Chest and Upper Back Injuries: Symptoms and Treatment Options

Q: Chest and Upper Back Injuries: Symptoms and Treatment Options

Hello： Chest compression due to gravity may lead to pneumothorax, hemothorax, rib fractures, and damage to the chest wall muscles, which can cause rhabdomyolysis and subsequently result in acute kidney failure. <br>Kidney disease may also lead to secondary hypertension and protei

Injury to the left chest and upper back due to gravitational compression?

Hello Dr.
Tsai,
I have experienced compression in my left chest and upper back.
The front of my chest was subjected to mechanical pressure from a screw with a diameter of 1.8 cm and a length of approximately 6 to 8 cm, which is pressing against my left chest (the center of the screw is located at a point 5 cm horizontally from the left nipple and 4.3 cm vertically upwards).
The upper back was compressed by a beam from a moving crane.
I am unsure how deep the compression is, but I heard a cracking sound from my bones.
Currently, there is a slight indentation in the left anterior lower chest wall, and I have costochondritis on the left side of my sternum.
The circular scar from the screw is still present, and the rib above the scar is slightly depressed.
Immediately after the injury, when my body leaned forward, the tissue above the scar would protrude about 2 cm, forming a bulge of approximately 3 to 4 cm at the base.
Now, it only protrudes about 1 cm and forms a gas-filled bulge of about 5 cm when I cough.
The pain was initially more severe.
After the injury, I experienced rhabdomyolysis leading to acute renal failure and pulmonary edema (about 500 cc of fluid was drained).
I also had hypertension.
After about 20 days, a cardiologist diagnosed me with mitral valve disease and other malignant secondary hypertension, along with left ventricular hypertrophy.
A kidney biopsy later revealed tubular damage.
A few months later, I developed cardiac arrhythmias, and my right kidney has also atrophied.
Currently, my urine still has bubbles that take a long time to dissipate, and the cause remains undetermined.
Additionally, I have a symptom where I frequently feel soreness, twitching, tightness, and an uncomfortable pulsing sensation starting from the left posterior neck (about 6 cm below the left ear), which then spreads throughout my head.
Sometimes, even turning my head is difficult.
Pressing on the aforementioned point behind my ear exacerbates the discomfort.
Are these symptoms related to cardiovascular or neurological issues? What is the pathological connection among these various conditions, and how should they be treated? Furthermore, what is the cause of the other malignant secondary hypertension? Thank you for your patience in reading this lengthy description.
I hope it provides you with a clearer understanding of my situation.
Please help me!

Luo Si Zhou, 40~49 year old female. Ask Date: 2010/09/29

Dr. Cai Ruiyuan reply Family Medicine

Hello: Chest compression due to gravity may lead to pneumothorax, hemothorax, rib fractures, and damage to the chest wall muscles, which can cause rhabdomyolysis and subsequently result in acute kidney failure.
Kidney disease may also lead to secondary hypertension and proteinuria (bubbles in the urine).
Additionally, chest compression may cause muscle strains in the head and neck region.
You may consider consulting with a thoracic surgeon or a cardiologist for further evaluation and follow-up on your condition.

Reply Date: 2010/09/29

More Info

I'm sorry to hear about the severe injuries and complications you've experienced following your accident. It sounds like you've been through a lot, and I appreciate your detailed description of your symptoms and medical history. Let's break down your concerns regarding chest and upper back injuries, as well as the associated symptoms and treatment options.

Understanding Your Injuries
From your description, it appears that you have sustained significant trauma to your left chest and upper back due to the pressure from the screw and the overhead beam. The symptoms you are experiencing, including the indentation in your chest wall, costochondritis (inflammation of the cartilage connecting the ribs to the sternum), and the presence of a "gas bag" that appears when you cough, suggest that there may be underlying structural damage to your ribs or sternum.

The acute complications you mentioned, such as rhabdomyolysis leading to acute kidney failure and pulmonary edema, are serious and indicate that your body has undergone significant stress due to the injury. Rhabdomyolysis occurs when muscle tissue breaks down and releases myoglobin into the bloodstream, which can damage the kidneys. The presence of fluid in your lungs (pulmonary edema) can also be a result of heart strain or fluid overload, which is concerning given your subsequent heart issues.

Symptoms and Their Implications
1. Chest Pain and Indentation: The indentation and pain in your chest could be due to rib fractures or costochondritis. The sound you heard during the injury might indicate a fracture or dislocation of the ribs or sternum.
2. Respiratory Symptoms: The cough-induced bulge suggests that there may be a herniation of soft tissue or fluid accumulation in the chest cavity. This could be related to the trauma and may require imaging studies to assess.

3. Cardiovascular Symptoms: The discomfort radiating from the area behind your ear and down your neck could be related to nerve irritation or vascular issues, especially given your history of hypertension and heart valve disease.
4. Kidney Issues: The kidney damage and the presence of bubbles in your urine could indicate ongoing renal issues, possibly related to the initial rhabdomyolysis or other underlying conditions.

Treatment Options
1. Pain Management: Given the severity of your pain, a multi-modal approach to pain management may be necessary. This could include medications such as NSAIDs (if tolerated), muscle relaxants, or even nerve blocks if the pain is severe.

2. Physical Therapy: Engaging in physical therapy can help improve mobility and strength in the affected areas. A therapist can provide exercises tailored to your condition, focusing on gentle stretching and strengthening without exacerbating your pain.

3. Imaging Studies: It would be beneficial to have imaging studies such as X-rays or a CT scan to assess for any fractures, hernias, or other structural issues in the chest and back.

4. Cardiovascular Evaluation: Given your history of heart issues, ongoing monitoring by a cardiologist is essential. They may recommend further testing, such as an echocardiogram or Holter monitor, to assess your heart's function and rhythm.

5. Nephrology Consultation: Since you have experienced kidney complications, a nephrologist should be involved in your care to monitor kidney function and manage any ongoing issues related to your renal health.

6. Addressing Hypertension: Managing your blood pressure is crucial, especially in the context of your heart and kidney health. This may involve medication adjustments and lifestyle changes.

Conclusion
The symptoms you are experiencing are complex and likely interrelated, stemming from the initial trauma and subsequent complications. A comprehensive approach involving pain management, physical therapy, and close monitoring of your cardiovascular and renal health is essential. It is crucial to maintain open communication with your healthcare providers to ensure that all aspects of your health are being addressed.

If you have not already done so, I strongly encourage you to seek a multidisciplinary team approach, including orthopedic specialists, cardiologists, nephrologists, and pain management specialists, to optimize your recovery and quality of life. Please take care, and I wish you the best in your healing journey.

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