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■ Redness and swelling around surgical site

■ Hamman sign (systolic crunching sound)

DIFFERENTIAL

Cellulitis, necrotizing fasciitis, pharyngitis, pneumonia, Ludwig angina

DIAGNOSIS

■ Mainly a clinical diagnosis

■ CXR and CT may reveal findings of pneumomediastinum, air fluid levels

or precervical, retropharyngeal, and paratracheal soft tissue swelling.

■ MRI is not useful if recent surgery with metallic hardware

TREATMENT

■ Ensure adequate airway protection.

■ Broad-spectrum antibiotics including coverage for MRSA, pseudomonas, and

oral and GI flora

■ Treat sepsis if present.

■ Surgical consult if debridement is necessary.

COMPLICATIONS

Sepsis, pneumoperitoneum, pneumothorax

PULMONARY IRRITANTS

Pneumoconiosis

Pneumoconiosis is a lung disease caused by inhalation of organic or inorganic

dusts. It usually develops over long periods of time and is often occupation

related. The chronic inflammation caused by these dust particles eventually →

pulmonary fibrosis.

CAUSES

Common dusts include: asbestos, silica minerals, talc, and carbon materials

(see Table 10.19), and rarely, beryllium and hard metals (cobalt, tungsten car-

bide, aluminum).

SYMPTOMS/EXAM

■ Often asymptomatic for 20–30 years from time of initial exposure

■ Depends on severity and length of exposure

■ Insidious onset of shortness of breath or dyspnea on exertion

■ Made worse with cigarette smoking

■ Cough, sputum production, and wheezing are unusual

■ Fine bibasilar and end-inspiratory crackles

DIFFERENTIAL

COPD, TB, fungal infection, interstitial lung disease, cancer, rheumatoid

nodules, sarcoidosis

DIAGNOSIS

■ Reliable exposure history

■ Evidence of interstitial fibrosis by:

THORACIC AND RESPIRATORY

DISORDERS