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Fan MI, Goh S, Choi J, Tan DJ. Spontaneous pneumomediastinum and pneumopericardium in a young male with asthma. J Asthma 2024:1-6. [PMID: 38639651 DOI: 10.1080/02770903.2024.2346151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity. CASE STUDY Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck. RESULTS The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home. CONCLUSION This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium.
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Affiliation(s)
- Meng Ivy Fan
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Sarah Goh
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Joseph Choi
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Australia
| | - Daniel J Tan
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Australia
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2
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Roby K, Barkach C, Studzinski D, Novotny N, Akay B, Brahmamdam P. Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population. Clin Pediatr (Phila) 2023; 62:1568-1574. [PMID: 37089060 DOI: 10.1177/00099228231166997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
What is the optimal management of spontaneous pneumomediastinum (SPM) and is there a risk of esophageal perforation in patients with SPM? We performed a retrospective case-control study of children through age 21, diagnosed with SPM in one hospital system over 10 years with the primary aim of describing the diagnostic workup, treatment patterns, and clinical outcomes. We hypothesized that SPM is a self-limited disease and is not associated with esophageal injury. Cases were identified using International Classification of Disease codes and excluded for trauma or severe infections. Median age was 16 years, 66% were male (n = 179). Chest radiography was performed in 97%, chest computed tomography (CT) in 33%, and esophagrams in 26%. Follow-up imaging showed resolution in 83% (mean = 17.2 days). SPM was not associated with esophageal perforation. We recommend avoiding CT scans and esophagrams unless there is discrete esophageal concern. Management of SPM should be guided by symptomatology.
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Affiliation(s)
- Kevin Roby
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Catherine Barkach
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Diane Studzinski
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Nathan Novotny
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Begum Akay
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
| | - Pavan Brahmamdam
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Surgery, Beaumont Children's Corewell Health East, Royal Oak, MI, USA
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Ganessane E, Devendiran A, Ramesh S, Uthayakumar A, Chandrasekar V, Sadasivam AS, Nathan B, Ayyan M. Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management. J Am Coll Emerg Physicians Open 2023; 4:e12935. [PMID: 37056716 PMCID: PMC10086517 DOI: 10.1002/emp2.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 04/15/2023] Open
Abstract
Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non-traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID-19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID-19 presenting with chest pain and breathlessness. A high level of suspicion is required to diagnose this condition promptly. Unlike in other disease conditions, pneumomediastinum in COVID-19 has a complicated course with higher mortality in intubated patients. No guidelines exist for managing pneumomediastinum patients with COVID-19. Therefore, emergency physicians should be aware of the various treatment modalities besides conservative management for pneumomediastinum and life-saving interventions for tension pneumomediastinum.
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Affiliation(s)
| | | | - Swetha Ramesh
- Department of Emergency MedicineJIPMERPuducherryIndia
| | | | | | | | | | - Manu Ayyan
- Department of Emergency MedicineJIPMERPuducherryIndia
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Subcutaneous emphysema, pneumothorax, pneumomediastinum and acute liver failure in a case of multiple hornet bites. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Pescaru CC, Marc MS, Costin EO, Pescaru A, Trusculescu AA, Maritescu A, Suppini N, Oancea CI. Massive Spontaneous Pneumomediastinum-A Form of Presentation for Severe COVID-19 Pneumonia. Medicina (B Aires) 2022; 58:medicina58111525. [PMID: 36363482 PMCID: PMC9692548 DOI: 10.3390/medicina58111525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.
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Affiliation(s)
- Camelia Corina Pescaru
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Steluța Marc
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Emanuela Oana Costin
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Pescaru
- ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana-Adriana Trusculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Maritescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Noemi Suppini
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristian Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Alahmari AK, Alhelali AA, Alahmari AK, Ahmed NJ, Alkathiri AA, Ardi KT, Baali MH, Mubarki MH, Alhamoud MA. Pneumothorax/pneumomediastinum as a complication of foreign body inhalation in 3 pediatric patients: A case series. Medicine (Baltimore) 2022; 101:e31073. [PMID: 36254063 PMCID: PMC9575795 DOI: 10.1097/md.0000000000031073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Foreign body inhalation (FBI) is a serious and common emergency in children. Such children present in the emergency room (ER) with cough, shortness of breath, choking, or wheezing but rarely present with pneumomediastinum. PATIENT CONCERNS Three children aged 2 to 5 years (2 girls and 1 boy) were seen in our ER complaining of FBI. Emergency bronchoscopy removal of the inhaled foreign body was performed; however, all 3 patients developed pneumomediastinum. DIAGNOSIS A foreign body inhalation complicated by Pneumomediastinum/pneumothorax. INTERVENTION AND OUTCOMES All the patients underwent emergency bronchoscopy and foreign body removal. After the ER intervention, 2 children were placed in the pediatric intensive care unit, and the pneumomediastinum resolved without intervention. The third patient required an operation for chest tube placement, which was then observed in the pediatric intensive care unit, and had several chest radiography follow-ups. After 5 days, the patient exhibited clinical improvement, and the chest tube was removed. CONCLUSION In this case series, we present 3 cases of children aged 2 to 5 years seen in our ER with a history of different types of organic FBI complicated by pneumomediastinum/pneumothorax. Pneumomediastinum/pneumothorax is a rare complication of FBI in pediatric patients. However, such complications require multidisciplinary collaboration for early diagnosis and intervention.
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Affiliation(s)
- Ahmed K. Alahmari
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Abdullah A. Alhelali
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Abdullah K. Alahmari
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, AL-Kharj, Saudi Arabia
- * Correspondence: Abdullah K. Alahmari, Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, AL-Kharj 11942, Saudi Arabia (e-mail: )
| | - Nehad J. Ahmed
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam Bin Abdulaziz University, AL-Kharj, Saudi Arabia
| | - Assaf A. Alkathiri
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Khalid T. Ardi
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Mohammed H. Baali
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Musleh H. Mubarki
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
| | - Mohammed A. Alhamoud
- Otolaryngology Department, Aseer Central Hospital, and Abha Children Hospital, Abha, Saudi Arabia
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Wong KK, Leung JW, Ho HH, Poon TT, Mak JY, Choi W, Leung S. Spontaneous pneumo‐mediastinum ‐ a benign rarity? SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Wing‐kee Choi
- Department of Surgery Tune Mun Hospital, New Territories, HKSAR
| | - Siu‐kee Leung
- Department of Surgery Tune Mun Hospital, New Territories, HKSAR
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8
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Reindl S, Al-Wheibi S, Umlauf J, Girdauskas E, Raab S. [Pneumomediastinum in Severe COVID-19-disease: a Case Series of Eight Patients]. Zentralbl Chir 2021; 146:612-616. [PMID: 34872115 DOI: 10.1055/a-1666-8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The most common cause of pneumomediastinum is trauma. However, in the context of COVID-19 pneumonia, this clinical picture is more often found in patients without underlying exogenous injury. Pathophysiologically, a cause analogous to the Macklin effect is suspected here, in which tears at the alveolar level lead to emphysema along the tracheobronchial tree with concentrating in the mediastinum. Here we present a case series of eight patients who were treated in our intensive care unit. In all patients, mediastinal emphysema could already be seen in the chest X-ray. Five patients also received a computed tomography scan of the thorax. Six patients had invasive ventilation. All patients received corticosteroids, anticoagulation and antibiotics. Pleural drainage was applied only in patients with an additional pneumothorax (n = 5). Bronchoscopy was performed only if there was a suspicion of iatrogenic injury to the tracheobronchial tree in relation to the appearance of the pneumomediastinum (n = 2). Three patients died during intensive care as part of the COVID-19 disease. A prognostic relationship between the occurrence of a pneumomediastinum and a fatal course of the disease is discussed.
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Affiliation(s)
- Sebastian Reindl
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Saja Al-Wheibi
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Julian Umlauf
- Klinik für Anästhesiologie und operative Intensiv-Medizin, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Evaldas Girdauskas
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Stephan Raab
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
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Alsamman M, Dunn S, Busse S, Hamza A. Asymptomatic Spontaneous Pneumopericardium, Pneumomediastinum, and Subcutaneous Emphysema: A Case Report of an Incidental Rare Presentation. Cureus 2021; 13:e20464. [PMID: 35070528 PMCID: PMC8760893 DOI: 10.7759/cureus.20464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Pneumopericardium (PP), pneumomediastinum (PM), epidural pneumatosis, and subcutaneous emphysema (SE) are identified by the existence of free air or gas in the associated spaces. They are normally self-limited unless tension pneumothorax, tension PM, cardiac herniation, air tamponade, and esophageal rupture accompany these disorders. PM and PP can be divided into "spontaneous" or "secondary" based on the preceding etiologies. Spontaneous PM is often extremely rare and benign in course. On the other hand, secondary PM and PP are more common and result from intrathoracic infections, trauma-related esophageal rupture, or tears along the tracheobronchial tree. Our patient presented four days after a fall from a chair and was found to have suffered a stroke, with complete left side paralysis. CT imaging on arrival was significant for PM, PP, and SE, the cause of which remains unclear. The patient was diagnosed with COVID-pneumonia approximately six months prior to presentation. As the COVID-19 pandemic has evolved, several scientific papers have been published reporting infected patients who had developed spontaneous PT, PM, or even PP, in the absence of invasive mechanical ventilation. Is it possible that the spontaneous findings in our patient were COVID-related? Or could the spontaneous PP, PM, and SE be a sequel to the trauma of her fall from a chair? The answer still remains unclear.
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Affiliation(s)
- Mrhaf Alsamman
- Internal Medicine, Health Corporation of America-University of Central Florida (HCA-UCF) Consortium, Ocala, USA
| | - Sandi Dunn
- Internal Medicine, Health Corporation of America-University of Central Florida (HCA-UCF) Consortium, Ocala, USA
| | - Shaye Busse
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Alan Hamza
- Internal Medicine, Ocala Regional Medical Center (ORMC), Ocala, USA
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Spontaneous Retropharyngeal Emphysema: A Triage Twist. Adv Emerg Nurs J 2021; 43:111-113. [PMID: 33915559 DOI: 10.1097/tme.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spontaneous retropharyngeal emphysema (SRE) is a rare condition, occurring in the absence of trauma. Symptoms usually include acute-onset odynophagia and dyspnea. This is an interesting case of a young, healthy woman who presented to an emergency department with benign upper respiratory symptoms but took a drastic turn while in the waiting room after being triaged. The features and implications of SRE are discussed in this case, including emergent thoracic surgery consultation and additional testing.
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Akhlaq S, Ejaz T, Aziz A, Ahmed A. Spontaneous pneumomediastinum in accidental chlorine gas inhalational injury: case report and review of literature. BMJ Case Rep 2021; 14:14/7/e236549. [PMID: 34330735 PMCID: PMC8327745 DOI: 10.1136/bcr-2020-236549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
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Affiliation(s)
- Safia Akhlaq
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Taymmia Ejaz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil Aziz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Arslan Ahmed
- Medicine, Aga Khan University, Karachi, Pakistan
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Haberal MA, Akar E, Dikis OS, Ay MO, Demirci H. Spontaneous pneumomediastinum incidence and clinical features in non-intubated patients with COVID-19. Clinics (Sao Paulo) 2021; 76:e2959. [PMID: 34550210 PMCID: PMC8420840 DOI: 10.6061/clinics/2021/e2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the presentation characteristics and disease course of seven patients with COVID-19 who spontaneously developed pneumomediastinum without a history of mechanical ventilation. METHODS A total of seven non-intubated patients with COVID-19, of age ranging from 18-67 years, who developed spontaneous pneumomediastinum between 01 April and 01 October 2020 were included in the study. Patients' demographic data, clinical variables, and laboratory values were examined. Spontaneous pneumomediastinum was evaluated using posteroanterior chest radiography and thorax computed tomography. RESULTS During the research period, 38,492 patients reported to the emergency department of our hospital with COVID-19 symptoms. Of these, spontaneous pneumomediastinum was detected in seven patients who had no previous history of intubation. Chronic obstructive pulmonary disease (2/7) and asthma bronchiale (2/7) were determined as the most common causes of comorbidity. CONCLUSIONS In our study, the frequency of spontaneous pneumomediastinum developing without pneumothorax was found to be high in non-intubated patients. Whether this is related to the nature of the disease or it is a result of the increase in cases diagnosed incidentally owing to the increasing use of low-dose computed tomography should be explored in further studies.
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Affiliation(s)
- Miktat Arif Haberal
- Department of Thoracic Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
- Corresponding author. E-mail:
| | - Erkan Akar
- Department of Thoracic Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Ozlem Sengoren Dikis
- Department of Pulmonary Medicine, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Mehmet Oguzhan Ay
- Department of Emergency Medicine, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
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Manna S, Maron SZ, Cedillo MA, Voutsinas N, Toussie D, Finkelstein M, Steinberger S, Chung M, Bernheim A, Eber C, Gupta YS, Concepcion J, Libes R, Jacobi A. Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19. Clin Imaging 2020; 67:207-213. [PMID: 32871424 PMCID: PMC7448957 DOI: 10.1016/j.clinimag.2020.08.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. MATERIALS AND METHODS A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. RESULTS Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. CONCLUSION SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.
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Affiliation(s)
- Sayan Manna
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA.
| | - Samuel Z Maron
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Mario A Cedillo
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Nicholas Voutsinas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Danielle Toussie
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Mark Finkelstein
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Sharon Steinberger
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Michael Chung
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Adam Bernheim
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Corey Eber
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Yogesh Sean Gupta
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Jose Concepcion
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Richard Libes
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
| | - Adam Jacobi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA
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Brogna B, Bignardi E, Salvatore P, Alberigo M, Brogna C, Megliola A, Fontanella G, Mazza EM, Musto L. Unusual presentations of COVID-19 pneumonia on CT scans with spontaneous pneumomediastinum and loculated pneumothorax: A report of two cases and a review of the literature. Heart Lung 2020; 49:864-868. [PMID: 32693960 PMCID: PMC7293476 DOI: 10.1016/j.hrtlng.2020.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease 2019 is a newly discovered viral disease whose knowledge is constantly evolving. Spontaneous pneumomediastinum and pneumothorax are rarely found in COVID-19 pneumonia. Computed Tomography is the modality of choice in the evaluation of Meckline effect.
Spontaneous pneumomediastinum (SPM) and Loculated pneumothorax (LPNX) are both generally rare clinical and radiological conditions associated with Coronavirus Disease 2019 (COVID-19). We report for the first time clinical data and radiological chest CT imaging of two patients affected by COVID-pneumonia associated with early radiological findings of SPM and LPNX.
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Affiliation(s)
- Barbara Brogna
- Radiology Unit, "Frangipane" Hospital, ASL Avellino, ASL Avellino, Via V. Emanuele 83031 Ariano irpino (AV), 83031, Italy.
| | - Elio Bignardi
- Radiology Unit, "Cotugno Hospital, Naples, Via Quagliariello 54, Naples, 80131, Italy
| | - Petronilla Salvatore
- Radiology Unit, "Frangipane" Hospital, ASL Avellino, ASL Avellino, Via V. Emanuele 83031 Ariano irpino (AV), 83031, Italy
| | - Martino Alberigo
- Radiology Unit, "Frangipane" Hospital, ASL Avellino, ASL Avellino, Via V. Emanuele 83031 Ariano irpino (AV), 83031, Italy
| | - Claudia Brogna
- Neuropsichiatric Unit ASL Avellino, Via Degli Imbimbo 10/12, 83100 Avellino AV, Italy
| | - Antonia Megliola
- Radiology Unit, "Frangipane" Hospital, ASL Avellino, ASL Avellino, Via V. Emanuele 83031 Ariano irpino (AV), 83031, Italy
| | - Giovanni Fontanella
- Department of Radiology, Sacred Hear of Jesus Hospital- Fatebenefratelli, 82100, Benevento, Italy
| | - Emerico Maria Mazza
- Radiology Unit, "Frangipane" Hospital, ASL Avellino, ASL Avellino, Via V. Emanuele 83031 Ariano irpino (AV), 83031, Italy
| | - Lanfranco Musto
- Radiology Unit, "Criscuoli" Hospital, ASL Avellino, Via Quadrivio 83054 Sant'Angelo Dei Lombardi, Avellino, Italy
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15
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Okafor C, Soin S, Ferraz JFFM. Spontaneous pneumomediastinum complicating asthma exacerbation. BMJ Case Rep 2019; 12:12/2/bcr-2018-229118. [PMID: 30755434 DOI: 10.1136/bcr-2018-229118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Chukwudumebi Okafor
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Illinois, USA
| | - Sarthak Soin
- Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, Illinois, USA
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16
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Management of Pneumomediastinum Associated with H1N1 Pneumonia: A Case Report. ACTA ACUST UNITED AC 2019; 5:28-33. [PMID: 30766920 PMCID: PMC6369568 DOI: 10.2478/jccm-2019-0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
Abstract
H1N1 is seen in tropical countries like India, occurring irrespective of the season. Complications of the disease are frequently encountered and there is little in the way or guidelines as to the how these should be managed. The treatment of one such complication, a recurrent pneumiomediastinum is the subject of the current paper. The management followed guidance for the treatment of a similar condition known as primary spontaneous pneumomediastinum, an uncommon condition resulting from alveolar rupture-otherwise known as the Macklin phenomenon.
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17
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Rampuri R, Ali Y, Verkerk M, Golding-Wood D. Unusual cause of pneumomediastinum. BMJ Case Rep 2018; 2018:bcr-2018-224343. [PMID: 29866681 DOI: 10.1136/bcr-2018-224343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Riaz Rampuri
- School of Medical Education, King's College London, London, UK
| | - Yousif Ali
- School of Medical Education, King's College London, London, UK
| | - Misha Verkerk
- Ear Institute, University College London, London, UK
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18
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Jain A, Nayyar P, Chitkeshi V, Bahl A. An unusual complication after endobronchial ultrasound-guided transbronchial needle aspiration: Case report. Breathe (Sheff) 2018; 14:e6-e11. [PMID: 29928465 PMCID: PMC6003265 DOI: 10.1183/20734735.014717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Bronchoscopy with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to be a safe procedure and is far less invasive than mediastinoscopy or percutaneous needle biopsy. It has been increasingly utilised for the diagnosis of sarcoidosis and unexplained mediastinal adenopathy, and for lung cancer staging. Complications from EBUS-TBNA are rare. Complications that have been reported are haemorrhages, pneumothorax, infectious complications like mediastinitis, pleuropericarditis, abscess, respiratory failure, airway injury and hypotension. Some of the patients also require intervention like tube drainage for pneumothorax [1]. Can you diagnose this unusual complication of EBUS-TBNA?http://ow.ly/y9bv30i73T4
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Affiliation(s)
- Ashish Jain
- Max Super Speciality Hospital, New Delhi, India
| | | | | | - Ankur Bahl
- Max Super Speciality Hospital, New Delhi, India
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19
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Abstract
Spontaneous pneumomediastinum is the presence of free air within the mediastinum that is not associated with trauma. It is a rare, self-limiting condition that can cause widespread subcutaneous surgical emphysema. We present the case of a 12-year-old boy who presented with widespread spontaneous surgical emphysema and pneumomediastinum, with no history of trauma or respiratory tract disease. We discuss our assessment of him and management with our multidisciplinary team (MDT), and whether radiological investigations including CT are helpful in such cases. In conclusion, we hypothesised that the child's coughing was the most likely cause of the tracheal rupture leading to the spontaneous surgical emphysema. Spontaneous pneumomediastinum in the paediatric patient is extremely rare. This case highlights how spontaneous pneumomediastinum can be successfully managed conservatively, and how MDT input can be helpful in guiding management in such unusual cases.
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Affiliation(s)
- Shilpa Ojha
- ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julian Gaskin
- ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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20
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Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F, Boal L, Bárbara C. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. ACTA ACUST UNITED AC 2017; 43:101-105. [PMID: 28538776 PMCID: PMC5474372 DOI: 10.1590/s1806-37562016000000052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/15/2016] [Indexed: 02/04/2023]
Abstract
Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.
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Affiliation(s)
- Patrícia Dionísio
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luís Martins
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Susana Moreira
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Alda Manique
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rita Macedo
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fátima Caeiro
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luísa Boal
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Cristina Bárbara
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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21
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Potz BA, Chao LH, Ng TT, Okereke IC. Clinical Significance of Spontaneous Pneumomediastinum. Ann Thorac Surg 2017; 104:431-435. [PMID: 28527963 DOI: 10.1016/j.athoracsur.2017.02.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spontaneous pneumomediastinum (SPM) is classified as free air in the mediastinum in the absence of any precipitating cause. It is relatively uncommon, and the clinical significance and risk associated with SPM is not well understood and has not been widely documented in the literature. Our goals were to determine the outcomes of patients who presented with SPM and to determine predictors of severe pathology associated with SPM. METHODS From 2004 through 2013, a retrospective review was conducted of patients who presented with SPM to our institution. Patient demographics, comorbidities, laboratory tests, and esophageal perforation were recorded. RESULTS In all, 249 patients were discovered to have SPM on chest radiograph or computed tomography scan. Mean age was 38.7 years (range, 17 to 81). Sixty-one percent of patients (151 of 249) were male. Ten percent of all patients (24 of 249) were ultimately discovered to have esophageal perforation, determined by upper endoscopy, upper gastrointestinal series, or intraoperatively during emergent surgery. Age (p < 0.01), pleural effusion (p < 0.01), and elevated white blood cell count (p < 0.01) were the only significant risk factors for esophageal perforation on multivariate analysis. CONCLUSIONS Spontaneous pneumomediastinum is usually associated with a benign clinical course. Risk factors for esophageal perforation in these patients include age, elevated white blood cell count, and a pleural effusion. In the absence of abnormal laboratory values or associated radiologic findings, the majority of patients with SPM may be safely observed without the need for further diagnostic testing.
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Affiliation(s)
- Brittany A Potz
- Department of Surgery and Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Linda H Chao
- Department of Surgery and Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas T Ng
- Department of Surgery and Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ikenna C Okereke
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas.
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22
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González García L, Rey C, Medina A, Mayordomo-Colunga J. Severe subcutaneous emphysema and pneumomediastinum secondary to noninvasive ventilation support in status asthmaticus. Indian J Crit Care Med 2016; 20:242-4. [PMID: 27303140 PMCID: PMC4906334 DOI: 10.4103/0972-5229.180047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old male with status asthmaticus developed subcutaneous emphysema and pneumomediastinum. He was transferred to our unit, where he received noninvasive ventilation (NIV). This respiratory support technique is not an absolute contraindication in these cases. After 2 h on NIV, he worsened sharply and the subcutaneous emphysema got bigger suddenly. He needed invasive ventilation for 5 days. Final outcome was satisfactory. This case illustrates that it is mandatory to keep a high level of vigilance when using NIV in patients with air leaks.
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Affiliation(s)
- Lara González García
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
| | - Corsino Rey
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
| | - Alberto Medina
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
| | - Juan Mayordomo-Colunga
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Asturias, Spain
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23
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An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis. Case Rep Pulmonol 2016; 2016:5092157. [PMID: 27213070 PMCID: PMC4861796 DOI: 10.1155/2016/5092157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/07/2016] [Indexed: 11/17/2022] Open
Abstract
Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing.
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24
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Aujayeb A, Miller J, Weatherhead M, Cooper D. Four cases of pneumomediastinum. Breathe (Sheff) 2015; 11:e1-6. [PMID: 27066130 PMCID: PMC4818219 DOI: 10.1183/20734735.009715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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