ABSTRACT
We report a case of a giant bullous emphysema misdiagnosed as a pneumothorax. A 18-year-old chronic smoker presented with right sided chest pain and dyspnoea. Initial respiratory rate was 35 /min, blood pressure was 136/90 mmHg, heart rate 80/min and SpO2 was 98% on room air. Clinical examination revealed reduced right air entry and left trachea deviation. Chest X-ray helped to arrive at a diagnosis of pneumothorax. Needle aspiration was then performed followed by a chest tube thoracostomy because of no improvement. Massive amount of blood was drained and patient deteriorated further. CT thorax revealed a right haemopneumothorax with multiple bullaes. Patient was rushed to OT for emergency thoracotomy for stapling of the ruptured bullae. Giant bullous emphysema can mimic pneumothorax and physician must be vigilant if draining a suspected pneumothorax.
Subject(s)
EmphysemaABSTRACT
BACKGROUND: The quantitative immunochemical faecal occult blood test (qFOBT) has been shown to be an accurate method of identifying significant colorectal neoplasia including cancer and advanced adenomas. This study reports the results of a Singapore population-based colorectal cancer screening event using the qFOBT. METHODS: This event was held as part of a colorectal cancer awareness exhibition. All asymptomatic individuals above the age of 40 years with no previous colorectal cancer screening in the last 1 year were invited to participate. Eligible participants were screened using two consecutive qFOBTs with a positive faecal haemoglobin threshold taken at 100 ng/mL. Participants with at least one positive qFOBT result were recalled and advised to undergo colonoscopy. Endoscopic polypectomy or surgery was performed according to colonoscopic findings. RESULTS: A total of 751 (55% male, 45% female) participants with a median age of 53 years (range, 40-85 years) took part in the screening event. Five hundred and forty (72%) participants returned the qFOBT samples, of which 57 (11%) tested positive. Fifty-two of these participants proceeded to colonoscopy. Three participants had sigmoid cancer and 12 had advanced polyps, all of which were located distally in the sigmoid colon or rectum. Five of the participants required surgery for colorectal neoplasia and all recovered well without complications. CONCLUSION: The qFOBT at a positive faecal haemoglobin threshold of 100 ng/ml has a high positive predictive value and is an effective screening tool for colorectal cancer in an Asian population.