You are on page 1of 12

CHEST RADIOGRAPH OF PATIENT

WITH PARAQUAT INGESTION

Y. Irsandy 1 , B.Murtala 2 , S. Asriyani 3


1 Resident, 2 Professor and Head , 3 Residency Training Officer and
Consultant
Radiology Department- Faculty of Medicine,
Hasanuddin University - Dr.Wahidin Sudirohusodo Hospital, Makassar
Address correspondence to Yohanes Irsandy (yohanesirsandy@yahoo.com)
CHEST RADIOGRAPH OF PATIENT
WITH PARAQUAT INGESTION
BACKGROUND

• Poisoning by paraquat herbicide is a


major medical problem in parts of Asia
while sporadic cases occur elsewhere.
The very high case fatality of paraquat is
due to inherent toxicity and lack of
effective treatments.
• We will learn how to recognize chest
imaging features found in the
emergency case of paraquat ingestion.
CASE REPORT

• A fifteen-years-old female, was referred to


emergency department with chief complaint
of a persistent chest pain, vomiting and
difficulty of breathing. Patient also
complaint of melena. The patient had history
of paraquat ingestion five days before
admission.
• On physical examination, blood pressure
140/80 mmHg, pulse rate 100 times/minute,
respiratory rate 40x/minute, temperature
38oC. Mucosal lesions of the mouth and the
tounge. Rhonchi is heard from both lungs.
Tenderness on palpation of epigastrium.
Laboratory result showed WBC : 12x103/uL,
AST : 40U/L, ALT : 119U/L, Ureum : 165mg/dl,
creatinine : 7,42mg/dl.
Chest X-Ray

Figure 1.
Chest X-Ray revealed
pneumomediastinum,
subcutaneous
emphysema, pleural
effusion and
pneumonia
DISCUSSION
• This patient with persistent chest pain,
vomitting and subcutaneous emphysema
(Mackler triad) should raise our suspicion
for esophageal perforation. Chest
radiograph showed features of
esophageal perforation with findings of
pneumomediastinum and subcutaneous
emphysema.
• However, these findings are not enough
to confirm the diagnosis of esophageal
perforation. Chest radiograph or MDCT
scan of chest and upper abdomen with
oral water-soluble contrast medium
should be performed to find a contrast
leak.
• In our case, both examinations could not
be done, because of the patient was
discharged against medical advice the day
after, and unfortunately our patient died 5
days post-discharge
CONCLUSION
• Chest radiograph showed features of
esophageal perforation with
pneumomediastinum and subcutaneous
emphysema found after ingesting
paraquat, but no esophageal contrast
study could be performed because the
patient was discharged against medical
advice.
REFERENCES
Jeyaratnam J. Acute pesticide poisoning: a major global health problem.
World Health Stat Q. 1990;43:139–44. [PubMed]
Dawson AH, Eddleston M, Senarathna L, Mohamed F, Gawarammana I,
Bowe SJ, Manuweera G, Buckley NA. Acute human lethal toxicity of
agricultural pesticides: a prospective cohort study. PLoS Med.
2010;7:e1000357. [PMC free article][PubMed]
Bismuth C, Hall AH. Paraquat Poisoning: Mechanisms, Prevention,
Treatment. New York: Marcel Dekker Inc; 1995.
Mackler SA: Spontaneous rupture of the esophagus; an experimental and
clinical study. Surg Gynecol Obstet 1952, 95:345-356.
Bladergroen MA, Lowe JE, Postlethwait AW. Diagnosis and recommended
management of esophageal perforation and rupture. Ann Thorac Surg
1986;42:235-239