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Weekly Chest CasesArchive of Old Cases

Case No : 572 Date 2008-10-13

  • Courtesy of Im Kyung Hwang, MD. / Hallym University College of Medicine, Korea.
  • Age/Sex 52 / M
  • Chief ComplaintSuddenly developed cough and dypnea 2-3 hours ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Acute Mercury Vapor Poisoning
Radiologic Findings
Fig 1. Initial chest AP radiograph shows bilateral, ill-defined opacities in both lungs. Note pneumomediastinum and subcutaneous emphysema in the lower neck.
Fig 2-4 HRCT scans show diffuse, patchy area of ground-glass opacity (GGO) in both lungs. Pneumomediastinum is also noted.

He has a history of mercury vapor inhalation at the home. During preparing a Chinese herb medicine in the confined space, he was accidentally exposed to mercury vapor for 3~4 hours.
Brief Review
Most cases of acute mercury inhalation occur in three settings: industrial accidents, accidents within the home, and in association with novice attempts to extract precious metals from mercury amalgam. Acute exposure to high level concentrations primarily involves the lung and results in chemical pneumonitis. The symptoms of acute inhalation are dyspnea, chest pain and cough. Most deaths are related to progressive respiratory failure.

The major radiographic abnormalities are diffuse bilateral interstitial infiltrates or consolidation. The early CT findings are ground glass opacity, alveolar consolidation and ill defined centrilobular nodules. In mild cases, scattered, ill defined nodular opacities are dominant. In more severe cases, patchy areas of ground glass opacity and consolidation, predominantly in the subpleural region and in the upper to mild lung zones, are seen. In the most severely affected cases, all lung zones are involved.

Postmortem studies have shown severe damage to the bronchi and bronchioles with marked alveolar edema. In the presence of marked necrosis, complications such as interstitial emphysema, pneumomediastinum and pneumothorax can occur.
References
1. Hashimoto M, Sato K, Heianna J et al. Pulmonary CT Findings in Acute Mercury Vapour Exposure. Clin Radiol 2001;56:17-21
2. Lim H.E, Shim J.J, Lee S.Y. et al. Mercury inhalation poisoning and acute lung injury. Korean J Intern Med 1998;13(2):127-130
3. Rowens B, Guerrero-Betancourt D, Gottlieb C. et al. Respiratory Failure and Death Following Acute Inhalation of Mercury Vapor. A Clinical and Histologic Perspective. Chest 1991; 99: 185-190.
Keywords
Lung, Mediastinum, Inhalation and aspiration disease,

No. of Applicants : 88

▶ Correct Answer : 2/88,  2.3%
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Semi-Correct Answer : 50/88,  56.8%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - EKH-Berlin , Germany Michael Weber
  • - POPOVO HOSPITAL , Bulgaria Vladislav Rusinov
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - OSWAL CANCER HOSP. , India VISHAL GARG
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - CHRU Lille , France Benjamin Damarey
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Osaka University , Japan Osamu Honda
  • - chest hospital , Egypt assaad assaad
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Royal Oldham Hospital , United Kingdom Rajesh Annamalaisamy
  • - Clinic 1 , Russian Federation Lepikhina Darya
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Lilavati hospital and Research center , India vivek gupta
  • - KMC , India VIJAY BHARODIYA
  • - Al-Hada Armed Forced Hospital , Saudi Arabia Ahmed FathiEid
  • - Madras scan systems , India R.P Babu.
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Stroger hospital , United States ky yoo
  • - SMG-SNU Boramae Hospital , Korea (South) Daehee Han
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Arora Neuro Centre,Ludhiana , India Devendra Kumar
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - CHRU lille , France manuel toledano
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - hospital Sao Paulo , Brazil israel missrie
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - clinique de SAVOIE , France, Metropolitan gay depassier philippe
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - CHU Grenoble , France Fabrice Bing
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt elsayed mousa
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - All India Institute of medical sciences , India Justin Moses
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