Post-traumatic swelling

[ismailalamin]

A 49 year old woman presented to the emergency department
with facial swelling (fig 1). She had fallen four days previously,
striking her back on a large piece of concrete. After picking
herself up she proceeded with her normal activities. The morning
after the fall she awoke with swelling of the ankles. The swelling
gradually spread throughout her body and four days later it
began to compromise her vision. On admission to the emergency
department she was generally fit and well, despite the swelling,
although she was slightly short of breath on exertion.


On examination she had gross swelling of the chest wall and
abdomen extending to the ankles and wrists in the periphery.
Breath sounds could be auscultated with a small amount of
continuous pressure to the chest wall with the stethoscope. There
was a hyper-resonant percussion note and reduced breath sounds
on the left side of the thorax, with mild tenderness to percussion
on the left posterior thorax over the eighth, ninth, and tenth ribs.
Her vision was reduced owing to restricted eye opening, but
when her eyelids were opened manually her pupils were equal
and reactive to light and accommodation bilaterally. Visual
acuity and eye movements were normal in both eyes. All other
systems examinations were normal and oxygen saturations on
room air were 96%. She underwent computed tomography of
the thorax (fig 2)


Questions
1 What is the differential diagnosis for widespread soft tissue
swelling?

2 What does the computed tomogram show about the type
of swelling and its causes?

3. What is the underlying pathophysiology of this condition
and what are the presenting symptoms and life threatening
complications?

4. What treatments should be implemented?

[ismailalamin]

this is a case from BMJ, i but it because we saw a case looks like this one and was misdiagnosed for up to 2 days.

[ismailalamin]

in our case we attributed the swelling to hypersensitivity due to analgesic given for the patient due to chest pain after patient falls, but it proved to be as this case here.