Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

<p><b>INTRODUCTION</b>Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital.</p><p><b>METHODS</b>Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality.</p><p><b>RESULTS</b>CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL.</p><p><b>CONCLUSION</b>Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL.</p>

Motor vehicle collisions with large animals

Motor vehicle collisions MVC with large animals are a worldwide problem. In this review, we aim to analyze the mechanisms and patterns of human injuries caused by MVC with large animals and various ways to prevent them. Reported studies on large animals that can cause such accidents include the moose, camels, deer, and kangaroos. The moose causes a typical rear-and downward deformity of the roof of the car. The camel falls on the roof of the car causing cervical and head injury to the occupants. Injuries caused by kangaroos and deer are usually mild. Injuries may be caused by direct collision with the animal or hitting another object when trying to avoid it. Alarming signs, underpasses or overpasses for animals, and reflectors that frighten the animals were all used to prevent the collisions. Roo-bars are used in Australia to reduce the car damage when hit by a kangaroo. Fencing has proven useful in United Arab Emirates. The mechanism of injury varies with the size and height of the animal and can be serious. Increased awareness of the effects of collision with large animals and ways to reduce it has to be promoted

Superior mesenteric vein thrombosis complicating appendicular masses

Mesenteric vein thrombosis [MVT] is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography [CT] scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation