Complications After Chest Injuries: A Comprehensive Guide

Why can various diseases develop after a chest injury?

Hello Dr.
Liao,
I experienced compression on the left side of my chest and upper back due to gravity.
My chest was impacted by a mechanical force, with a screw measuring 1.8 cm in diameter and approximately 6 to 8 cm in length pressing against my left chest (the center of the screw is located 5 cm horizontally from the left nipple towards the sternum and 4.3 cm vertically upwards).
This may be near the position of the heart.
The upper back was compressed by a horizontal beam of a fixed crane while I was in motion.
I am unsure how deep the compression was, but I heard the sound of bones cracking.
Currently, there is a slight indentation in the left anterior lower chest wall, and I have left-sided costochondritis.
The circular scar from the screw is still present, and the rib above the scar appears slightly sunken.
When I lean forward, the tissue above the scar protrudes about 2 cm, forming a bulge approximately 3 to 4 cm in diameter, which currently protrudes about 1 cm when I cough.
There is also a gas pocket approximately 5 cm in size.
Initially, the pain was more severe.
After the injury, I experienced rhabdomyolysis leading to acute kidney failure and pulmonary edema (about 500 cc of fluid was drained).
I also had hypertension (with systolic pressure reaching nearly 200).
After about 20 days, a cardiologist diagnosed me with mitral valve disease and other malignant secondary hypertension, as well as left ventricular hypertrophy.
A kidney biopsy later revealed tubular damage, and a few months later, I developed cardiac arrhythmias.
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, 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, and pressing on that specific point behind my ear increases the discomfort.
Is this symptom related to cardiovascular or neurological issues? Are there any connections among the various symptoms I have described? What is the causal relationship, and what are the underlying pathologies? How should I be treated? Furthermore, what is the reason for the other malignant secondary hypertension? Thank you for patiently reading this lengthy description, as I hope it provides you with a better understanding of my condition.
Please help me! I was injured in March 2009.

Luo Si Zhou, 40~49 year old female. Ask Date: 2010/09/30

Dr. Liao Yaopan reply Family Medicine

Hello, thank you for your message! The symptoms mentioned are indeed quite complex.
It is still recommended that you visit the clinic for a more thorough examination, as this will allow for a clearer understanding of your issues.
Thank you for your concern, Dr.
Liao Yao-Pan from Changhua Hospital.

Reply Date: 2010/09/30

More Info

I'm sorry to hear about your injuries and the complications you've been experiencing. It sounds like you've gone through a lot since your accident, and it's understandable to have concerns about your health and recovery. Let’s break down your situation and address your questions.

Understanding Your Injuries and Symptoms
From your description, it appears that you have sustained significant trauma to your left chest and upper back, which has led to multiple complications, including:
1. Chest Wall Deformity: The indentation in your chest wall and the rib cartilage inflammation (costochondritis) suggest that there may have been damage to the rib cage and surrounding soft tissues. This can lead to chronic pain and discomfort, especially with movements or pressure on the area.

2. Muscle Damage and Rhabdomyolysis: The mention of rhabdomyolysis indicates that there was significant muscle damage, which can lead to kidney complications, as you've experienced with acute kidney injury. This condition occurs when muscle fibers break down and release myoglobin into the bloodstream, which can be harmful to the kidneys.

3. Fluid Accumulation: The pleural effusion (fluid in the lungs) you mentioned is a common complication after chest trauma. This can cause difficulty breathing and may require drainage, as you have experienced.

4. Cardiovascular Issues: The development of hypertension, mitral valve disease, and ventricular hypertrophy (thickening of the heart muscle) could be related to the stress your body has undergone due to the injury and subsequent complications. Chronic pain and stress can also contribute to elevated blood pressure.

5. Neurological Symptoms: The discomfort you feel in your neck and head, particularly the tightness and pulsating sensations, could be related to nerve compression or irritation, possibly stemming from the trauma to your upper back and neck. This could also be exacerbated by muscle tension or spasm in the surrounding areas.

Potential Connections and Pathophysiology
The various symptoms you've described may indeed be interconnected. For example, the trauma to your chest could have led to muscle damage and inflammation, which in turn could affect your cardiovascular system and kidney function. The stress response from the injury can also lead to elevated blood pressure and other systemic effects.

Treatment and Management
1. Pain Management: It's crucial to manage your pain effectively. This may involve medications such as NSAIDs for inflammation, muscle relaxants, or even physical therapy to help improve mobility and reduce discomfort.

2. Cardiovascular Monitoring: Given your history of hypertension and heart issues, regular monitoring by a cardiologist is essential. They may recommend lifestyle changes, medications, or further interventions to manage your blood pressure and heart health.

3. Kidney Function: Regular follow-ups with a nephrologist are important, especially since you've experienced acute kidney injury. They can monitor your kidney function and suggest dietary changes or medications to support kidney health.

4. Physical Rehabilitation: Engaging in a structured rehabilitation program can help improve your strength, flexibility, and overall function. This is particularly important for addressing any musculoskeletal issues resulting from your injuries.

5. Neurological Evaluation: If your neck and head symptoms persist, a consultation with a neurologist may be beneficial. They can assess for any nerve-related issues and recommend appropriate treatments.

6. Psychological Support: Given the trauma you've experienced, psychological support may also be beneficial. Therapy can help you cope with the emotional and psychological impacts of your injuries.

Conclusion
Your situation is complex, and it’s important to have a multidisciplinary approach to your care. Regular follow-ups with your healthcare providers, adherence to treatment plans, and open communication about your symptoms will be key to your recovery. Don’t hesitate to seek help from specialists as needed, and remember that recovery can take time. It's important to be patient with yourself as you navigate this healing process.

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