Spontaneous pneumomediastinum

Spontaneous Pneumomediastinum and Subcutaneous Emphysema following Cocaine Inhalation and Ecstasy Ingestion

Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema are rare complications of illicit drug abuse. Thorough history, examination, and investigations are required to rule out fatal complications such as oesophageal perforation. We present a case of a 21-year-old male presenting with pleuritic chest pain one day after cocaine inhalation and ingesting ecstasy. Conservative supportive management is appropriate when this occurs spontaneously without radiological evidence of visceral perforation.

Pneumomediastinum from a severe asthma attack

Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

Asymptomatic spontaneous cervical and mediastinal emphysema

We report our experience with four patients presenting with spontaneous pneumomediastinum (SPM) within a 3-month period. The patients (three male and one female, aged 15-17 years) were hospitalised with SPM. All patients were kept under observation, successfully treated and followed up for several years, with no recurrences reported. Two patients had histories of asthma, while the other two developed SPM during sporting activities. SPM carries the possibility of being latent. For symptoms such as chest pain without evidence of pneumothorax in young people, it is necessary to always consider SPM and make the diagnosis accordingly.

[Diagnostic and therapeutic procedure for spontaneous emphysema of the neck and mediastinum]

BACKGROUND

Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge. PATIENT COLLECTIVE: Over the last 5 years, we treated four patients (three male, one female; aged 3-29 years) with cervical and/or mediastinal emphysema of unknown cause.

RESULTS

Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment. After involution of the emphysema, we performed an endoscopy which revealed no abnormalities. A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema. The immediate endoscopies were without pathologic findings. All patients recovered completely without any complications or recurrences.

CONCLUSIONS

If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided. The aim is to avoid any further spread of the emphysema and of pathogens. If there is a history of a foreign body or trauma, an immediate endoscopy is indicated.

Chest pain among adolescents with anorexia nervosa

Chest pain is common among adolescents. However, chest pain among adolescents with eating disorders is unique. We report a case of an anorexic adolescent presenting to the emergency room with acute onset of chest pain due to spontaneous pneumomediastinum. The pathophysiology, etiology, and risk factors of chest pain among adolescents with anorexia nervosa are reviewed.

Idiopathic spontaneous pneumomediastinum: an uncommon emergency in children

Spontaneous pneumomediastinum (SPM) occurs rarely in children. The diagnosis is based on physical examination and chest radiography. Conservative therapy usually leads to recovery. However, SPM in association with severe hypoxia, tachycardia, metabolic acidosis, and high ventilation pressures indicates clinically significant tension in the mediastinum. A collar mediastinotomy is the treatment of choice in these circumstances.

A case of spontaneous pneumomediastinum and pneumopericardium in a young adult

Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.

Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature

Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.

Spontaneous pneumomediastinum, pneumothorax and ecstasy abuse

A case report is presented of a patient with bilateral pneumothoraces and spontaneous pneumomediastinum associated with ecstasy use. Pneumothorax and spontaneous pneumomediastinum should be considered in an ecstasy user who complains of chest pain, neck pain or shortness of breath.

Spontaneous pneumomediastinum in children

SUMMARY. Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema, and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma.

Pneumomediastinum acquired by glass blowing

Pneumomediastinum is uncommon. We present a case of spontaneous pneumomediastinum, which occurred in a young man whose profession is glass blowing. He presented not only with typical complaints of chest pain and odynophagia, but also with the unusual complaint of a "foreign body" sensation in the middle of his chest.

Persistent pneumomediastinum in interstitial fibrosis associated with rheumatoid arthritis: treatment with high-concentration oxygen

We present a case of persistent spontaneous pneumomediastinum precipitated by an upper respiratory infection in a patient with interstitial fibrosis associated with rheumatoid arthritis who was receiving chronic corticosteroid treatment. The persistent nature of the mediastinal emphysema over 2 months eventually required treatment with high concentrations of inhaled oxygen that resulted in rapid resolution of the pneumomediastinum without recurrence over 6 months of follow-up. This case, along with others in the medical literature, emphasizes the need for early use of high-concentration inhaled oxygen in the treatment of pneumomediastinum in high-risk patients, such as those with connective tissue disorders.

Spontaneous pneumomediastinum

Spontaneous pneumomediastinum, or Hamman's syndrome, is a rare condition which may present with the symptoms of chest pain, dyspnoea, dysphagia, or neck pain. The signs of subcutaneous emphysema and Hamman's crunch (the presence of a crepitance sound that varies with the heartbeat on auscultation of the precordium) are usually present. A case of this syndrome occurring in an elderly patient with none of the recognised risk factors is presented.

Pneumomediastinum in a surf lifesaver

Pneumomediastinum is an uncommon complication of sporting activity. The case of a young asthmatic surf lifesaver is reported in which several factors are thought to have been involved in the aetiology of his condition. Treatment was expectant and a full recovery was made over a short period. This is the first reported case of pneumomediastinum occurring following training for a surf belt race.