An unusual aetiology of ‘collapse query cause’: penetrating chest trauma
Aims
To describe an interesting case of collapse with an unusual and unexpected aetiology.
Methods
A retrospective review of case notes was performed. An extensive search of electronic databases (Medline, EMBASE, PubMed) was used to identify existing case reports of penetrating trauma involving wooden object and collapse query cause.
Results
We describe an 81-year-old man presenting to the emergency department with an unwitnessed syncope. All initial examinations and investigations were non-diagnostic. He was admitted for observation, during which he developed type 1 respiratory failure and mild fever. Computerised tomography of pulmonary angiography (CTPA) was carried out to rule out pulmonary embolism. This revealed a foreign body in the mediastinum. This patient was treated with intravenous antibiotics and was transferred to the cardiothoracic unit for exploration.
A wooden foreign object was found in the mediastinum. Removal resulted in rapid clinical improvement and the patient recovered well.
Conclusion
Our case highlights the importance of examining for evidence of related trauma as well as the underlying aetiology of the collapse. Plain radiography has low sensitivity for detecting wooden objects, approximating 15%. As a result, we highlight the importance of a thorough external examination, having a high index of suspicion for injury and ultimately appropriate investigation and management strategy.
- © Royal College of Physicians 2015. All rights reserved.
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