José María Galván Román, Carolina López Molina, Rosa de Miguel Buckley and Iluminada GarcÃa Polo
A former smoker 85-year-old man with a history of emphysematous COPD was admitted to hospital with a mild COPD exacerbation. He also reported a costal trauma 48 hours before. The following day the patient began to complain that he was "swelling up"; a physical examination was performed without findings at the time.
Within two days of admission and after a fit of coughing, the patient experienced a large and fast increase of volume of soft tissue on the face, neck, chest and upper extremities, with crackling to the touch. Chest CT was performed in which fractures in several ribs and significant subcutaneous emphysema, pneumomediastinum and a small pneumothorax were observed. A drainage tube was placed with full resolution of emphysema and the patient was discharged two weeks later, without further treatment.
This case report shows how a good physical examination can help to diagnose a serious condition in advance. As such, this paper should be of interest to a broad readership including those interested in respiratory medicine, thoracic surgery or general internal medicine.PDF
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