovascular aetiologies, such as acute myocardial infarction, congestive heart failure, aortic dissection and pulmonary embolism, a small subset of patients have underlying noncardiovascular conditions, although they present with similar symptoms of chest pain, dyspnoea, cough, haemoptysis and haematemesis. This article aims to describe the imaging findings in common noncardiovascular conditions of the chest that are frequently encountered in the emergency department, with a review of the existing literature.
Chest Pain ; diagnosis ; etiology ; Diagnosis, Differential ; Diagnostic Imaging ; Emergencies ; Humans ; Myocardial Infarction ; complications ; diagnosis ; Pulmonary Embolism ; complications ; diagnosis

A boy, aged 5 years, was admitted due to chest pain for 4 months, right lower limb weakness for 2 months, and weakness of both lower limbs for 10 days. There were no symptoms of defecation/urination disorders or disturbance of consciousness, and the boy had upper motor neuron paralysis in both lower limbs, without cranial nerve involvement or sensory disorder. Spine magnetic resonance imaging revealed tumor in the spinal canal between cervical vertebra 6 and thoracic vertebra 2, which put pressure on the spinal cord. He was transferred to the department of neurosurgery for surgical treatment and fully recovered after tumor resection, and no recurrence was observed after 6 years of follow-up. The pathological diagnosis was clear cell meningioma (WHO grade II). For children with chest pain and dyskinesia, spinal meningioma should be considered.
Chest Pain ; etiology ; Child, Preschool ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms ; complications ; Meningioma ; complications ; Neoplasm Recurrence, Local

Noncardiac chest pain (NCCP) is defined as recurring, angina-like, retrosternal chest pain of noncardiac origin. Although patients with NCCP have excellent long-term prognosis, most suffer persistently from their symptoms. Several pathophysiological mechanisms have been suggested, including gastroesophageal reflux disease (GERD), esophageal motility disorder, esophageal hypersensitivity, and psychological comorbidity. Among them, GERD is the most common cause of NCCP. Therefore, GERD should first be considered as the underlying cause of symptoms in patients with NCCP. Empirical proton pump inhibitor (PPI) treatment with a preferably double dose for more than 2 months could be cost-effective. PPI test can also be used for diagnosis of GERD-related NCCP, but it should be considered for patients with NCCP occurring at least weekly and its duration should be at least 2 weeks. However, upper endoscopy and esophageal pH monitoring are necessary when the diagnosis of GERD is uncertain. Esophageal impedance-pH monitoring could further improve the diagnostic yield. Patients with GERD-related NCCP should preferably be treated with a double dose PPI until symptoms remit (may require more than 2 months of therapy for optimal symptom control), followed by dose tapering to determine the lowest PPI dose that can control symptoms. However, treatment of patients with non-GERD-related NCCP is challenging. An empirical treatment of antidepressants could be considered. If there are specific esophageal motility disorders, smooth muscle relaxants or endoscopic treatment may be considered in selected cases. If none of these traditional treatments is effective, a psychology consultation for cognitive behavioral therapy should be considered.
Chest Pain/*diagnosis/etiology ; Esophageal pH Monitoring ; Gastroesophageal Reflux/complications/*diagnosis/drug therapy ; Humans ; Manometry ; Proton Pump Inhibitors/therapeutic use