Chief Complaint: " I can't see "

Here is a regular CXR - for comparison.

An individual presented to the ER with the main complaint being " I can't see".

Stroke, Tumor, Retinal detachment - there are a few possibilities for this condition.
This patient had an interesting cause.

Here is what happened.

The patient had fallen several days prior to their vision loss (possibly a week before). Unknown to them (or possibly ignored by them) they had broken some ribs and punctured their lung. The air leaking out of there lung had steadily leaked out of the chest and into the space between the ribs / muscle and the skin (an area typically full of fat) called the Subcutaneous (SubQ) layer of tissue.

As the air continued to leak out it tracked up and down that subQ tissue plane until it had eventually caused swelling in their eyelids to the point where he could not open them any longer, hence his chief complaint. They had air literally from the top of their head to their toes. They felt kind of crinkly / crunchy when we touched them.

Obviously there are a few questions here like -- did you not notice that you were swelling up like a balloon. Very bizarre. In any case the patient recovered fully.

I have examples of subcutaneous emphysema above to illustrate the situation.

When good valves go bad!

As most of you who know me already know, my mom had to have surgery this week to replace her mitral valve. The mitral valve is one of four valves in the heart. (See picture 1)

Her valve was damaged by rhumatic fever as a child and had gotten progressivly thickened and scarred to the point where it was not allowing much blood past it. (Picture 2 is a valve with sclerosis from rhumatic disease)

After several years of progressing fatigue she and her physicians elected to replace it.

On Dec 5th, she had a new valve made out of bovine (cow) tissue placed. It was done minimally invasive meaning she didn't have to have a sternotomy, (they went through her right ribcage), but it is still pretty painful. (Picture 3 shows the approach and you can see the valve at the 11 oclock position)

In any case, she seems to be doing well for now and should be out of the ICU tonight.

Thanks to all of you for your prayers and concern.