Today, Dr. Jason Mannion presented an interesting case of a young male with sickle cell anemia and Cluster B personality disorder who presented with sharp, substernal chest pain concerning initially for acute chest syndrome, but was found on CXR to have swallowed a foreign body.
Learning Points: The diagnostic criteria for acute chest syndrome include:
- A new segmental radiographic pulmonary infiltrate AND at least one of the following:
- Temperature > 38.5C
- A >2% decrease in SpO2
- PaO2 <60 data-preserve-html-node="true" mmHg
- Intercostal retractions, nasal flaring, or use of accessory muscles of respiration
- Chest pain
Management of ACS includes: adequate and immediate pain control, fluid management to prevent hypovolemia, supplemental oxygen and IS, blood transfusion, antibiotics, and VTE prophylaxis.
Check out this excellent article in Gastroenterology & Hepatology. The highlights of the article are below:
- Intentional foreign body ingestion is most commonly seen in adults with intellectual or mental disabilities, significant substance abuse, psychiatric disorders, or external motivations (such as avoidance of a jail sentence).
- The management protocol of foreign body ingestions depends on the object type, shape, location, associated symptoms, time course, and complications.
- Treatment should include a multidisciplinary team including endoscopists, surgeons, and psychiatrists.