Article Text
Chest clinic
Pulmonary puzzles
Pulmonary puzzle: a precordial crunch
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Three patients with unusual additional sounds heard on auscultation of the precordium were admitted to a military hospital in Afghanistan.
Patient 1: A male in his 20s was shot in his left flank. Injuries included a left haemothorax and visceral injuries. An intercostal drain (ICD) was inserted. After surgery, he was admitted to the intensive care unit (ICU) where a ‘click’ was heard on auscultation of the precordium just after the second heart sound, loudest in expiration. A chest radiograph was taken (figure 1).
Patient 2: A male in his 20s was very close to an explosion. He had fragmentation wounds to his chest, abdomen and limbs. Initial CT scan demonstrated …