Letters to Editor
5.
Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark’s and Palla’s signs in acute pulmonary embolism. Circulation 2007;115:e211.
6.
Ristic L, Rancic M, Pejcic T. Pulmonary embolism in patients with chronic hypoxemia. Med Pregl 2010;63:492-6. Access this article online Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125645
Figure 1: Chest x-ray on a PA projection that shows focal relative oligemia of the right upper lung (Westermark’s sign, circle), in contrast to significantly dilated right descending pulmonary artery, with a “sausage-like” appearance (Palla’s sign, arrow)
Double trouble: Testicular dislocation associated with hip dislocation Sir, Traumatic dislocation of testes is a rare injury.[1] It occurs as a result of direct external pressure to perineum, dislocating testis into the surrounding soft tissue. High-energy trauma leading to such injury may also lead to concomitant hip dislocation. To the best of our knowledge, such an association has not been reported.
Figure 2: CT pulmonary angiogram, coronal view, maximum intensity projection (MIP) series, with evidence of a large sized, saddle pulmonary embolus at the right pulmonary artery (arrow), with eccentric appearance suggestive of chronic thromboembolism; there are also smaller filling defects on the left pulmonary artery (ellipse), consistent with acute emboli
Jorge A. Brenes-Salazar Department of Medicine, Division of Cardiovascular Diseases, 200 First St SW Rochester MN, 55905, United States. E-mail: [email protected]
REFERENCES 1.
Tapson VF. Acute pulmonary embolism. N Engl Med J 2008;358:1037-52.
2.
Pipavath SN, Godwin JD. Acute pulmonary thromboembolism: A historical perspective. AJR Am J Roentgenol 2008;191:639-41.
3.
Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938;19:357-72.
4.
Palla A, Donnamaria V, Petruzzelli S, Rossi G, Riccetti G, Giuntini C. Enlargement of the right descending pulmonary artery in pulmonary embolism. AJR Am J Roentgenol 1983;141:513-7.
58
A 35-year-old male presented to our emergency department with history of road traffic accident. He was riding a motorcycle when he crashed into a stationed truck. He immediately experienced severe pain in his left hip, which he was unable to move. On physical examination, left hip was in attitude of flexion, abduction and external rotation. There was no distal neurovascular deficit. Radiograph of pelvis showed anterior dislocation of left hip joint into obturator foramen [Figure 1].The dislocation was immediately reduced under sedation without any difficulty by traction in the line of deformity followed by gentle abduction and internal rotation. After 2 hrs, the patient complained that his left testis could not be located in scrotum. He was sure that both testes were in normal position, prior to accident. On palpation, there was a tender ovoid mass in left inguinal region. Ultrasound confirmed an empty scrotum and demonstrated left testis in the groin. Closed reduction was performed under general anesthesia and was successful [Figure 2]. Testicular dislocation usually results from high-speed motorcycle crashes, with sudden deceleration causing direct straddling of scrotum on saddle.[2] Motorcycle accidents have been identified as Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Letters to Editor
manual reduction to surgical orchiopexy with lysis of adhesions and even orchiectomy, with possible deleterious effects of ectopic position. Traumatic testicular dislocation is frequently associated with other severe injuries such as hip dislocation. Knowledge of such an association by orthopedic surgeon, general surgeon s and emergency medicine physicians will prevent delay in diagnosis. High index of suspicion and thorough physical examination is the key for early diagnosis. Delayed diagnosis or treatment may lead to poor results.
Sanjay Meena, Nilesh Barwar, Buddhadev Chowdhury Figure 1: Anteroposterior (AP) radiograph of the pelvis at the time of presentation showing anterior dislocation of left hip
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:[email protected]
REFERENCES 1.
Chang KJ, Sheu JW, Chang TH, Chen SC. Traumatic dislocation of the testis. Am J Emerg Med 2003;21:247-9.
2.
Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V. Traumatic testicular dislocation a review of 36 cases. J Med Assoc Thai 2000;83:208-12.
3.
Munter DW, Faleski EJ. Blunt scrotal trauma: Emergency department evaluation and management. Am J Emerg Med1989;7:227-34.
4.
Meena S, Kishanpuria T, Gangari SK, Sharma P. Traumatic posterior hip dislocation in a 16-month-old child: A case report and review of literature. Chin J Traumatol 2012;15:382-4.
5.
Onyemaechi NO, Eyichukwu GO. Traumatic hip dislocation at a regional trauma centre in Nigeria. Niger J Med 2011;20:124-30.
Figure 2: Anteroposterior (AP) radiograph of the pelvis after reduction showing congruent reduction of left hip Access this article online
one of the most common causes of testicular dislocation.[3] Hip position during trauma defines the direction of dislocation.[4,5] The position of patients involved in motorcycle accidents makes them more prone for anterior hip dislocation due to the position of leg. Our patient while riding his motorcycle had hit a stationary truck. Due to this sudden impact, there was wide abuction, external rotation and flexion at hip joint leading to anterior hip joint dislocation. These forces also led to the scrotum hitting the seat/fuel tank, which may have caused testicular dislocation. Diagnosis of testicular dislocation can be made by physical examination when a well-developed but empty scrotal sac is found or an abnormally located testis is palpated. However, other concomitant injuries may preclude disclosure of testicular dislocation. Testicular dislocation can be diagnosed on computed tomography (CT) which reveals empty scrotum or presence of dislocated testis in locations including the inguinal, pubic, penile, perineal, or even intra-abdominal regions. CT or sonography can also reveal testicular dislocation that is masked by severe scrotal edema, hematoma, or associated pelvic injuries. Once testicular dislocation is diagnosed, early treatment should be instituted. A delay in diagnosis of testicular dislocation may convert Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125646
Surgical digestive emergencies in prisoners, about a prospective study Sir, The prison environment is a breeding ground for a number of gastrointestinal diseases. It has been rarely studied and 59
Copyright of Journal of Emergencies, Trauma & Shock is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
5.
Sreenivasan S, Bennett S, Parfitt VJ. Images in cardiovascular medicine. Westermark’s and Palla’s signs in acute pulmonary embolism. Circulation 2007;115:e211.
6.
Ristic L, Rancic M, Pejcic T. Pulmonary embolism in patients with chronic hypoxemia. Med Pregl 2010;63:492-6. Access this article online Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125645
Figure 1: Chest x-ray on a PA projection that shows focal relative oligemia of the right upper lung (Westermark’s sign, circle), in contrast to significantly dilated right descending pulmonary artery, with a “sausage-like” appearance (Palla’s sign, arrow)
Double trouble: Testicular dislocation associated with hip dislocation Sir, Traumatic dislocation of testes is a rare injury.[1] It occurs as a result of direct external pressure to perineum, dislocating testis into the surrounding soft tissue. High-energy trauma leading to such injury may also lead to concomitant hip dislocation. To the best of our knowledge, such an association has not been reported.
Figure 2: CT pulmonary angiogram, coronal view, maximum intensity projection (MIP) series, with evidence of a large sized, saddle pulmonary embolus at the right pulmonary artery (arrow), with eccentric appearance suggestive of chronic thromboembolism; there are also smaller filling defects on the left pulmonary artery (ellipse), consistent with acute emboli
Jorge A. Brenes-Salazar Department of Medicine, Division of Cardiovascular Diseases, 200 First St SW Rochester MN, 55905, United States. E-mail: [email protected]
REFERENCES 1.
Tapson VF. Acute pulmonary embolism. N Engl Med J 2008;358:1037-52.
2.
Pipavath SN, Godwin JD. Acute pulmonary thromboembolism: A historical perspective. AJR Am J Roentgenol 2008;191:639-41.
3.
Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938;19:357-72.
4.
Palla A, Donnamaria V, Petruzzelli S, Rossi G, Riccetti G, Giuntini C. Enlargement of the right descending pulmonary artery in pulmonary embolism. AJR Am J Roentgenol 1983;141:513-7.
58
A 35-year-old male presented to our emergency department with history of road traffic accident. He was riding a motorcycle when he crashed into a stationed truck. He immediately experienced severe pain in his left hip, which he was unable to move. On physical examination, left hip was in attitude of flexion, abduction and external rotation. There was no distal neurovascular deficit. Radiograph of pelvis showed anterior dislocation of left hip joint into obturator foramen [Figure 1].The dislocation was immediately reduced under sedation without any difficulty by traction in the line of deformity followed by gentle abduction and internal rotation. After 2 hrs, the patient complained that his left testis could not be located in scrotum. He was sure that both testes were in normal position, prior to accident. On palpation, there was a tender ovoid mass in left inguinal region. Ultrasound confirmed an empty scrotum and demonstrated left testis in the groin. Closed reduction was performed under general anesthesia and was successful [Figure 2]. Testicular dislocation usually results from high-speed motorcycle crashes, with sudden deceleration causing direct straddling of scrotum on saddle.[2] Motorcycle accidents have been identified as Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Letters to Editor
manual reduction to surgical orchiopexy with lysis of adhesions and even orchiectomy, with possible deleterious effects of ectopic position. Traumatic testicular dislocation is frequently associated with other severe injuries such as hip dislocation. Knowledge of such an association by orthopedic surgeon, general surgeon s and emergency medicine physicians will prevent delay in diagnosis. High index of suspicion and thorough physical examination is the key for early diagnosis. Delayed diagnosis or treatment may lead to poor results.
Sanjay Meena, Nilesh Barwar, Buddhadev Chowdhury Figure 1: Anteroposterior (AP) radiograph of the pelvis at the time of presentation showing anterior dislocation of left hip
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail:[email protected]
REFERENCES 1.
Chang KJ, Sheu JW, Chang TH, Chen SC. Traumatic dislocation of the testis. Am J Emerg Med 2003;21:247-9.
2.
Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V. Traumatic testicular dislocation a review of 36 cases. J Med Assoc Thai 2000;83:208-12.
3.
Munter DW, Faleski EJ. Blunt scrotal trauma: Emergency department evaluation and management. Am J Emerg Med1989;7:227-34.
4.
Meena S, Kishanpuria T, Gangari SK, Sharma P. Traumatic posterior hip dislocation in a 16-month-old child: A case report and review of literature. Chin J Traumatol 2012;15:382-4.
5.
Onyemaechi NO, Eyichukwu GO. Traumatic hip dislocation at a regional trauma centre in Nigeria. Niger J Med 2011;20:124-30.
Figure 2: Anteroposterior (AP) radiograph of the pelvis after reduction showing congruent reduction of left hip Access this article online
one of the most common causes of testicular dislocation.[3] Hip position during trauma defines the direction of dislocation.[4,5] The position of patients involved in motorcycle accidents makes them more prone for anterior hip dislocation due to the position of leg. Our patient while riding his motorcycle had hit a stationary truck. Due to this sudden impact, there was wide abuction, external rotation and flexion at hip joint leading to anterior hip joint dislocation. These forces also led to the scrotum hitting the seat/fuel tank, which may have caused testicular dislocation. Diagnosis of testicular dislocation can be made by physical examination when a well-developed but empty scrotal sac is found or an abnormally located testis is palpated. However, other concomitant injuries may preclude disclosure of testicular dislocation. Testicular dislocation can be diagnosed on computed tomography (CT) which reveals empty scrotum or presence of dislocated testis in locations including the inguinal, pubic, penile, perineal, or even intra-abdominal regions. CT or sonography can also reveal testicular dislocation that is masked by severe scrotal edema, hematoma, or associated pelvic injuries. Once testicular dislocation is diagnosed, early treatment should be instituted. A delay in diagnosis of testicular dislocation may convert Journal of Emergencies, Trauma, and Shock I 7:1 I Jan - Mar 2014
Quick Response Code: Website: www.onlinejets.org
DOI: 10.4103/0974-2700.125646
Surgical digestive emergencies in prisoners, about a prospective study Sir, The prison environment is a breeding ground for a number of gastrointestinal diseases. It has been rarely studied and 59
Copyright of Journal of Emergencies, Trauma & Shock is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
