Sonisha Gupta

Abstract

Background & Objective: Thoracic CT is the most common imaging modality used after screening with chest x-ray in treatment of lung pathologies. But high cost, radiation, immobility & availability restrict its widespread use. For many years transthoracic ultrasound is being used in examination of pleural effusions in ICU patients. To study the role of chest ultrasonography in diagnosing pleural & parenchymal pathologies in OPD patients this study was carried out. Materials and Methods: 32 adult patientswithdyspnoea, cough & other chest symptoms coming to OPD of pulmonary department of Santosh hospitals from January 2017 to July 2018 were enrolled in the study. Results: In diagnosing pleural lung diseases- pleural effusion, pneumothorax, hydropneumothorax and pleural thickening, US showed a sensitivity, specificity, PPV & NPV all of 100% and accuracy of 1.00. But for parenchymal lesions taken all together (Consolidation, collapse, atelectasis, lung abscess, fibrocavitary lesion with necrosis, idiopathic pulmonary fibrosis, bleb/ bulla) it showed low accuracy of 0.62 with 42.86% sensitivity, 86.36% specificity, 80% positive and 54.29% negative predictive values respectively. Conclusion: Thoracic US offers fast, cheap, safe, radiation free, widely available, easily reproducible and non-invasive diagnostic modality for evaluating pleural lung diseases in OPD patients. But low sensitivity in diagnosis of parenchymal diseases is not encouraging. Keywords: USG, Pleural, Parenchymal lung diseases.

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Abstract

Spontaneous pneumomediastinum is a rare finding in a young adult without any co-morbidities or underlying lung pathology. A 22 year old male smoker, of average built presented with complaints of acute cough, throat pain and chest pain of 2 days duration. After admission he had an episode of hemoptysis & developed swelling over the neck and upper chest. Radiological assessment showed subcutaneous emphysema with tracheal tear. There was no pnemothorax. Likely cause of tracheal tear in this case could be either aspiration of a chicken bone leading to a direct injury to trachea or vigorous cough leading to raised intratracheal pressure causing rupture. As there was no pre existing lung diseases and the patient was not in respiratory distress, he was managed conservatively. The patient was discharged after complete recovery. It shows that spontaneous pneumomediastinum can present without pneumothorax, caused by tracheal rupture due to vigorous cough from food aspiration. Keywords: Spontaneous pneumomediastinum, Tracheal rupture, Subcutaneous emphysema, Tracheal tear, Vigorous cough, Food aspiration, Ganja.

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