Consider the following statements regarding flail chest: 1. Three or more ribs are fractured at two or more places. 2. The chest wall shows paradoxical motion. 3. An X-ray chest AP view is the gold standard for diagnosis. 4. Treatment involves oxygen support, analgesia and physiotherapy. Which of the statements given above are correct?
1, 2 and 4
The correct combination is 1, 2 and 4. Flail chest is fracture of three or more contiguous ribs at two or more sites, freeing a segment of chest wall. The flail segment moves paradoxically, drawn in during inspiration and out during expiration. However, hypoxia is caused mainly by the underlying pulmonary contusion rather than the paradoxical movement. Management is supportive: oxygen, aggressive analgesia (intercostal, paravertebral or epidural block), chest physiotherapy and pulmonary toilet, with ventilation or operative rib fixation reserved for respiratory failure.
Statement 3 is wrong. Flail chest is a clinical, bedside diagnosis made by inspecting and palpating paradoxical movement; a plain AP chest film is insensitive and misses non-displaced, anterior and costochondral fractures. CT chest is far more accurate for the fracture pattern and associated contusion, haemothorax and pneumothorax. Options 1,2,3; 1,3,4; and 2,3,4 all include this false statement.
Key point: Diagnose flail chest clinically by paradoxical movement and treat the pulmonary contusion; never strap the chest.
Important Questions from Chest & Lung Surgery
Which of the following are correct for herniation via foramen of Morgagni?
1. It occurs posteriorly in chest.
2. Transverse colon is the commonest content.
3. Defect is between sternal and costal attachments.
4. It is a type of congenital hernia.
Select the answer using the code given below.
A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is $26$ breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagno- sis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left second intercostal space should be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
Select the correct answer using the code given below :
- A patient of road traffic accident presents to the emergency with increasing restlessness and difficulty in breathing. The respiratory rate is 26 breaths/minute; there are distended neck veins; trachea is deviated to the right side with hyper-resonant note and absence of breath sounds on the left side. Which of the following statements are correct?
1. The most probable clinical diagno-sis is left tension pneumothorax
2. Immediate chest decompression using wide bore cannula in left second intercostal space should be done
3. Immediate chest X-ray should be done to confirm the clinical diagnosis
4. Definitive chest tube insertion in left fifth intercostal space should be done
Select the correct answer using the code given below : - A 50 year old male presented with pain along the left arm and ptosis. His chest X-ray showed soft tissue opacity at the apex of the left lung along with the erosion of the adjacent rib. The probable diagnosis is:
- Which of the following are the Indications for lung transplantation?
1. Emphysema
2. Primary pulmonary hypertension
3. Obliterative bronchiolitis
Select the correct answer using the code given below:
