Spontaneous Tracheal Rupture in a Case of Interstitial Lung Disease (ILD): A Case Report

Diagnosis, imaging, and potential morbidities of the hallux interphalangeal joint os interphalangeus

Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2-13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle.

A Rare Yet Morbid Complication of Endotracheal Intubation: Tracheal Rupture

Tracheal tears are an uncommon phenomenon that can occur due to infection, blunt or penetrating trauma or iatrogenic causes secondary to endotracheal intubation or procedures such as bronchoscopy. Post-intubation tracheal laceration is a very rare yet serious complication with high morbidity and mortality rates. Here, we report the case of a 53-year-old woman with a medical history of hypertension who presented with complaints of facial swelling after undergoing arthroscopic debridement of the coracoacromial ligament as well as partial resection of the acromion for impingement of the right shoulder under general anaesthesia. The patient was found to have extensive pneumomediastinum, subcutaneous emphysema, and a large tracheal tear. We aim to highlight this rare complication of endotracheal intubation, discuss the presenting signs and symptoms, and explore the various management options.

LEARNING POINTS

Iatrogenic tracheal laceration after intubation is a rare but life-threatening complication.Prompt recognition and treatment is required to reduce morbidity and mortality.

Acute tracheal tear - A potential cause of spontaneous pneumomediastinum in patients with COVID-19

Spontaneous pneumomediastinum following prolonged periods of severe coughing should raise the suspicion of tracheal rupture in COVID-19 patients.

STUDIES ON THE APPLICATION OF THE VIRTUAL BRONCHOSCOPY METHOD FOR TRACHEAL AND BRONCHIAL RUPTURES

Traumatic injuries of major airways (trachea and main bronchus) are rare in medical practice but represent extremely life-threatening conditions. The study aims to present a summary of research findings on the diagnostic capabilities of Virtual bronchoscopy (VB) in ruptures of trachea and bronchi. There is very little research into the applicability of VB in Bulgaria. Still, the modern equipment for MDCT VB during the last years provides to use the VB in diagnostic practice and for scientific examinations. The method of VB is recognized as a reliable tool in diagnostic practice and the research of tracheal and bronchial ruptures.