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Chilukuru RTR, Aarthi J, Vuchuru V, Neela A, T A V. Spontaneous Pneumomediastinum in a Patient With Undiagnosed Ankylosing Spondylitis. Cureus 2024; 16:e66751. [PMID: 39268258 PMCID: PMC11391400 DOI: 10.7759/cureus.66751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Spontaneous pneumomediastinum (SPM) is an uncommon condition characterized by air in the interstices of the mediastinum. Management generally involves supportive care; however, if a patient inspires high concentrations of oxygen, the mediastinal air will be absorbed faster. A 23-year-old man who presented with acute-onset breathlessness with a history of more than a year of lower backache was diagnosed with SPM and accompanying ankylosing spondylitis (AS) by a chest CT and spinal MRI and was treated conservatively. This case is being reported for its uniqueness, as SPM with underlying AS is rare.
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Affiliation(s)
| | - J Aarthi
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Vishnupriya Vuchuru
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Akhil Neela
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
| | - Vidya T A
- General Medicine, SRM Medical College Hospital and Research Centre, Chengalpattu, IND
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2
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Mahmood W, Zafar M, Berliti S, Islam AI, Clarke V, Hacikurt K. Spontaneously Resolving Pneumoperitoneum and Pneumomediastinum: A Report of Two Cases. Cureus 2024; 16:e61930. [PMID: 38978953 PMCID: PMC11228559 DOI: 10.7759/cureus.61930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/10/2024] Open
Abstract
We present here an interesting case report of two patients with spontaneous pneumomediastinum and iatrogenic pneumoperitoneum. The patients were assessed and queried following a chest X-ray abnormality and query based on the history of recent urological procedures on a background of awaiting gastro-oesophageal surgery at a tertiary centre respectively. Although these patients were successfully managed with the best supportive approach and periodic imaging review, it remains important to be aware that fatalities have been reported in the literature. We hope this case report will help those involved in the care of the patient to be aware of these conditions as differentials when history points towards episodes of coughing or recent surgical input.
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Affiliation(s)
- Wardah Mahmood
- Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-sea, GBR
| | - Mansoor Zafar
- Gastroenterology, Hammersmith Hospital - Imperial College Healthcare NHS Trust, London, GBR
| | - Stefano Berliti
- Acute Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-sea, GBR
| | - Ariful Islam Islam
- Acute Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-sea, GBR
| | - Viktoriya Clarke
- Acute Medicine, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-sea, GBR
| | - Kadir Hacikurt
- Radiology, Conquest Hospital - East Sussex Healthcare NHS Trust, St. Leonards-on-sea, GBR
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3
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Carrozzi A, Chu R, Nigole W, Goldman H, Hope S, Li R, Archis C. A case of pneumomediastinum complicating immunotherapy associated pneumonitis. Respirol Case Rep 2024; 12:e01406. [PMID: 38887430 PMCID: PMC11181010 DOI: 10.1002/rcr2.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
We describe the case of an 87-year-old gentleman referred to a metropolitan hospital in Sydney with pneumomediastinum complicating immunotherapy associated pneumonitis and recent bronchoscopic intervention. The contribution of pneumonitis in the setting of interstitial lung disease has been well described to developing pneumomediastinum however this is less clear in the setting of immunotherapy associated pneumonitis and to what extent bronchoscopic intervention compounds this risk.
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Affiliation(s)
- Anthony Carrozzi
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - Rex Chu
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - William Nigole
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - Hariette Goldman
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - Serena Hope
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - Richard Li
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
| | - Con Archis
- Respiratory MedicineThe Sutherland HospitalSydneyNew South WalesAustralia
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4
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Chowdhury D. Mediastinal emphysema in the context of perforated gastric ulcer. World J Clin Cases 2024; 12:2479-2481. [PMID: 38817226 PMCID: PMC11135447 DOI: 10.12998/wjcc.v12.i15.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery related. The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging. The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic. Oesophageal perforation (Boerhaave syndrome) is associated with Mackler's triad in upto 50% of patients (severe retrosternal chest pain, pneumomediastinum, mediastinitis). Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.
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Affiliation(s)
- Debkumar Chowdhury
- Department of Emergency Medicine, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom
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5
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Golino G, Forin E, Boni E, Martin M, Perbellini G, Rizzello V, Toniolo A, Danzi V. Secondary pneumomediastinum in COVID-19 patient: A case managed with VV-ECMO. IDCases 2024; 36:e01956. [PMID: 38681081 PMCID: PMC11047182 DOI: 10.1016/j.idcr.2024.e01956] [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] [Received: 11/01/2023] [Revised: 03/10/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
Air leak syndrome, including pneumomediastinum (PM), pneumopericardium, pneumothorax, or subcutaneous emphysema, is primarily caused by chest trauma, cardiothoracic surgery, esophageal perforation, and mechanical ventilation. Secondary pneumomediastinum (SP) is a rare complication, with a much lower incidence reported in patients with coronavirus disease 2019 (COVID-19). Our patient was a 44-year-old nonsmoker male with a previous history of obesity (Body Mass Index [BMI] 35 kg/m2), hyperthyroidism, hypokinetic cardiopathy and atrial fibrillation in treatment with flecainide, who presented to the emergency department with 6 days of fever, cough, dyspnea, and respiratory distress. The COVID-19 diagnosis was confirmed based on a polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After initiation of mechanical ventilation, a chest computed tomography (CT) on the first day revealed bilateral multifocal ground-glass opacities, consolidation and an extensive SP and pneumoperitoneum. Our therapeutic strategy was initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as a bridge to recovery after positioning 2 drains (mediastinal and pleural), for both oxygenation and carbon dioxide clearance, to allow protective and ultra-protective ventilation to limit ventilator-induced lung injury (VILI) and the intensity of mechanical power for lung recovery. After another chest CT scan which showed a clear reduction of the PM, 2 pronation and neuromuscular relaxation cycles were also required, with improvement of gas exchange and respiratory mechanics. On the 15th day, lung function recovered and the patient was then weaned from VV-ECMO, and ultimately made a good recovery and was discharged. In conclusion, SP may be a reflection of extensive alveolar damage and should be considered as a potential predictive factor for adverse outcome in critically ill SARS-CoV2 patients.
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Affiliation(s)
- Gianlorenzo Golino
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Edoardo Forin
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Elisa Boni
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Marina Martin
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Guido Perbellini
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Veronica Rizzello
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Anna Toniolo
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
| | - Vinicio Danzi
- Ospedale San Bortolo, Vicenza, Italy
- Department of Anesthesia and Intensive Care, Vicenza 36100, Italy
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6
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Mada PK, Khan MH. Pneumocystis jirovecii Pneumonia Complicated by Pneumomediastinum: A Case Report. Cureus 2024; 16:e58189. [PMID: 38741853 PMCID: PMC11089481 DOI: 10.7759/cureus.58189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Pneumomediastinum refers to the presence of air in the mediastinum (the space in the chest between the lungs). It can arise from various etiologies, including trauma, esophageal perforation, infections, medical procedures, or underlying lung diseases. Pneumocystis jirovecii pneumonia (PJP) is a common opportunistic infection seen in immunocompromised individuals, especially those with HIV/AIDS. Pneumomediastinum is a rare but serious complication of PJP that occurs in immunosuppressed patients, leading to significant morbidity and mortality. We present a rare case of pneumomediastinum caused by P. jirovecii pneumonia in an AIDS patient.
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Affiliation(s)
| | - Muhammad H Khan
- College of Osteopathic Medicine, Michigan State University, East Lansing, USA
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7
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Wald L, Yergin C, Petroze R, Larson S, Islam S. The unnecessary workups and admissions of adolescents and young adults with spontaneous pneumomediastinum. Sci Rep 2024; 14:4501. [PMID: 38402248 PMCID: PMC10894201 DOI: 10.1038/s41598-024-55134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare condition in children and young adults that raises concern for esophageal perforation or extension of an air leak, resulting in admissions with multiple interventions performed. To assess our outcomes, and to evaluate our resource utilization, we reviewed our experience with SPM. We conducted a retrospective review of SPM cases in patients aged 5-25 years old occurring between 2011 and 2021 at a single academic tertiary care center. Clinical, demographic, and outcome variables were collected and analyzed, and cohorts were compared using Fischer's Exact Test and Welch's T Test. 166 SPM cases were identified-all of which were Emergency Department (ED) presentations. 84% of the cases were admitted. 70% had Computerized Tomography (CT) scans, with no defined criteria for imaging. Comparison of floor admissions with discharges from the ED showed no significant difference in presenting symptoms, demographics, or outcomes between the two groups. Recurrence was noted in 4 patients with a range of 5.9 months-4.9 years from the initial episode. In the largest SPM study in the pediatric and young adult population, we noted no significant difference in management or outcomes in admitted or ED discharge patients nor those with CT imaging. Our results suggest that a large number of SPM can be managed safely with discharge from the ED.
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Affiliation(s)
- Lindsay Wald
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA.
| | - Celeste Yergin
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Robin Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Shawn Larson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100119, Gainesville, FL, 32610, USA
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8
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Siddiqui S, Falak U, Frost N, Athar W, Memon MHM, Qazi AZ. Can sub-cutaneous drain safely counter debilitating surgical emphysema? A retrospective study in quest for an answer. Respirol Case Rep 2024; 12:e01285. [PMID: 38269314 PMCID: PMC10807986 DOI: 10.1002/rcr2.1285] [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] [Received: 10/03/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Literature evidence on sub-cutaneous drain insertion in severe surgical emphysema (SE) is lacking. We retrospectively reviewed the clinical notes of 5 patients who underwent insertion of sub-cutaneous drains to manage SE of various aetiologies between September 2022 to August 2023 in a single district general hospital in the UK. Case history, outcome following sub-cutaneous drain insertion, and side effects due to the procedure were collected. Clinical decompression were noticed within an hour of drain insertion in all patients. Radiological resolution ranged between 2 and 10 days with a median 3 days and mean of 4.8 days. Patients with uni-lateral sub-cutaneous drain required more time for radiological improvement than patients on bi-lateral drains (median 6.5 vs. 2, mean 6.5 vs. 3.6). Maximum duration for resolution was 10 days for patients receiving uni-lateral sub-cutaneous drain versus 7 days in patients having bi-lateral drains. Only one patient had no prior lung disease making it difficult to comment if having healthy lungs affects outcomes. Sub-cutaneous drain insertion is a safe procedure which can accelerate recovery in severe SE.
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Affiliation(s)
- Saquib Siddiqui
- Respiratory MedicineRoyal Victoria Infirmary HospitalNewcastle Upon TyneUK
| | - Umair Falak
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
| | - Ned Frost
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
| | - Waseem Athar
- Respiratory MedicineQueen Elizabeth HospitalGatesheadUK
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9
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Chen N, Daly TK, Nadaraja R. Pneumomediastinum and Pericardium During Labour: A Report on a Rare Postpartum Phenomenon. Cureus 2023; 15:e50850. [PMID: 38249191 PMCID: PMC10798797 DOI: 10.7759/cureus.50850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Hamman's syndrome (HS) is characterised by spontaneous pneumomediastinum and subcutaneous emphysema. It is a rare phenomenon that can occur during labour. Its incidence is 1 in 100,000 births and predominantly affects young primiparous women with prolonged labour. Patients commonly present with subcutaneous emphysema, chest pain, and dyspnoea. We present the case of a 20-year-old primigravida female with no other medical history who had prolonged labour at 43 weeks gestation. Sudden-onset, right-sided cheek pain and swelling was noted immediately after delivery accompanied by pleuritic chest pain. Chest X-ray (CXR) and computed tomography (CT) demonstrated significant pneumomediastinum and pneumopericardium with subcutaneous emphysema extending to the neck. She was managed symptomatically in addition to antibiotics and discharged after three days with complete resolution of symptoms. No concerns were raised during the follow-up. HS is a rare phenomenon that can occur during labour, particularly in young primiparous females with a prolonged second stage. Radiological investigations in the form of CXR and CT are recommended to rule out life-threatening complications and other conditions that may require immediate management. HS occurs due to rupture of peripheral alveoli secondary to increased intrathoracic pressures from excessive Valsalva manoeuvre allowing air to dissect and enter into the mediastinum. Pneumopericardium in association with HS is extremely rare. It is particularly clinically important because it can cause cardiac tamponade requiring immediate surgical management. HS is otherwise a self-limiting condition and management is symptomatic only. Our case is unique due to the presence of pneumopericardium in association with HS, the fourth ever reported in the literature. Due to its rarity, the incidence of tamponade in this cohort of patients is yet to be delineated.
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Affiliation(s)
- Nelson Chen
- General Surgery, Austin/Northern Hospital, Melbourne, AUS
| | - Tessa K Daly
- General Surgery, Northern Hospital, Melbourne, AUS
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10
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Daecher A, Hartman B, Krueger J. A Case Report of Pneumoretroperitoneum from Blunt Trauma in a Patient with Chronic Obstructive Pulmonary Disease. Clin Pract Cases Emerg Med 2023; 7:237-241. [PMID: 38353192 PMCID: PMC10855284 DOI: 10.5811/cpcem.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction Pneumomediastinum is a rare complication of blunt traumatic injury and is thought to be due to the Macklin effect, a pathophysiologic process comprised of three steps: alveolar rupture secondary to blunt injury; air dissecting along bronchovascular sheaths; and spread of pulmonary interstitial edema into the mediastinal space. Pneumomediastinum is rarely associated with pneumoretroperitoneum. Case Report We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum. Conclusion This case highlights the complications that can arise from blunt trauma and how underlying lung pathology can worsen these complications.
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Affiliation(s)
- Annemarie Daecher
- Albert Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Brittany Hartman
- Albert Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - James Krueger
- Albert Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania
- Albert Einstein Medical Center, Department of Toxicology, Philadelphia, Pennsylvania
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11
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Susai CJ, Banks KC, Alcasid NJ, Velotta JB. A clinical review of spontaneous pneumomediastinum. MEDIASTINUM (HONG KONG, CHINA) 2023; 8:4. [PMID: 38322193 PMCID: PMC10839511 DOI: 10.21037/med-23-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/12/2023] [Indexed: 02/08/2024]
Abstract
Primary spontaneous pneumomediastinum is a rare, often benign and self-limited condition defined by air within the mediastinum. However, correctly distinguishing primary spontaneous pneumomediastinum from secondary causes, especially esophageal perforation, remains a diagnostic challenge. There is significant debate regarding the balance of completing a thorough but not overly invasive and costly diagnostic workup. This clinical review aims to gather the limited data regarding spontaneous pneumomediastinum management from case series and retrospective cohort studies, and presents an evaluation algorithm and treatment plan stratified by clinical history. Understanding specifically if the patient presents with coughing versus forceful vomiting is critical to help elucidate the etiology and guide management of pneumomediastinum. Patients who present with forceful vomiting or retching should be considered with higher degree of suspicion for secondary causes of pneumomediastinum, specifically esophageal perforation. However, especially in children, aggressive diagnostic workup is not warranted in every case. After ruling out other etiologies of pneumomediastinum, spontaneous pneumomediastinum can be commonly treated with symptomatic management without the aggressive use of antibiotics or diet restriction. Hospital length of stay may also be minimized on a case-by-case basis. Overall, recurrence of spontaneous pneumomediastinum is rare and outpatient follow up may be safely limited to those at highest risk of recurrence.
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Affiliation(s)
- Cynthia J. Susai
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Kian C. Banks
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Nathan J. Alcasid
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Jeffrey B. Velotta
- Department of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
- Department of Clinical Science at Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Department of Surgery, UCSF School of Medicine, San Francisco, CA, USA
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12
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Tegenbosch C, Wellekens S, Meysman M. A swollen face and neck after dental surgery: Think of subcutaneous emphysema and pneumomediastinum. Respir Med Case Rep 2023; 46:101926. [PMID: 37915544 PMCID: PMC10616542 DOI: 10.1016/j.rmcr.2023.101926] [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] [Received: 07/24/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Pneumomediastinum and subcutaneous emphysema are defined as the pathological presence of free air in the mediastinum or subcutaneous tissue, respectively. In the majority of cases, pneumomediastinum is secondary to an iatrogenic cause, but has rarely been described after a routine dental extraction. This condition is generally self-limiting, but major complications can occur, such as mediastinitis, which is more frequently associated with iatrogenic pneumomediastinum. To highlight the importance of including this presumably underdiagnosed complication in the differential diagnosis, we present a case of a 50-year-old man with dysphagia, facial pain and swollen face and neck following a dental extraction.
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Affiliation(s)
- Charlotte Tegenbosch
- Respiratory Division, Department of Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Shauni Wellekens
- Respiratory Division, Department of Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
| | - Marc Meysman
- Respiratory Division, Department of Medicine, Universitair Ziekenhuis Brussel, 1090, Brussels, Belgium
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13
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Meloy P, Bhambri A, Emeli IM. A Case Report of Spontaneous Pneumomediastinum From an Unusual Cause: Baritone Practice. Cureus 2023; 15:e47289. [PMID: 38021896 PMCID: PMC10656280 DOI: 10.7759/cureus.47289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population. Symptoms include sudden onset chest pain, dyspnea, neck pain, vomiting, and odynophagia. Physical examination usually reveals subcutaneous emphysema, hoarse voice, tachycardia, tachypnea, and occasionally a Hamman's sign, which is a mediastinal "crunch" sound heard on cardiac auscultation. We present a case of an 18-year-old male baritone player who presented to the ED with chest pain and odynophagia shortly after waking up one morning. The patient's chest radiograph (CXR) revealed free air in the mediastinum with subcutaneous air tracking into the soft tissues of the neck and supraclavicular region. CT of the chest with contrast esophagram confirmed the diagnosis of primary SPM. The cause of his condition was likely due to barotrauma secondary to playing the baritone in his marching band. He had no evidence of esophageal injury or infectious process which further supports the diagnosis of primary SPM. After an extensive workup, the patient was discharged from the ED with instructions on rest, analgesia, and antitussives as needed. Evaluation of chest pain patients in the ED should include a CXR, in addition to other indicated tests, to rule out this potentially debilitating condition. Fortunately, though SPM is potentially life-threatening, most cases resolve spontaneously without surgical intervention.
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Affiliation(s)
- Patrick Meloy
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Amit Bhambri
- Emergency Medicine, Swedish Hospital - Part of NorthShore University HealthSystem, Chicago, USA
| | - Iyesatta M Emeli
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
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14
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Partheeban S, Glean K, Boodram S, Dassrath K, Persad N, Bradshaw P, Carvalho R, Ramraj P. Acute Airway Compromise Due to Spontaneous Pneumomediastinum in COVID-19 Infection and Subsequent Rapid Formation of Pulmonary Subpleural Bullae: A Case Report. Cureus 2023; 15:e46011. [PMID: 37900450 PMCID: PMC10602207 DOI: 10.7759/cureus.46011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM), an increasingly documented complication of COVID-19 infection, usually presents with retrosternal chest pain and dyspnea but can present atypically. In this case, an exceptionally rare presentation could have led to inappropriate management and a poor outcome. Here, a previously healthy 41-year-old Afro-Caribbean male non-smoker presents with acute airway compromise due to SPM. Conservative management proved effective, with anxiolysis to mitigate patient self-induced lung injury (PSILI) and oxygen supplementation via a non-rebreather mask to increase the resolution rate till the patient stabilized over the following days. The sequelae of the lung insult were noted in subsequent imaging, showing the formation of many subpleural bullae. Our case demonstrates the need for a high index of suspicion for pneumomediastinum among teams caring for COVID-19 cases. It also highlights the potential need for follow-up for further research on pulmonary sequelae.
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Affiliation(s)
| | - Kerron Glean
- Internal Medicine, South West Regional Health Authority, San Fernando, TTO
| | - Sharda Boodram
- Covid Team, South West Regional Health Authority, San Fernando, TTO
| | | | - Navindra Persad
- Internal Medicine, South West Regional Health Authority, San Fernando, TTO
| | - Prisca Bradshaw
- Anaesthetics & Intensive Care Unit, South West Regional Health Authority, San Fernando, TTO
| | - Randall Carvalho
- Anaesthetics & Intensive Care Unit, South West Regional Health Authority, San Fernando, TTO
| | - Parasram Ramraj
- Department of Surgery, South West Regional Health Authority, San Fernando, TTO
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15
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Magouliotis DE, Sgantzou I, Salemis NS, Rountas C, Samara A, Zotos PA, Athanasiou T, Spiliopoulos K. Pneumomediastinum: Experience with 87 Patients. Acta Med Acad 2023; 52:88-94. [PMID: 37933505 DOI: 10.5644/ama2006-124.408] [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: 01/09/2023] [Accepted: 06/27/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the necessity of identifying true SPM cases as they are currently inadequately defined. METHODS This is a single-center, retrospective study, conducted in a university hospital. Consecutive adult patients with pneumomediastinum (PM) between January 2009 and March 2020 were involved in the series. The data about age, gender, symptoms, signs, treatment, length of hospital stay (LOS), and in-hospital mortality were evaluated. RESULTS In total, 87 cases with pneumomediastinum (37 with spontaneous and 50 with secondary PM) were analyzed. Patients in both groups were of similar ages (P=0.4). Sufferers with secondary PM were more likely to have: an associated pneumothorax (19% vs 58%, P<0.05), a chest tube placed (18.9% vs 58%, P<0.05), an associated pleural effusion (0% vs 18%, P<0.05). They presented with a longer LOS (3.9 vs 5.3 days, P<0.05), and were more likely to die (0% vs 10%, P<0.05). Additionally they showed a higher prevalence of radiologic subcutaneous emphysema (49% vs 74%, P<0.05). CONCLUSION Spontaneous pneumomediastinum is an onset of clinical importance with a low mortality rate, short LOS and good longterm prognosis. It often presents with chest pain, dyspnea and/or subcutaneous emphysema. However, secondary causes of mediastinal air must be ruled out, due to their potential devastating outcome if not diagnosed promptly. A consensus aimed at an update of the classification guidelines is more than indispensable.
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Affiliation(s)
| | - Ioanna Sgantzou
- Department of Radiology, University of Thessaly, Larissa, Greece
| | | | - Christos Rountas
- Department of Radiology, University of Thessaly, Larissa, Greece
| | - Athina Samara
- Department of Radiology, University of Thessaly, Larissa, Greece
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University of Thessaly, Larissa, Greece
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16
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Alneyadi M, Jaiganesh T, Chatha H. Spontaneous Pneumomediastinum in an asthmatic pediatric patient, triggered by SARS-COVID-19 infection. VISUAL JOURNAL OF EMERGENCY MEDICINE 2023; 32:101734. [PMID: 37303484 PMCID: PMC10245798 DOI: 10.1016/j.visj.2023.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Maitha Alneyadi
- Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Hamid Chatha
- Department of Emergency Medicine, Tawam Hospital, Al Ain, United Arab Emirates
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17
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Yong N, Olowu O. Spontaneous pneumomediastinum: A report of two cases at a district general hospital. Obstet Med 2023; 16:134-137. [PMID: 37441656 PMCID: PMC10334040 DOI: 10.1177/1753495x211019231] [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: 10/10/2020] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 06/04/2024] Open
Abstract
Spontaneous pneumomediastinum is a rare condition thought to be caused by excessive Valsalva manoeuvre during the second stage of labour. Women with pneumomediastinum typically presents with chest pain or tightness, dyspnoea, and a tearing sensation around the neck. It is commonly diagnosed with a chest radiograph but further imaging may be necessary to exclude more sinister conditions with similar clinical features. We describe two cases of pneumomediastinum and the different management approaches with different multi-disciplinary input. It is often a self-limiting condition. We propose a management algorithm for women suspected to have pneumomediastinum during the intrapartum and postpartum period.
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Affiliation(s)
- Nathanael Yong
- Department of Obstetrics and Gynecology, Frimley Park Hospital, Camberley, UK
| | - Oladimeji Olowu
- Department of Obstetrics and Gynecology, Broomfield Hospital, Chelmsford, UK
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18
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Cristea AM, Zaharia DC, Dumitrache-Rujinski S, Tintea A, Bogdan MA. Pathological Presence of Free Air in the Thorax: Pneumothorax and Pneumomediastinum as a Complication of COVID-19. Cureus 2023; 15:e40996. [PMID: 37503506 PMCID: PMC10371297 DOI: 10.7759/cureus.40996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION The abnormal presence of free air in the thorax, pneumothorax, and pneumomediastinum are complications for critically ill patients suffering from coronavirus disease 2019 (COVID-19). The development of these events may lead to a poor prognosis and make the management of this category of patients more difficult. STUDY DESIGN We performed an observational retrospective study, including patients with SARS-CoV-2 infection and pneumonia who were hospitalized, to analyze the cases that developed pneumothorax or pneumomediastinum as a complication. RESULTS A total of 28 cases (1.51%) from 1844 patients with SARS-CoV-2 pneumonia developed pneumothorax or pneumomediastinum during hospitalization. Of them, 21 (75%) needed intensive care unit admission and ventilation, and 10 (35.71) were cured. CONCLUSION The male gender is more probable to be involved in the development of pneumothorax or pneumomediastinum in patients with SARS-CoV-2 pneumonia. The incidence of these events is low, and conservative treatment could provide a better outcome.
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Affiliation(s)
- Alexandra M Cristea
- Department of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, ROU
| | - Dragos C Zaharia
- Department of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, ROU
| | - Stefan Dumitrache-Rujinski
- Department of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Pneumology, Marius Nasta Institute of Pneumology, Bucharest, ROU
| | - Alexandra Tintea
- Department of Public Health, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Miron A Bogdan
- Department of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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19
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Früh J, Abbas J, Cheufou D, Baron S, Held M. [Spontaneous pneumomediastinum (Hamman's syndrome) with pneumorrhachis as a rare cause of acute chest pain in a young patient with acute asthma exacerbation]. Pneumologie 2023. [PMID: 36750171 DOI: 10.1055/a-2007-9778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pneumomediastinum, defined as abnormal presence of air in the mediastinum, is a rare cause of acute chest pain. The condition may occur spontaneously as well as a secondary consequence of trauma or medical interventions. The spontaneous pneumomediastinum (Hamman's syndrome) is associated with a good prognosis, even without intervention. However, undelying severe conditions such as gastrointestinal perforations should be excluded. Diagnosis might be made using conventionell chest x-ray; a CT scan may give additional useful information. A subcutanous emphysema is a common finding in patients with pneumomediastinum. The presence of air in the epidural space of the spinal canal (pneumorrhachis) is a rarely seen but likewise mostly benign complication. We report a case of a young man with Hamman's syndrome and pneumorrhachis, provoked by acute asthma exacerbation; despite pronounced symptoms, his condition could be treated conservatively.
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Affiliation(s)
- Jonas Früh
- Pneumologie, Klinikum Würzburg Mitte gGmbH Standort Missioklinik, Würzburg, Deutschland
| | - Jasmin Abbas
- Radiology, Klinikum Würzburg Mitte gGmbH Standort Juliusspital, Würzburg, Deutschland
| | - Danjouma Cheufou
- Thoraxchirurgie, Klinikum Würzburg Mitte gGmbH Standort Missioklinik, Würzburg, Deutschland
| | - Stefan Baron
- Pneumologie, Klinikum Würzburg Mitte gGmbH Standort Missioklinik, Würzburg, Deutschland
| | - Matthias Held
- Pneumologie, Klinikum Würzburg Mitte gGmbH Standort Missioklinik, Würzburg, Deutschland
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20
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Khaire N, Deshmukh S, Agarwal E, Mahale N, Khaladkar S, Desai S, Kulkarni A. "Pneumomediastinum: A marker of severity in Covid-19 disease". Heliyon 2023; 9:e12981. [PMID: 36647393 PMCID: PMC9834123 DOI: 10.1016/j.heliyon.2023.e12981] [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] [Received: 02/10/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Objective The goal of this study was to look at the incidence, risk factors, clinical characteristics, and radiological aspects of COVID-19 patients who developed pneumomediastinum and compare these features between those who died and those who survived. Materials and methods This retrospective observational study included COVID-19 patients having pneumomediastinum on CT from May 2020 to May 2021 in a COVID-19 care hospital. 1st wave patients were considered between the period of May 2020 to January 2021 and those in the second wave between February 2021 to May 2021. The clinical details were analyzed by a consultant intensivist and CT scans were read by a team of 6 resident radiologists and 5 experienced radiologists. Demographic data, co-morbidities, clinical parameters, hemodynamic markers, radiological involvement and associated complications were analyzed. Results During the study period, 10,605 COVID-19 patients were admitted to our hospital of which 5689 underwent CT scan. 66 patients were detected to have pneumomediastinum on CT; 26 of them in the first wave and 40 in the second wave. Out of 66, 28 patients were admitted to ICU, 9 during the first wave and 18 during the second wave. The overall incidence of developing pneumomediastinum was 1.16%. Incidence in the 1st wave was 1.0% and in the 2nd wave was 1.29%. The overall mortality rate in admitted COVID-19 patients was 12.83% while it was 43.9% in COVID-19 patients who developed pneumomediastinum. Incidence of pneumomediastinum and pneumothorax was high in patients with extensive parenchymal involvement. 59/66 (89%) cases of pneumomediastinum had severe CT score on imaging. Conclusion We conclude that pneumomediastinum is a marker of poor prognosis. Timely diagnosis of interstitial emphysema or pneumomediastinum will aid in planning early protective ventilation strategies and timely intervention of complications.
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Affiliation(s)
- Nivedita Khaire
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sonali Deshmukh
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Esha Agarwal
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India,Corresponding author. Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Near Mhatre Bridge, Erandawne, Pune, India.411004.
| | - Nilesh Mahale
- Department of Critical Care Medicine, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sanjay Khaladkar
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sanjay Desai
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Ashwini Kulkarni
- Department of Radiology, Deenanath Mangeshkar Hospital and Research Center, Pune, India
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21
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Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in Critically Ill COVID-19 Patients: A Retrospective Cohort Study. Crit Care Res Pract 2023; 2023:4675910. [PMID: 36875553 PMCID: PMC9977517 DOI: 10.1155/2023/4675910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/02/2023] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission. Methods This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality. Results Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6-13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (N = 21), pneumomediastinum (N = 25), and subcutaneous emphysema (N = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833-115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; p < 0.0001) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310-5.918). Conclusion s. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality.
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22
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Xiang T, Fang J, Cheng T, Li Z, Wu D, Zhang S, Ge S, Zhang W. Case report: Severe pneumonia and pneumomediastinum in a previously robust adolescent caused by Omicron BA.5.2. Front Med (Lausanne) 2023; 10:1132630. [PMID: 37138757 PMCID: PMC10149875 DOI: 10.3389/fmed.2023.1132630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
The manifestation of severe pneumonia is only occasional, and pneumomediastinum is a condition that occurs rarely in Coronavirus disease 2019 (COVID-19) patients, especially in those patients who are infected with the Omicron variant. In addition, whether severe pneumonia or pneumomediastinum often occurs in patients in older age, in poor physical condition, or with underlying diseases remains to be ascertained. To date, severe pneumonia and pneumomediastinum due to Omicron infection had not been reported in a young patient with an excellent physical condition. In this study, we report such a case with the aforementioned manifestations in a robust adolescent infected with Omicron BA.5.2.
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Affiliation(s)
- Tianxin Xiang
- Department of Hospital Infection Control, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, China
| | - Jianhua Fang
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Cheng
- Department of Respiratory Medicine, The Second People's Hospital of Shangrao, Shangrao, China
| | - Zhongmin Li
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daxian Wu
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shouhua Zhang
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Shanfei Ge
- Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhang
- The Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Clinical Research Center for Respiratory Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- *Correspondence: Wei Zhang
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23
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Muacevic A, Adler JR. Pneumomediastinum and Pneumopericardium as Uncommon Complications of COVID-19 Infection: A Review Article. Cureus 2022; 14:e30244. [PMID: 36381752 PMCID: PMC9650929 DOI: 10.7759/cureus.30244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/03/2022] Open
Abstract
There is an emerging body of literature describing an increasing incidence of pneumomediastinum and, to a lesser extent, pneumopericardium as a complication of COVID-19. However, the literature lacks information regarding patients' characteristics and a general view of this unusual condition. The purpose of this paper is to summarize the current literature on this phenomenon. In this study, we summarize the risk factors/etiology, imaging modalities, management, and prognosis of known cases in the literature. In total, 48 articles were included in the study, ranging from case reports to case series. Most patients were male (83.3%). The overall mortality rate was 27.1% and the recovery rate was 62.5%.
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24
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Thuan PQ, Phuong PPP, Anh HPN, Long LP, Khoi LM. Surgical treatment of tension pneumomediastinum in patients with covid-19 at the field hospital: a case series. J Cardiothorac Surg 2022; 17:202. [PMID: 36002853 PMCID: PMC9399585 DOI: 10.1186/s13019-022-01966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tension pneumomediastinum is one of the most serious complications in COVID-19 patients with respiratory distress requiring invasive mechanical ventilation. This complication can lead to rapid hemodynamic instability and death if it is not recognized in a timely manner and intervenes promptly. CASE PRESENTATION We reported 7 COVID-19 patients with tension pneumomediastinum at a field hospital. All patients were critically ill with ARDS. These 7 patients, including 3 females and 4 males in this series, were aged between 39 and 70 years. Tension pneumomediastinum occurred on the first day of mechanical ventilation in 3 patients and later in the course of hospital stay, even 10 days after being intubated and ventilated. The tension pneumomediastinum caused hemodynamic instability and worsened respiratory mechanics with imminent cardiopulmonary collapse. In this series, we used two surgical techniques: (i) mediastinal decompression by suprasternal drainage with or without simultaneous pleural drainage in the first two cases and (ii) mediastinal drainage via suprasternal and subxiphoid incisions in 5 patients. The surgical procedures were feasible and reversed the pending cardiopulmonary collapse. Four patients had a favorable postprocedural period and were discharged from the intensive care center. Both patients undergoing suprasternal drainage died of failed/recurrent tension pneumomediastinum and nosocomial infection. Only one in five patients who underwent mediastinal drainage via suprasternal and subxiphoid incisions died of septic shock secondary to ventilator-associated pneumonia. CONCLUSION Tension pneumomediastinum was a life-threatening complication in critically ill COVID-19 patients requiring mechanical ventilation. Surgical mediastinal decompression was the salvage procedure. The surgical technique of mediastinal drainage via suprasternal and subxiphoid incisions proved an advantage in tension relief, hemodynamic improvement and mortality reduction.
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Affiliation(s)
- Phan Quang Thuan
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam.,Department of Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Pham Phan Phuong Phuong
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam.,Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Le Phi Long
- Department of Thoracic and Vascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Le Minh Khoi
- COVID-19 Intensive Care Center, University Medical Center, Ho Chi Minh City, Vietnam. .,Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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25
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Belfiore MP, Russo GM, Gallo L, Atripaldi U, Tamburrini S, Caliendo V, Impieri L, Del Canto MT, Ciani G, Parrella P, Mangoni di Santo Stefano ML, Salvia AAH, Urraro F, Nardone V, Coppola N, Reginelli A, Cappabianca S. Secondary Complications in COVID-19 Patients: A Case Series. Tomography 2022; 8:1836-1850. [PMID: 35894019 PMCID: PMC9326591 DOI: 10.3390/tomography8040154] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Coronavirus SARS-CoV-2, the causative agent of COVID-19, primarily causes a respiratory tract infection that is not limited to respiratory distress syndrome, but it is also implicated in other body systems. Systemic complications were reported due to an exaggerated inflammatory response, which involves severe alveolar damage in the lungs and exacerbates the hypercoagulation that leads to venous thrombosis, ischemic attack, vascular dysfunction and infarction of visceral abdominal organs. Some complications are related to anticoagulant drugs that are administrated to stabilize hypercoagulability, but increase the risk of bleeding, hematoma and hemorrhage. The aim of this study is to report the diagnostic role of CT in the early diagnosis and management of patients with severe COVID-19 complications through the most interesting cases in our experience. MATERIAL AND METHODS The retrospective analysis of patients studied for COVID-19 in our institution and hospitals, which are part of the university training network, was performed. CASES Pneumomediastinum, cortical kidney necrosis, splenic infarction, cerebral ischemic stroke, thrombosis of the lower limb and hematomas are the most major complications that are reviewed in this study. CONCLUSIONS Since the onset of the COVID-19 pandemic, the CT imaging modality with its high sensitivity and specificity remains the preferred imaging choice to diagnose early the different complications associated with COVID-19, such as thrombosis, ischemic stroke, infarction and pneumomediastinum, and their management, which significantly improved the outcomes.
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Affiliation(s)
- Maria Paola Belfiore
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Umberto Atripaldi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, Via Enrico Russo, 80147 Naples, Italy;
| | - Valentina Caliendo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Luigi Impieri
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Maria Teresa Del Canto
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Giovanni Ciani
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Pasquale Parrella
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | | | - Antonio Alessandro Heliot Salvia
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Nicola Coppola
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 80138 Naples, Italy; (M.P.B.); (L.G.); (U.A.); (V.C.); (L.I.); (M.T.D.C.); (G.C.); (P.P.); (A.A.H.S.); (F.U.); (V.N.); (N.C.); (A.R.); (S.C.)
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Maalouf HH, Aby Hadeer R, Tabbikha O, Abou-Malhab C, Wakim R. Symptomatic Pneumomediastinum Following Laparoscopic Cholecystectomy: A Case Report and a Literature Review. Cureus 2022; 14:e24604. [PMID: 35651390 PMCID: PMC9138895 DOI: 10.7759/cureus.24604] [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] [Accepted: 04/29/2022] [Indexed: 11/17/2022] Open
Abstract
Isolated pneumomediastinum is a rare complication after laparoscopic procedures. Herein, we present a case of a 38-year-old woman who presented two days after laparoscopic cholecystectomy with pleuritic chest pain and dyspnea and was found to have isolated pneumomediastinum. The patient was admitted for monitoring, oxygen therapy, and antibiotic prophylaxis and she was discharged on the fourth postoperative day when her symptoms resolved both subjectively and radiologically. Only two other cases of symptomatic isolated pneumomediastinum after laparoscopic cholecystectomy were reported in the literature and all of them were female patients, diagnosed radiologically, and treated conservatively. Therefore, isolated pneumomediastinum should be included in the differential diagnosis of dyspnea and chest pain after laparoscopic surgeries in order to have an early diagnosis, start early treatment, and prevent unnecessary investigations or advancement of the disease.
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Soni R, Brewster W, Weeks W, Graves S. A Unique Presentation of Spontaneous Pneumomediastinum Following COVID-19 Infection. Cureus 2022; 14:e24565. [PMID: 35651375 PMCID: PMC9138616 DOI: 10.7759/cureus.24565] [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] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Pneumomediastinum is a rare, life-threatening condition in which air leaks into the mediastinum. Usually, it results from a traumatic event that leads to the escape of air from the airway, lungs, or bowel into the chest cavity. Patients with underlying lung pathology or a history of invasive mechanical ventilation have an increased risk of developing a pneumomediastinum. A spontaneous pneumomediastinum (SPM) occurs in the absence of these risk factors. Patients with coronavirus disease 2019 (COVID-19) pneumonia tend to have a higher risk of developing an SPM, however, this is usually linked to mechanical ventilator use. Although rare, cases of healthy young patients with no history of underlying lung pathology or mechanical ventilator use developing an SPM are increasingly being reported. In efforts to bring more attention to this complication, we present the case of an SPM in a 40-year-old female patient with COVID-19 pneumonia and highlight the importance of close follow-up.
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A Rare Complication during Vaginal Delivery, Hamman's Syndrome: A Case Report and Systematic Review of Case Reports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084618. [PMID: 35457486 PMCID: PMC9026799 DOI: 10.3390/ijerph19084618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022]
Abstract
Background: Spontaneous pneumomediastinum (SPM) during pregnancy or labor is a rare event. We presented a case report and a systematic review of the literature to provide comprehensive symptoms, treatments, and complications analysis in the pregnant population affected by SPM. Methods: We conducted a comprehensive search of four databases for published papers in all languages from the beginning to 1 September 2021; Results: We included 76 papers with a total of 80 patients. A total of 76% patients were young primiparous, with a median age of 24 ± 5.4 years. The median gestational age was 40 ± 2.4 weeks, with a median duration of labor of 7.4 ± 4.2 h. In 86%, the ethnic origin was not specified. SPM develops in 55% of cases during the second stage of labor. Subcutaneous swelling and subcutaneous emphysema were present in 91.4%. Chest pain and dyspnea were present in 51.4% and 50% of the patients, respectively. We found that 32.9% patients had crepitus, and less common symptoms were dysphonia and tachycardia (14.3% and 14.3%, respectively). Oxygen and bronchodilators were used in 37.7% of the cases. Analgesics or sedatives were administered in 27.1%. Conservative management or the observation was performed in 21.4% and 28.6%, respectively. Antibiotics treatment was offered in 14.3%, whereas invasive procedures such as chest-tube drainage were used in just 5.7% of patients. There were no complications documented in most SPM (70.0%). We found that 16.7% of the SPM developed a pneumothorax and 5% developed a pneumopericardium.; Conclusions: In pregnancy, SPM occurs as subcutaneous swelling or emphysema during the second stage of labor. The treatment is usually conservative, with oxygen and bronchodilators and a low sequela rate. A universal consensus on therapy of spontaneous pneumomediastinum in pregnancy is necessary to reduce the risk of complications.
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Spontaneous pneumomediastinum and subcutaneous emphysema after masturbation. Radiol Case Rep 2022; 17:1722-1726. [PMID: 35345564 PMCID: PMC8956920 DOI: 10.1016/j.radcr.2022.02.080] [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] [Received: 02/19/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 12/03/2022] Open
Abstract
Spontaneous pneumomediastinum is a rare condition that mostly affects young men and generally follows a benign and self-limiting course. In contrast to secondary pneumomediastinum, which is caused by trauma, iatrogenic intervention or esophageal perforation, spontaneous pneumomediastinum is triggered by violent coughing, excessive vomiting, strenuous physical exercise or Valsalva maneuver. It results from an abrupt increase in intrathoracic pressure leading to alveolar rupture and air leak along the tracheobronchial tree into the mediastinal cavity. Extended spontaneous pneumomediastinum goes along with subcutaneous emphysema of the chest, neck or head. We present a case of a healthy young man who developed pneumomediastinum and profound subcutaneous emphysema with onset during masturbation. Since there is no literature on spontaneous pneumomediastinum associated with autoerotic experiences, we consider our case an unusual presentation of this entity.
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Brandi N, Ciccarese F, Rimondi MR, Balacchi C, Modolon C, Sportoletti C, Renzulli M, Coppola F, Golfieri R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics (Basel) 2022; 12:846. [PMID: 35453894 PMCID: PMC9032937 DOI: 10.3390/diagnostics12040846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Cecilia Modolon
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Camilla Sportoletti
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
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Staiano PP, Patel S, Green KR, Louis M, Hatoum H. A Case Series of Secondary Spontaneous Pneumomediastinum and Pneumothorax in Severe COVID-19 Pneumonia. Cureus 2022; 14:e22247. [PMID: 35340519 PMCID: PMC8930020 DOI: 10.7759/cureus.22247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Pneumomediastinum and pneumothorax are uncommon complications in COVID-19 patients. The exact prevalence, etiology, and outcomes are not well known. We report a case series of patients in our institution with COVID-19 related pneumomediastinum and pneumothorax and address these questions. Methods We conducted a single-center retrospective chart review of patients admitted at our institution with a positive polymerase chain reaction (PCR) confirming the diagnosis of COVID-19. A cohort of 500 potential study candidates was identified, of whom eight were investigated. Demographic data, hospital course, patient co-morbidities, and outcome data were collected. Results Eight patients were included in our study who were identified as having an event (i.e., pneumomediastinum and/or pneumothorax) during the specified timeframe. Overall, 62% of patients were on high-flow nasal cannula with an average FiO2 of >70%. The average oxygen saturation//fraction of inspired oxygen (SpO2/FiO2) ratio leading up to an event was 113.7286 (range: 101.11-130.66), and all of the patients not on mechanical ventilation met the criteria for acute respiratory distress syndrome (ARDS) based on the Kigali definition with SpO2/FiO2 < 315. The three patients who developed an event while requiring mechanical ventilation both had PaO2/FiO2 < 100, consistent with severe ARDS at the time of an event. The mean time in days, counted from the day of hospital admission until an event, was 10 days (range: 3-23 days). None of the cases had documented pulmonary parenchymal disease prior to developing COVID-19. To the best of our knowledge, these events were not iatrogenic in nature. Conclusion Secondary spontaneous pneumomediastinum and pneumothorax are rare albeit well-documented phenomena in hospitalized patients with COVID-19 infection. Interestingly, the majority of patients in our study were on high-flow nasal cannula at the time of an event. The majority of previously published data on this topic are on those who required positive pressure ventilation; however, there have been more recent papers that also describe these events in non-mechanically ventilated patients. The exact pathophysiology remains unknown, but it is likely multifactorial, and additional studies are needed to further evaluate this phenomenon.
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Çetin M, Türk İ, Fındık G, Aydoğdu K, Gülhan SŞE, Bıçakçıoğlu P, Kaya S. Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-021-00106-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up.
Results
Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case.
Conclusion
Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.
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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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Kajiyazdi M, Norooznezhad AH. Pneumomediastinum, pneumopericardium and subcutaneous emphysema following acute lymphoblastic leukemia and chemotherapy: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S379-S382. [PMID: 34760087 PMCID: PMC8559649 DOI: 10.22088/cjim.12.0.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/12/2019] [Accepted: 12/31/2019] [Indexed: 11/07/2022]
Abstract
Background: Pneumomediastinum and subcutaneous emphysema are mostly detected in non-malignant conditions such as certain infections, thoracic surgeries, and trauma. Although this condition is asymptomatic in most cases, sometimes it could be symptomatic and may even be lethal in some patients. Case Presentation: This letter reports a 9-year-old girl with acute lymphoblastic leukemia (ALL) on chemotherapy who developed pneumothorax with the clinical feature of respiratory distress for that a chest tube was inserted immediately. Following the insertion, pneumomediastinum and pneumopericardium developed in the patient. As the next step, a pericardium window was inserted by an expert heart surgeon. During these procedures, all the evaluations for any bacterial or fungal infection were negative. Unfortunately, the patient expired before any further complementary evaluations and it was not clear that the mentioned situation was a result of chemotherapy or ALL. Conclusion: Although pneumomediastinum and subcutaneous emphysema are rare in patients with ALL, authors strongly suggest clinicians consider them in any similar patients presenting respiratory signs/symptoms for faster onset of action.
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Affiliation(s)
- Mohammad Kajiyazdi
- Pediatric Hematology and Oncology Ward, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Norooznezhad
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Al Armashi AR, Somoza-Cano FJ, Patell K, Homeida M, Desai O, Zubaidi AA, Altaqi B, Ravakhah K. Spontaneous pneumomediastinum: A collaborative sequelae between COVID-19 and self-inflicted lung injury - A case report and literature review. Radiol Case Rep 2021; 16:3655-3658. [PMID: 34630794 PMCID: PMC8489288 DOI: 10.1016/j.radcr.2021.08.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 10/28/2022] Open
Abstract
Spontaneous pneumomediastinum is an infrequent complication of COVID-19. The mechanism is still unknown and thought to be related to patient self-inflicted lung injury. Our patient is a 49-year-old male who presented with shortness of breath and cough. A COVID-19 Polymerase Chain Reaction was positive. He required a high-flow nasal cannula, but he did not demand mechanical ventilation. Computed tomography angiography scan of the chest revealed pneumomediastinum. He was managed conservatively, and a complete recovery was achieved. This case highlights the emerging association of COVID-19, patient self-inflicted lung injury, and pneumomediastinum. Furthermore, spontaneous pneumomediastinum should be suspected even in patients who were not mechanically ventilated.
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Affiliation(s)
| | | | - Kanchi Patell
- St. Vincent Charity Medical Center, Cleveland, OH, USA
| | | | - Omkar Desai
- Yale University School of Medicine, New Haven, CT, USA
| | - Anas Al Zubaidi
- Baptist Health North Little Rock North Little Rock, North Little Rock, AR, USA
| | - Basel Altaqi
- St. Vincent Charity Medical Center, Cleveland, OH, USA
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Naik VM, Nusrath S, Rayani BK, Reddy P, Yalamnchilli R. Pneumomediastinum: A Rare Complication of Epidural Analgesia. Cureus 2021; 13:e18747. [PMID: 34790493 PMCID: PMC8588832 DOI: 10.7759/cureus.18747] [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: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
Pneumomediastinum is a rare complication following epidural block using the loss of resistance (LOR) technique with air. It is speculated to result from the opening of potential space connecting the epidural space and the posterior mediastinum via intervertebral foramina through fascial planes. To date, only two cases of pneumomediastinum after epidural block have been reported. An incidental finding of pneumomediastinum two days after the procedure has not been reported before. Epidural block as a cause should be considered among multiple causes while interpreting the imaging of this life-threatening complication in the postoperative period.
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Affiliation(s)
- Vibhavari M Naik
- Department of Anaesthesiology, Surgical Critical Care, Pain and Palliative Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND
| | - Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND
| | - Basanth K Rayani
- Department of Anaesthesiology, Surgical Critical Care, Pain and Palliative Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND
| | - Pratap Reddy
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND
| | - Rohit Yalamnchilli
- Department of Radiodiagnosis, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND
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Gutierrez-Ariza JC, Rodriguez Yanez T, Martinez-Ávila MC, Almanza Hurtado A, Dueñas-Castell C. Pneumomediastinum and Pneumothorax Following Non-invasive Respiratory Support in Patients With Severe COVID-19 Disease. Cureus 2021; 13:e18796. [PMID: 34796074 PMCID: PMC8590743 DOI: 10.7759/cureus.18796] [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: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic led to an increased number of patients with pneumothorax and pneumomediastinum owing to complications attributed to viral pneumonia regardless of the use of mechanical invasive ventilation and the elapsed time of infection. The pathophysiology remains unknown. However, the Macklin effect is shown as the most plausible mechanism along with possible barotrauma secondary to a high-flow nasal cannula and noninvasive mechanical ventilation. We present two cases of patients who developed pneumomediastinum and tension pneumothorax. One of the patients was studied during infection and the other after recovery. Both received appropriate and timely treatments with successful outcomes. It is important to be aware of these potentially fatal complications as early management can reduce the associated morbidity and mortality.
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Ravago MA, Maldjian PD. Pneumomediastinum From Vacuum Disc and Vertebral Trauma. Cureus 2021; 13:e16942. [PMID: 34513510 PMCID: PMC8412849 DOI: 10.7759/cureus.16942] [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: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
We present a case of pneumomediastinum associated with an endplate fracture adjacent to a vacuum disc. Pneumomediastinum from trauma can be due to damage to the lungs, airway, or esophagus. In this case, we present a unique complication of the vacuum disc phenomenon in which vertebral injury at the site of a vacuum disc releases gas bubbles into the mediastinum. We believe that compressive forces from the trauma produced a disruption of the annulus fibrosis and forced gas previously sequestered in the intervertebral disc space to escape into the mediastinum.
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Affiliation(s)
- Mark A Ravago
- Department of Radiology, Rutgers University, Newark, USA
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Hassan H, Ferguson L. Spontaneous Pneumomediastinum in a Healthy Pediatric Patient. Cureus 2021; 13:e17847. [PMID: 34660053 PMCID: PMC8502003 DOI: 10.7759/cureus.17847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare condition, especially in children with no predisposing factors. In the vast majority of patients, this condition is benign and self-limiting; however, there is always the possibility that serious and potentially life-threatening complications such as mediastinitis or cardiac tamponade could arise. Early recognition, prompt diagnosis, and appropriate management allow for ideal care and prevent unnecessary and excessive investigations in these patients. An eight-year-old female was admitted to the emergency department with SPM after swimming and no known predisposing lung conditions. The probable causative event was likely to be pressure changes in the alveoli during swimming. This is notable because the patient's SPM occurred in the absence of an underlying cause such as asthma. The patient was admitted overnight for monitoring and pain control. The symptoms resolved the following day, along with a decrease in the size of the SPM on the chest X-ray. Physicians should be aware of the signs of SPM in young patients who present with chest pain in the absence of trauma or pulmonic disease. A review of literature highlighted the pathophysiology and recommended treatment course for similar cases.
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Affiliation(s)
- Hebah Hassan
- Internal Medicine, New York Institute of Technology College, Old Westbury, USA
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40
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Hogan G. COVID-19-Associated Pneumomediastinum: An Emerging Clinical Presentation. Cureus 2021; 13:e18287. [PMID: 34722063 PMCID: PMC8546193 DOI: 10.7759/cureus.18287] [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: 09/25/2021] [Indexed: 11/05/2022] Open
Abstract
Recent publications have suggested an association between coronavirus disease 2019 (COVID-19) pneumonitis and pneumomediastinum. The association has been linked to the frequent use of mechanical ventilation in these patients; however, there have also been increasing reports of spontaneous pneumomediastinum in the absence of mechanical ventilation. These reports suggest a direct association between COVID-19 pneumonitis and increased alveolar fragility. In this report, we present a case of a spontaneous mediastinum in a 64-year-old male patient with COVID-19 without any history of mechanical ventilation.
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Affiliation(s)
- George Hogan
- Internal Medicine, Eastbourne District General Hospital, Eastbourne, GBR
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41
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Somasundram K, Agbontaen K, Singh S. Pneumomediastinum in COVID-19: Merely a Matter of Lung Frailty? Respiration 2021; 100:1251-1255. [PMID: 34515225 PMCID: PMC8450820 DOI: 10.1159/000518367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Suveer Singh
- Intensive care unit, Chelsea and Westminster Hospital, London, UK
- Intensive care unit, Royal Brompton Hospital, London, UK
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42
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Jesrani G, Gupta S, Kumar V, Gupta M, Arya Y. Spontaneous Pneumomediastinum in COVID-19 Pneumonia. Cureus 2021; 13:e16129. [PMID: 34367760 PMCID: PMC8330509 DOI: 10.7759/cureus.16129] [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: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is the collection of air within the mediastinal cavity, which is commonly described in the literature for mechanical ventilation and perforation of hollow viscera. Coronavirus disease 2019 (COVID-19) is a rare but salient etiology of this complication in the current pandemic. Here, we are narrating a case of a 46-year-old male, in whom COVID-19 pneumonia was complicated by SPM. The complication was identified on chest computed tomography (CT) and was managed conservatively, leading to a favorable outcome. SPM has undemanding management, but timely identification and appropriate treatment institution are crucial in this milieu. A literature search revealed similar cases of SPM in COVID-19 with different outcomes and the important ones are included in this report.
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Affiliation(s)
- Gautam Jesrani
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Samiksha Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Vivek Kumar
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Yajur Arya
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, IND
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Lin KP, Stefaniak C, Bunch CM, March R, Zamlut M, Raza S, Osorio W, Korzan J, Show J, Mjaess N, Patel S, Zackariya S, Sualeh A, Wiarda G, Al‐Fadhl H, Thomas AV, Khan RZ, Gillespie L, Walsh MM. Tension pneumomediastinum and diffuse subcutaneous emphysema with severe acute respiratory syndrome coronavirus 2 infection requiring operative management for impending airway collapse: A case report. Clin Case Rep 2021; 9:e04656. [PMID: 34430018 PMCID: PMC8364998 DOI: 10.1002/ccr3.4656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/08/2022] Open
Abstract
Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS-CoV-2 infection.
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Affiliation(s)
- Kevin P. Lin
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | | | - Connor M. Bunch
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | - Robert March
- Department of Cardiothoracic SurgerySt. Joseph Regional Medical CenterMishawakaINUSA
| | - Mahmud Zamlut
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Syed Raza
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Walter Osorio
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Josh Korzan
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Jeffery Show
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Nicolas Mjaess
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Shivani Patel
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Sufyan Zackariya
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Ali Sualeh
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Grant Wiarda
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Hamid Al‐Fadhl
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | - Rashid Z. Khan
- Department of HematologyMichiana Hematology OncologyMishawakaINUSA
| | - Laura Gillespie
- Department of Quality Assurance and Performance ImprovementSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
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Kalpaxi A, Kalokairinou M, Katseli P, Savvopoulou V, Ioannidi P, Triantafyllou E, Flokatoula M, Pythara C, Papaevangelou A. Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging. Radiol Case Rep 2021; 16:2586-2592. [PMID: 34178187 PMCID: PMC8220909 DOI: 10.1016/j.radcr.2021.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
Spontaneous pneumomediastinum is a rare complication of coronavirus disease 2019. The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital, 3 coronavirus disease 2019 patients developed spontaneous pneumomediastinum: 1 on admission at the emergency department and the other 2 during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.
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Affiliation(s)
- Angeliki Kalpaxi
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Mariana Kalokairinou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Paraskevi Katseli
- Department of Internal Medicine, Thriassio General Hospital of Elefsina, Magoula, Athens, Greece
| | - Vasiliki Savvopoulou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Pinelopi Ioannidi
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Evangelia Triantafyllou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Maria Flokatoula
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Chrystalla Pythara
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
| | - Angeliki Papaevangelou
- Department of Radiology, Thriassio General Hospital of Elefsina, Gennimata Avenue 19600, Magoula, Athens 19600, Greece
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Cherian A, Jha AK, Padala SRAN, Senthilnathan M. Unusual complications of spontaneous pneumomediastinum and subcutaneous emphysema in patients with SARS-CoV-2 infection: A case report. Indian J Anaesth 2021; 65:483-486. [PMID: 34248193 PMCID: PMC8252999 DOI: 10.4103/ija.ija_192_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anusha Cherian
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kipourou M, Karozis K, Lampridis S, Gkintikas S, Molyvas D, Koutoukoglou P, Kaitalidou E, Giannopoulou I, Tsanaktsidis I, Karapiperis D. Spontaneous Pneumomediastinum and Subcutaneous Emphysema in the course of COVID-19 disease: A case report and review of the literature. PNEUMON 2021:1-6. [DOI: 10.18332/pne/136001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
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Paul M, Paul P, Dey D, Bhardwaj A, Paul K. A Case of Spontaneous Pneumomediastinum Following Ecstasy and Marijuana Use. Cureus 2021; 13:e15871. [PMID: 34327096 PMCID: PMC8302393 DOI: 10.7759/cureus.15871] [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: 06/20/2021] [Indexed: 11/08/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a benign and self-limiting condition more commonly seen in young adults. Radiology imaging of the chest, including X-ray or CT scan, is the gold standard for diagnosis. Ecstasy, also known as 3,4-methylenedioxymethamphetamine (MDMA) is a synthetic amphetamine derivative widely abused for an increased sense of well-being and euphoria. Marijuana is also abused for recreational purposes. SPM has been reported after both Ecstasy and marijuana use. SPM after these illicit drugs abuse usually has a benign and self-limiting course with supportive management. However, it is always important to rule out serious associated conditions like esophageal perforation. Here, we present a 22-year-old male who developed SPM after Ecstasy ingestion and marijuana inhalation.
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Affiliation(s)
- Mishouri Paul
- Medicine, Interfaith Medical Center, New York City, USA
| | - Prodip Paul
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Dipon Dey
- Epidemiology and Public Health, ZWH Medical Care PC, Queens, USA
| | - Amit Bhardwaj
- Internal Medicine, Geisinger Community Medical Center, Scranton, USA
| | - Koushik Paul
- Clinical Pathology, Community Based Medical College Hospital, Mymensingh, BGD
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48
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Ramalingam S, Arora H, Gunasekaran K, Muruganandam M, Nagaraju S. A Unique Case of Spontaneous Pneumomediastinum in a Patient With COVID-19 and Influenza Coinfection. J Investig Med High Impact Case Rep 2021; 9:23247096211016228. [PMID: 33978499 PMCID: PMC8120538 DOI: 10.1177/23247096211016228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spontaneous pneumomediastinum is reported in patients with coronavirus disease-2019 (COVID-19) and influenza infection independently, usually associated with noninvasive and mechanical ventilation. We report a case of spontaneous pneumomediastinum in a patient with COVID-19 and influenza coinfection. A 58-year-old male admitted with shortness of breath, diagnosed with COVID-19 and influenza infection. A computed tomography angiogram showed pneumomediastinum. He was treated conservatively with 15 L of oxygen, remdesivir, convalescent plasma, and oseltamivir. The case is being reported for its uniqueness since this is the first documented case of spontaneous pneumomediastinum in COVID-19 and influenza coinfection.
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49
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Heijboer F, Oswald L, Cretier S, Braunstahl GJ. Pneumomediastinum in a patient with COVID-19 due to diffuse alveolar damage. BMJ Case Rep 2021; 14:14/5/e242527. [PMID: 33975848 PMCID: PMC8117474 DOI: 10.1136/bcr-2021-242527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 74-year-old man with COVID-19 was admitted and experienced progressive dyspnoea while receiving supplemental oxygen via high-flow nasal cannula (HFNC). A CT of the thorax showed a pneumomediastinum. The HFNC was temporally interrupted, since it was uncertain whether the positive end-expiratory pressure of the HFNC could be the cause of the pneumomediastinum. After restart of the HFNC, there was no increase of symptoms. We suggest that the pneumomediastinum was the result of COVID-19-related alveolar damage, and not due to the use of HFNC. This observation is relevant since HFNC is often used in the treatment of severe COVID-19 pneumonia.
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Affiliation(s)
- Frank Heijboer
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Laurien Oswald
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Sander Cretier
- Radiology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands .,Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
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Jafari R, Cegolon L, Dehghanpoor F, Javanbakht M, Tabatabaei SMH. Typical Covid-19 case with primary pneumomediastinum in a 37 year old male. Radiol Case Rep 2021; 16:2286-2288. [PMID: 33995745 PMCID: PMC8106896 DOI: 10.1016/j.radcr.2021.04.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
We report the case of a 37-year-old man who was admitted to Baqiyatallah hospital in Tehran (Iran) for retrosternal pain, fever, fatigue, dyspnoea and severe non-productive cough. The patient was subsequently confirmed as positive for COVID-19 at real-time polymerase chain reaction (RT-PCR) test. Chest computed tomography (CT) revealed also the presence of pneumomediastinum. This case highlights the importance of chest CT imaging for COVID-19 pneumonia to detect co-existing conditions as pneumomediastinum.
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Affiliation(s)
- Ramezan Jafari
- Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Luca Cegolon
- Public Health Department, Local Health Unit N. 2 "Marca Trevigiana", Treviso, Italy
| | - Fatemeh Dehghanpoor
- Department of Radiology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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