Presentation
The patient has 2nd degree burns. There has been recent surgical management.
Patient Data
A portable supine chest X-ray done in the ICU reveals a geographic distribution of surgical skin staples projected over the left hemithorax. In addition, there is a medical gauze wrap applied horizontally across the thorax, identified by the presence of radio-opaque markers.
There is a nasogastric tube (NGT) in situ, the distal tip of which is not identified on the chest X-ray however the tube does project below the left hemidiaphragm. The endotracheal tube (ETT) is infra-clavicular and the tip is just above the carina. There is a left internal jugular venous (IJV) access central venous catheter(CVP). The cardiomediastinal contour is normal. There is peribronchial thickening.
Case Discussion
Whenever one encounters a geographic and unusual anatomical distribution of surgical staples, consider a possible dermal surgical intervention such as skin grafting as in this instance, in a patient with 2nd degree burns.
The horizontal radio-opaque markers further allude to a large medical gauze wrap overlying the thoracic wounds/burns.
Surgical skin staples are usually made from titanium and nickel nowadays, while in the past stainless steel was used in their manufacture.
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