• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.272-274
• /
• 2009

Xiphodynia is a term used to describe a painful xiphoid process, and this is a rare musculoskeletal disorder that can radiate to the anterior chest, epigastrium, neck, shoulders and back. Clinical awareness of xiphodynia is important for making its correct diagnosis. We report here on two cases of xiphodynia. The diagnosis was suggested by the reproduction of the anterior chest pain or/and the epigastrium pain with light pressure on the xiphoid process. The patient of case 1 had suffered from xiphodynia throughout the years, and this patient underwent surgical excision of the xiphoid process. The patient of case 2 received an injection of local anesthetic agent to the xiphoid process.

• Journal of Trauma and Injury
• /
• v.27 no.1
• /
• pp.9-12
• /
• 2014

Violent or severe persistent coughing is rarely associated with rib fracture. We report a rare case of a cough-induced rib fracture in a patient without any traumatic history or any other underlying disease. A 32-year-old female presented to the emergency department complaining of having had right-sided pleuritic chest pain for 5 days. She had a background of an 8-week coughing illness. A posteroanterior view of the chest radiograph showed no definite fractured line. Chest computed tomography revealed a subtle break cortical line of the 7th rib in the right-sided chest wall. Early identification of a cough-induced fracture of the rib by using computed tomography may avoid unnecessary further work-ups including laboratory examination and may lead to appropriate discharge instructions including rest and reassurance. The clinical presentations and radiologic findings of rib fractures caused by coughing are presented along with a review of the literature.

• Journal of Chest Surgery
• /
• v.57 no.3
• /
• pp.291-299
• /
• 2024

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

• The Journal of Churna Manual Medicine for Spine and Nerves
• /
• v.10 no.2
• /
• pp.27-35
• /
• 2015

Objectives: The purpose of this study is to discriminate the cough-induced rib fracture with chest pain occurred after chuna therapy. Methods: A 68-year-old female patient who is suffering from left chest wall pain with chronic cough was treated by Korean medical treatment and chuna therapy from November 11th 2014 to November 15th 2014. The improvement of the patient's pain was measured by 100 mm Visual Analog Scale (VAS). For diagnosis the rib fracture, we conducted the radiography, computed tomography (CT), and bone scan. Results: After treatment, pain intensity was decreased and the rib fracture was negative in radiography and CT. But, in bone scan, the 5th-8th rib fractures in left side were detected. Conclusions: When the patient with chest pain visit the hospital after chuna therapy, a doctor keep in mind the possibility of coughinduced rib fracture.

• Clinics in Shoulder and Elbow
• /
• v.7 no.1
• /
• pp.46-50
• /
• 2004

The snapping scapula is a relatively uncommon phenomenon occuring as a consequence of some anomalous conditioin existing between the thoracic wall and the undersurface of the scapula. It may present in several ways like crepitus, pain during scapular movement and limitation of scapular motion. The causes of snapping scapula are changes in the intervening soft tissues, the muscles, or the bursae between the scapula and the chest wall; and changes in the congruence between the anterior scapular surface and the underlying chest wall. The congenital elbow fusion or humeroradioulnar synostosis is an extremely rare inheritable disorder that previously described just a few reports. Recently we experienced a case of snapping scapular with congenital bilateral elbow fusion treated by arthroscopic scapulothoracic bursectomy and consequent open superomedial scapulectomy. We would describe the clinical feature of a snapping scapula and result of treatment with literature review.

• Journal of Chest Surgery
• /
• v.13 no.3
• /
• pp.312-318
• /
• 1980

The first case was a 20 year old female who has been suffered from epigastric pain, and anorexia for 2 years. A thumb tip sized pulsion diverticulum 4cm above the esophagocardial junction was elicited by esophagogram and on exploration. A diverticulectomy with long esophagocardiomyotomy was performed. The second case was a 30 year old house wife who has had postprandial epigastric pain for 2 months accompained with frequent vomiting. Fiberscopy and esophagogram showed epiphrenic diverticulum of the esophagus. Same operative procedures were carried out and obtained a good result as first case. The third case was a 55 year old house wife who was admitted to this Chest Surgery Department because of regurgitation and intermittent vomiting for approximately 3 months. Esophagogram showed a large epiphrenic diverticulum of the esophagus. On exploration, a tennis ball sized pulsion diverticulum was found on the anterolateral wall of the esophagus. A partial esophagectomy including the diverticulum and esophagoesophagostomy was performed. The specimenshowed some erosive changes of the mucosal surface of the diverticulum and also the esophagus suggestive of diverticulitis and esophagitis. She has been satisfactory result until 4 months postoperatively, when she developed regurgitation and epigastric pain. Esophagogram showed stenosis of the operative site. Readmission and esophageal dilatations were done and improved without any problem. Epiphrenic or supradiaphragmatic diverticulum of the esophagus is a rare condition. Pathophysiologically, the conditions accompanied the spasm of the esophagus, many authors prefered the procedures of a diverticulectomy plus long esophagocardiomyotomy rather than simple diverticulectomy or esophagectomy and esophagoesophagostomy. Here we report the cases and reviewed the literatures.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.3
• /
• pp.222-224
• /
• 2008

Spontaneous pneumomediastinum is defined as a clinical syndrome that's characterized by the presence of air in the mediastinal space, which is not due to an old previous injury or surgery. The condition is caused by a sustained increase in the intraalveolar and intrabronchial pressure with extravasated air dissecting along the perivascular spaces of the mediastinum. This is an uncommon complication of sports activity. The most common symptom is chest pain. This diagnosis should be considered for younger people who present with pleuritic chest pain or dyspnea and a characteristic crackling feel (known as subcutaneous crepitation) when touching of the skin covering the chest wall or neck, and they look otherwise well with normal vital signs. Usually no treatment is required, but the mediastinal air will be absorbed faster if the patient inspires high concentrations of oxygen. We present here a case of spontaneous pneumomediastinum that occurred during a Taekwondo match, along with a review of the relevant literature.

• Journal of Chest Surgery
• /
• v.28 no.5
• /
• pp.521-524
• /
• 1995

Esophageal leiomyoma is a very rare disease. We present a patient who underwent enucleation of esophageal leiomyoma through a left thoracotomy. The patient was suffered from substernal pain and chest discomfort for 4 months.The esophagogram revealed irregular ovoid smooth filling defect in just proximal portion of G-E junction with the normal mucosal folds. Chest CT demonstrated well-defined, polypoid tumor mass on the anterolateral wall of the distal esophagus. Esophagoscopy revealed normal intact mucosal patterns with swollen hard protruded tumor mass lesion from the just proximal portion of G-E junction. In June, 1993, patient underwent enucleation of esophageal leiomyoma through the left thoracotomy. A horseshoe and spiral shaped, whitish firm tumor mass was noted on the distal esophagus, and the tumor mass was enucleated by blunt dissection carefully. The esophageal leiomyoma was confirmed with histopathological examination. The postoperative course was smooth and uneventful.

• Journal of Chest Surgery
• /
• v.49 no.5
• /
• pp.361-365
• /
• 2016

Background: Sternal fractures are relatively rare, and caused mainly by blunt anterior chest wall trauma. In most cases, sternal fractures are treated conservatively. However, if the patient exhibits problematic symptoms such as intractable chest wall pain or bony crepitus due to sternal instability, surgical correction is indicated. But no consensus exists regarding the most appropriate surgical method. We analyzed the results of surgical fixation in cases of sternal fracture in order to identify which surgical method led to the best outcomes. Methods: We retrospectively reviewed the medical records of patients with sternal fractures from December 2008 to December 2011, and found 19 patients who underwent open reduction and internal fixation of the sternum with a longitudinal plate (L-group) or a T-shaped plate (T-group). We investigated patients' characteristics, clinical details regarding each case of chest trauma, the presence of other associated injuries, the type of open reduction and fixation, whether a combined operation was performed, and postoperative complications. Results: Of the 19 patients, 10 patients (52.6%) were male, and their average age was 56.8 years (range, 32 to 82 years). Seven patients (36.8%) had isolated sternal fractures, while 12 (63.2%) had other associated injuries. Seven patients (36.8%) were in the L-group and 12 patients (63.2%) were in the T-group. Three patients in the L-group (42.9%) showed a loosening of the fixation. In all patients in the T-group, the fracture exhibited stable alignment. Conclusion: Open reduction and internal fixation with a T-shaped plate in sternal fractures is a safer and more efficient treatment method than treatment with a longitudinal plate, especially in patients with a severely displaced sternum or anterior flail chest, than a longitudinal plate.

• The Korean Journal of Pain
• /
• v.6 no.1
• /
• pp.109-116
• /
• 1993

In March of l992, We performed two intentional total spinal blocks for the relief of pain. This was for 2 cases of post-traumatic cervical syndrome whose various symptoms were chronically unresponsive to the usual conservative treatments. We regularly checked the blood pressure, pulse rate, oxygen saturation and observed clinically the changes of respiration, consciousness, lid and light reflexes during the total spinal block. Pain relief was evaluated by using the Visual Analog Scale which is designed to measure the subjective intensity of pain. The results were as follows; 1) The effectiveness of total spinal block was 60% in case 1, 40% in case 2. 2) We observed two complications from the procedure. Firstly during the block, these were transient periods of hypotension. Following the block, accidental procedures related direct neural trauma resulted in anterior chest wall pain. In conclusion we believe that total spinal block is a satisfactory and reliable method for the treatment of post-traumatic cervical syndrome.