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2.
Am J Med ; 133(10): 1135-1142, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32442508

RESUMO

Chest pain is a common presenting complaint in the primary care setting. Imaging plays a key role in the evaluation of the multiple organ systems that can be responsible for chest pain. With numerous imaging modalities available, determination of the most appropriate test and interpretation of the findings can be a challenge for the clinician. In this 2-part series, we offer resources to guide primary care physicians in the selection of imaging studies and present the imaging findings of various causes of nonemergent chest pain. In Part 2, we focus on the radiologic appearance of common noncardiac sources of chest pain, including gastrointestinal, pulmonary, and musculoskeletal etiologies.


Assuntos
Dor no Peito/etiologia , Transtornos da Motilidade Esofágica/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Atenção Primária à Saúde , Doenças Respiratórias/diagnóstico por imagem , Transtornos da Motilidade Esofágica/complicações , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico por imagem , Hérnia Hiatal/complicações , Humanos , Imageamento por Ressonância Magnética , Doenças Musculoesqueléticas/complicações , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Radiografia Torácica , Doenças Respiratórias/complicações , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Nurs Clin North Am ; 53(3): 421-431, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30100007

RESUMO

Noncardiac chest pain is an angina-type discomfort without indication of ischemia. Diagnosis can be difficult because of its heterogeneous nature. Classification varies by specialty; gastroenterology uses the terminology gastroesophageal reflux disease related versus non-gastroesophageal reflux disease related. Other disciplines recognize noncardiac chest pain etiologies as having gastrointestinal, musculoskeletal, psychiatric, or pulmonary/other as underlying etiologies. Diagnostics yield a specific cause for effective treatment, which is aimed at the underlying etiology, but it is not always possible. Some patients with noncardiac chest pain have comorbidities and ongoing pain that lead to decreased quality of life and continued health care use.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/enfermagem , Dor no Peito/terapia , Transtorno Depressivo/complicações , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Transtorno de Pânico/complicações , Síndrome de Tietze/complicações
5.
Thorac Cardiovasc Surg ; 64(3): 239-44, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25742551

RESUMO

BACKGROUND: Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. METHODS: This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. RESULTS: In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). CONCLUSION: Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.


Assuntos
Dor no Peito/etiologia , Radiografia Torácica/métodos , Neoplasias Torácicas/diagnóstico , Parede Torácica/diagnóstico por imagem , Síndrome de Tietze/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Torácicas/complicações , Síndrome de Tietze/complicações , Adulto Jovem
6.
An. sist. sanit. Navar ; 38(2): 329-332, mayo-ago. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-140736

RESUMO

El síndrome de la costilla deslizante (SCD) es una entidad infrecuente, que exige un diagnóstico diferencial preciso incluyendo patología digestiva, cardiaca, respiratoria, infecciosa y músculo-esquelética torácica o abdominal. Se presenta el caso de dos niñas, en edad puberal, con dolor torácico incapacitante de varios meses de evolución y sin antecedente traumático. En la exploración existía un punto de dolor a la palpación de la parrilla costal y la 'maniobra del gancho' era dolorosa. Se realizó una resección de los cartílagos costales, respetando el pericondrio. La evolución tras uno y cuatro años de seguimiento, fue satisfactoria sin complicaciones y con resolución inmediata de la sintomatología. La cirugía de resección costal parece una opción muy agresiva, aunque con resultados muy satisfactorios. Un abordaje mínimamente invasivo podría ser mejor opción a considerar en el futuro (AU)


Slipping rib syndrome (SRS) is an unusual cause of recurrent chest or abdominal pain in children. The diagnosis is elusive, including gastroenterological, cardiac, respiratory, infectious and chest or abdominal muscular pathologies. Two paediatric patients were diagnosed with SRS, both of them were female teenagers with a similar clinical pattern: crippling unilateral chest pain without a traumatic event. On physical examination, all patients had reproducible pain with the 'hooking maneuver'. Surgical excision of the costal cartilages was done, preserving the perichondrium. No complications were reported. In both cases we achieve an excellent outcome after one and four years of follow-up, resolving the symptoms completely. The surgical excision of the costal cartilages seems to be an aggressive option but with an excellent outcome. A minimum invasive approach could be a better option in the future (AU)


Assuntos
Criança , Feminino , Humanos , Síndrome da Costela Cervical/diagnóstico , Síndrome da Costela Cervical/cirurgia , Diagnóstico Diferencial , Dor no Peito/complicações , Dor no Peito/etiologia , Síndrome de Tietze/complicações , Síndrome de Tietze/cirurgia , Cartilagem Costal/cirurgia
7.
Br J Hosp Med (Lond) ; 76(5): 296-300, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25959942

RESUMO

A simple clinical approach to patients presenting with chest pain is outlined, which is easily taught and can be quickly applied. This approach was demonstrated in a large cohort of patients and this article discusses the characteristics of the various diagnostic sub-groups.


Assuntos
Dor no Peito/diagnóstico , Anamnese , Dor Referida/diagnóstico , Exame Físico , Adulto , Idoso , Dor no Peito/etiologia , Estudos de Coortes , Dispepsia/complicações , Dispepsia/diagnóstico , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Dor Referida/etiologia , Pleurisia/complicações , Pleurisia/diagnóstico , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico , Fatores de Tempo
8.
BMC Fam Pract ; 14: 154, 2013 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-24138299

RESUMO

BACKGROUND: Chest pain is a common complaint and reason for consultation in primary care. Traditional textbooks still assign pain localization a certain discriminative role in the differential diagnosis of chest pain. The aim of our study was to synthesize pain drawings from a large sample of chest pain patients and to examine whether pain localizations differ for different underlying etiologies. METHODS: We conducted a cross-sectional study including 1212 consecutive patients with chest pain recruited in 74 primary care offices in Germany. Primary care providers (PCPs) marked pain localization and radiation of each patient on a pictogram. After 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient, deciding on the etiology of chest pain at the time of patient recruitment. PCP drawings were entered in a specially designed computer program to produce merged pain charts for different etiologies. Dissimilarities between individual pain localizations and differences on the level of diagnostic groups were analyzed using the Hausdorff distance and the C-index. RESULTS: Pain location in patients with coronary heart disease (CHD) did not differ from the combined group of all other patients, including patients with chest wall syndrome (CWS), gastro-esophageal reflux disease (GERD) or psychogenic chest pain. There was also no difference in chest pain location between male and female CHD patients. CONCLUSIONS: Pain localization is not helpful in discriminating CHD from other common chest pain etiologies.


Assuntos
Dor no Peito/fisiopatologia , Doença das Coronárias/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Transtornos Psicofisiológicos/diagnóstico , Síndrome de Tietze/diagnóstico , Dor no Peito/etiologia , Estudos de Coortes , Doença das Coronárias/complicações , Estudos Transversais , Diagnóstico Diferencial , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Masculino , Exame Físico , Pleuropneumonia/complicações , Pleuropneumonia/diagnóstico , Atenção Primária à Saúde , Transtornos Psicofisiológicos/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Gastropatias/complicações , Gastropatias/diagnóstico , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico , Síndrome de Tietze/complicações
9.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 55(3): 175-180, mayo-jun. 2011.
Artigo em Espanhol | IBECS | ID: ibc-129074

RESUMO

Introducción. En la práctica clínica observamos con cierta frecuencia una prominencia esternoclavicular dolorosa, deformidad que constituye el principal signo de dos entidades con baja incidencia, aunque bien definidas: la hiperostosis esterno-costo-clavicular (HECC) y la osificación inter-esterno-costo-clavicular (OIECC). El diagnóstico diferencial de estas afecciones debe incluir la artrosis esterno-clavicular, la enfermedad de Paget, la osteitis condensante, la osteomielitis, la pustulosis, la enfermedad de Friederich, el síndrome de Tietze y el osteoma osteoide. Esto es especialmente importante en los casos en los que la afectación sea unilateral. Material y método. Presentamos una serie de nueve pacientes cuyo motivo de consulta fue una prominencia esterno-costo-clavicular, compatible con HECC u OIECC. El motivo de consulta en la mayoría de los pacientes fue el descartar la presencia de un tumor en esa localización. Resultados. Los estudios radiológicos mostraron un aumento variable tanto de la densidad como de la masa ósea, así como diferentes intensidades de afectación de la articulación esterno-costo-clavicular. Discusión. Descartado un tumor y con un diagnóstico concreto de la causa de la prominencia, generalmente, se considera suficiente con el tratamiento antiinflamatorio en la mayoría de los pacientes. En la práctica clínica parece irrelevante la diferenciación entre HECC y OIECC, ya que el tratamiento y el pronóstico de ambas afecciones son superponibles. La biopsia de la articulación y los procedimientos diagnósticos invasivos pueden ser innecesarios(AU)


Introduction. In clinical practice, we see quite often painful sterno-clavicular prominence, deformity, which is the hallmark of two entities with a low incidence, although well defined hyperostosis cost sterno-clavicular (HECC) and ossification cost inter-sterno-clavicular (OIECC). The differential diagnosis of these conditions, you must include sterno-clavicular arthritis, Paget's disease, condensing osteitis, osteomyelitis, pustulosis, Friederich's disease, Tietze's syndrome and osteoid osteoma. This is especially important in cases where the involvement is unilateral. Material and methods. We present a series of nine patients complaining of a painful sterno- clavicular prominence, compatible with HECC or OIECC. The reason for consultation in most patients was rule out the presence of a tumor in that location. Results. Image studies showed a variable increase both the density and bone mass as well as different intensities of joint involvement sterno-clavicular cost. Conclusion. Ruled out a tumor and a specific diagnosis of these, you do not need aggressive treatment, is generally considered sufficient anti-inflammatory treatment in most patients. In clinical practice, it is irrelevant and OIECC HECC differentiation, since treatment and prognosis of both conditions are similar. The biopsy of the joint and aggressive diagnostic procedures may be unnecessary (AU)


Assuntos
Humanos , Masculino , Feminino , Articulação Esternoclavicular/anormalidades , Hiperostose Esternocostoclavicular/complicações , Hiperostose Esternocostoclavicular/diagnóstico , Osteogênese/fisiologia , Osteoartrite/complicações , Osteoma Osteoide/complicações , Articulação Esternoclavicular/patologia , Articulação Esternoclavicular , Hiperostose Esternocostoclavicular/patologia , Hiperostose Esternocostoclavicular/fisiopatologia , Hiperostose Esternocostoclavicular , Diagnóstico Diferencial , Osteíte Deformante/complicações , Psoríase/complicações , Síndrome de Tietze/complicações
11.
Rev. Soc. Esp. Dolor ; 17(2): 99-103, mar. 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-79794

RESUMO

Alcanzar el diagnóstico de certeza en el dolor torácico subagudo o crónico debe ser una meta básica para predecir una posible muerte súbita, como ocurrió en este caso, que fue una muerte súbita de origen cardíaco: arritmia cardíaca con patrón electrocardiográfico de intervalo PQ corto junto a intervalo QT largo (AU)


Achieving certainty in the diagnosis of subacute or chronic chest pain should be a basic goal to predict possible sudden death, as in this case, it was a sudden cardiac death: cardiac arrhythmia with an electrocardiographic pattern of Short PQ interval alongside a Long QT interval (AU)


Assuntos
Humanos , Masculino , Adulto , Síndrome de Tietze/complicações , Morte Súbita Cardíaca/etiologia , Síndrome do QT Longo/complicações , Eletrocardiografia , Torsades de Pointes/complicações , Diagnóstico Diferencial
12.
G Ital Med Lav Ergon ; 31(2): 169-71, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19827277

RESUMO

The term costochondritis (ChC) indicates a painful and persistent inflammation at the costochondral or costosternal junction. The usual conservative treatment (NSAIDs), local splinting, local heat) and sometimes disappointing. The aim of this study is to evaluate the effect of stretching exercises in a group of patients affected with ChC. This retrospective open study involved 51 outpatients with diagnosis of ChC: thirty four consecutive patients were treated with stretching exercises, 34 patients matched for age, pain and disease duration constituted the control group. All the patients had spontaneous pain at least in the one of the costochondral junctions at the third to seventh rib. The intensity of spontaneous pain was measured by means of the visual analogic scale of Scott-Huskisson. The homogeneity of the two groups at the beginning of the study was checked for VAS, for disease duration and age by means of Mann-Whitney test for non-parametric measures. The statistical analysis of pain was done by Friedman analysis of variance and Student-Newman-Keuls multiple comparisons tests. The results showed a progressive significant amelioration in patients treated with stretching exercises as respect as the control group (p<0.001). The goal of therapy of costochondritis is to reduce inflammation and the pain. The NSAIDs, local injection of anaesthetic or steroid has insufficient effectiveness. The possibility to improve the pain by means of simple stretching exercises can supply a useful instrument in order to treat the condition of these patients.


Assuntos
Dor no Peito/terapia , Exercícios de Alongamento Muscular/métodos , Síndrome de Tietze/terapia , Idoso , Estudos de Casos e Controles , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico
18.
J Manipulative Physiol Ther ; 30(4): 321-5, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17509441

RESUMO

OBJECTIVE: This study was conducted to discuss the conservative care used to treat a female collegiate volleyball player with acute costochondritis. CLINICAL FEATURES: A 21-year-old collegiate volleyball player had right anterior chest pain and midthoracic stiffness of 8 months duration. INTERVENTION AND OUTCOME: High-velocity, low-amplitude manipulation was performed to the associated hypokinetic costovertebral, costotransverse, and intervertebral zygapophyseal thoracic joints. Instrument-assisted soft tissue mobilization was performed by using the Graston technique. Pain levels improved on numeric pain scale, as did functional status identified on Dallas Pain Questionnaire and Functional Rating Index. CONCLUSION: This athlete seemed to respond positively to manipulation, soft tissue mobilization, and taping.


Assuntos
Traumatismos em Atletas/terapia , Síndrome de Tietze/terapia , Adulto , Traumatismos em Atletas/complicações , Bandagens , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Doença Crônica , Feminino , Humanos , Manipulação da Coluna/métodos , Medicina Esportiva/instrumentação , Medicina Esportiva/métodos , Vértebras Torácicas , Síndrome de Tietze/complicações , Resultado do Tratamento
19.
J Rheumatol ; 31(11): 2269-71, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15517642

RESUMO

OBJECTIVE: We identified patients presenting with chest pain diagnosed as costochondritis by a consultant rheumatologist. The time taken to diagnosis was determined and the influence of diagnosis on subsequent management was assessed. We then estimated any cost benefits that early diagnosis and treatment of costochondritis might confer. Finally, we evaluated our current experience of sulfasalazine as a treatment for recurrent costochondritis. METHODS: This was a retrospective observational study of 25 consecutive patients (17 female), mean age 50 years (range 26-75), with costochondritis who initially presented with acute chest pain. RESULTS: The mean time to diagnosis was 9.4 (0-57) months. The total number of chest pain admissions pre-review was 39 compared with 6 post-review (p < 0.0001). The number of minor investigations was 169 pre-review compared with 17 post-review (p < 0.0001), and major investigations 30 compared with 0 (p < 0.01). All 13 patients treated with corticosteroid injections reported symptomatic improvement, and 10 of the 11 whose symptoms recurred responded to sulfasalazine. CONCLUSION: Patients with costochondritis frequently present with acute chest pain, often resulting in multiple admissions and investigations. In this study admission and investigation rates were significantly reduced following rheumatological review. How much of this reduction is directly a result of rheumatological intervention is unclear, given the limitations of the study. The findings suggest early review may improve patient care and reduce expenditure; in recurrent cases of costochondritis, sulfasalazine may be of additional longterm benefit.


Assuntos
Dor no Peito/etiologia , Hospitalização , Reumatologia/métodos , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia/economia , Sulfassalazina/uso terapêutico , Síndrome de Tietze/tratamento farmacológico , Fatores de Tempo
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