Post-Traumatic Abnormal Breathing Pattern

AFFILIATIONS:
¹University of Maryland College Park, MD 
²Saint Louis University School of Medicine, St. Louis, MO 
³Post Acute Medical, Dover, DE 
⁴ChristianaCare Christiana Hospital, Newark, DE 

CITATION:
Close A, Chaudhry M, Alekseyev K, Chaudhry B. Post-traumatic abnormal breathing pattern. Consultant. 2023;63(7):e3. doi:10.25270/con.2023.07.000001.

Received October 26, 2022. Accepted February 3, 2023. Published online July 13, 2023.

DISCLOSURES:
The authors report no relevant financial relationships.

ACKNOWLEDGEMENTS
None.

CORRESPONDENCE:
Alexandra Close, University of Maryland College Park, 4816 Waltonshire Circle, Olney, MD 20832 (a1tara2c@gmail.com)

A 60-year-old woman presented to the emergency department with blunt thoracic trauma after a head-on motor vehicle accident.

History. The patient had a past medical history significant for obesity, hyperlipidemia, and degenerative disc disease. An initial examination revealed fractures of the manubrium, ribs, femur, and scaphoid, along with abnormal chest wall movement and shortness of breath. On evaluation, all other vitals were stable. After a brief discharge of 3 days, she was readmitted due to progressive dyspnea. She did not appear to be in pain and was placed on 5 L of supplementary oxygen.

Diagnostic testing. An X-ray revealed an irregularity on the right 1st to 3rd ribs and a large right hemopneumothorax as a cause of the abnormal chest wall movement (Video 1). To relieve pressure in the thoracic cavity, a 12 French pigtail catheter was inserted under computed tomography (CT) guidance (Figure 1) and drained a total of 4.4 L of blood. Oxygen was then consistently lowered over the course of 3 days to a minimum of 2 L.

Video 1. The patient’s abnormal chest wall movement resulting from the blunt thoracic trauma.

Figure 1. The additional CT image of the irregularity.