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Sciarretta JD, Noorbakhsh S, Joung Y, Bailey DW, Freedberg M, Nguyen J, Smith RN, Ayoung-Chee P, Davis MA, Benjamin ER, Todd SR. Pneumopericardium following severe thoracic trauma. Injury 2024; 55:111303. [PMID: 38218676 PMCID: PMC11023791 DOI: 10.1016/j.injury.2023.111303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/24/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a pneumothorax, interstitial air tracking along the pulmonary perivascular sheaths from ruptured alveoli to the pericardium, or direct trachea-bronchial-pericardial communication. Our objectives were to describe the modern management approach to PPC and to identify variables that could improve survival with severe thoracic injury. METHODS We conducted a retrospective study of the trauma registry between 2015 and 2022 at a Level I verified adult trauma center for all patients with PPC. Demographics, injury patterns, and treatment characteristics were compared between blunt and penetrating trauma. This study focused on the management strategies and the physiologic status regarding PPC and the development of tension physiology. The main outcome measure was operative versus nonoperative management. RESULTS Over a seven-year period, there were 46,389 trauma admissions, of which 488 patients had pneumomediastinum. Eighteen patients were identified with PPC at admission. Median age was 39.5 years (range, 18-77 years), predominantly male (n = 16, 89 %), Black (n = 12, 67 %), and the majority from blunt trauma (78 %). Half had subcutaneous emphysema on presentation while 39 % had recognizable pneumomediastinum on chest x-ray. Tube thoracostomy was the most common intervention in this cohort (89 %). Despite tube thoracostomy, tension PPC was observed in three patients, two mandating emergent pericardial windows for progression to tension physiology, and the remaining requiring reconstruction of a blunt tracheal disruption. The majority of PPC patients recovered with expectant management (83 %), and no deaths were directly related to PPC. CONCLUSIONS Traumatic PPC is a rare radiographic finding with the majority successfully managed conservatively in a monitored ICU setting. These patients often have severe thoracic injury with concomitant injuries requiring thoracostomy alone; however, emergent surgical intervention may be required when PPC progresses to tension physiology to improve overall survival.
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Affiliation(s)
- Jason D Sciarretta
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US.
| | - Yoo Joung
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US
| | - Daniel W Bailey
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Mari Freedberg
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Jonathan Nguyen
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Randi N Smith
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Patricia Ayoung-Chee
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Millard A Davis
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Elizabeth R Benjamin
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - S Rob Todd
- Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
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Ohn MH. Iatrogenic postintubation tracheal perforation in a patient with acute asthma exacerbation complicated with subcutaneous emphysema, pneumomediastinum, pneumopericardium, pneumothorax and pneumoperitoneum. BMJ Case Rep 2024; 17:e258934. [PMID: 38565225 PMCID: PMC10989107 DOI: 10.1136/bcr-2023-258934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- May Honey Ohn
- Cardiology department, St George's University Hospitals NHS Foundation Trust, London, UK
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Angelini M, Belletti A, Landoni G, Zangrillo A, De Cobelli F, Palumbo D. Macklin Effect: From Pathophysiology to Clinical Implication. J Cardiothorac Vasc Anesth 2024; 38:881-883. [PMID: 38378321 DOI: 10.1053/j.jvca.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 02/22/2024]
Abstract
Air leak syndromes (such as pneumomediastinum, pneumothorax, or subcutaneous emphysema) are frequent complications of acute respiratory distress syndrome (ARDS). Unfortunately, the development of air leaks is associated with worse outcomes. In addition, it has been hypothesized that the development of pneumomediastinum could be a marker of disease severity in patients with respiratory failure receiving noninvasive respiratory support or assisted ventilation. The so-called Macklin effect (or pulmonary interstitial emphysema) is the air dissection of the lung bronchovascular tree from peripheral to central airways following injury to distal alveoli. Ultimately, the progression of the Macklin effect leads to the development of pneumomediastinum, subcutaneous emphysema, or pneumothorax. The Macklin effect is identifiable on a chest computed tomography (CT) scan. The Macklin effect could be an accurate predictor of barotrauma in patients with ARDS (sensitivity = 89.2% [95% CI: 74.6-96.9]; specificity = 95.6% [95% CI: 90.6-98.4]), and may be a marker of disease severity. Accordingly, the detection of the Macklin effect on a chest CT scan could be used to select which patients with ARDS might benefit from different treatment algorithms, including advanced respiratory monitoring, early intubation, or, potentially, the institution of early extracorporeal support with or without invasive ventilation. In this video, the authors summarize the pathophysiology and potential clinical significance and applications of the Macklin effect in patients with acute respiratory failure.
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Affiliation(s)
- Matteo Angelini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Jin Q, Lin S, Chen X, Xu Y, Tian X, He L, Jiang W, Chen F, Shu X, Lu X, Peng Q, Wang G. Spontaneous pneumomediastinum in anti-MDA5-positive dermatomyositis: Prevalence, risk factors, and prognosis. Semin Arthritis Rheum 2024; 65:152352. [PMID: 38185078 DOI: 10.1016/j.semarthrit.2023.152352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/15/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To depict the clinical panorama of spontaneous pneumomediastinum (SPM) in anti-MDA5 antibody-positive dermatomyositis (anti-MDA5+ DM). METHODS A total of 1352 patients with idiopathic inflammatory myopathy (IIM), including 384 anti-MDA5+ DM patients were retrospectively enrolled. The clinical profiles of anti-MDA5+ DM-associated SPM were analyzed. RESULTS We identified that 9.4 % (36/384) of anti-MDA5+ DM patients were complicated with SPM, which was significantly higher than that of non-anti-MDA5+ DM and other IIM subtypes (P all <0.001). SPM developed at a median of 5.5 (3.0, 12.0) months after anti-MDA5+ DM onset. Anti-MDA5+ DM patients complicated with SPM showed a significantly higher frequency of fever, dyspnea, and pulmonary infection including viral and fungal infections compared to those without SPM (P all < 0.05). Cytomegalovirus (CMV) and fungal infections were identified to be independent risk factors for SPM development in the anti-MDA5+ DM. SPM and non-SPM patients in our anti-MDA5+ DM cohort showed comparable short-term and long-term survival (P = 0.236). Furthermore, in the SPM group, we found that the non-survivors had a lower peripheral lymphocyte count, higher LDH level, and higher frequency of intensification of immunosuppressive treatment (IST) than survivors. The elevated LDH level and intensification of IST were independent risk factors for increased mortality in anti-MDA5+ DM-associated SPM patients. CONCLUSIONS Nearly one-tenth of patients with anti-MDA5+ DM develop SPM. Both CMV and fungal infections are risk factors for SPM occurrence. The development of SPM does not worsen the prognosis of anti-MDA5+ DM patients, and the intensification of IST does harm to the SPM prognosis.
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Affiliation(s)
- Qiwen Jin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Sang Lin
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Yuetong Xu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaolan Tian
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Linrong He
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Wei Jiang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Fang Chen
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Shu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Qinglin Peng
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China.
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China; Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China.
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Huang W, Chen D, Ren F, Luo L, Zhou J, Huang D, Tian M, Qian K, Jiang Y, Tang L. The clinical characteristics of subcutaneous and mediastinal emphysema in anti-melanoma differentiation-associated 5 positive dermatomyositis associated with interstitial lung disease. Clin Exp Rheumatol 2024; 42:262-268. [PMID: 38147317 DOI: 10.55563/clinexprheumatol/84kd56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics of subcutaneous emphysema (SE) and mediastinal emphysema (ME) occurring in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated with interstitial lung disease (anti-MDA5-positive DM-ILD). METHODS In this retrospective study, a total of 117 anti-MDA5-positive DM-ILD patients were admitted to our hospital. All patients underwent an assessment of autoantibodies, serum ferritin levels, and lung high-resolution CT scans. RESULTS In patients with anti-MDA5-positive DM-ILD, the incidence of SE/ME was found to be 11.1%, which was significantly higher compared to patients with anti-synthetase syndrome (p<0.01). The mortality rate among anti-MDA5-positive DM-ILD patients with SE/ME was significantly higher than those without SE/ME (p=0.0022). There was no statistically significant difference in the occurrence of SE/ME between patients with positive anti-Ro-52 antibodies and those with negative anti-Ro-52 antibodies (p=0.18). Patients with higher serum ferritin levels (1000 ng/ml ≤serum ferritin ≤1500 ng/ml) had a higher likelihood of developing SE/ME compared to patients with lower serum ferritin levels (serum ferritin <500 ng/ml) (p<0.01). Among 13 anti-MDA5-positive DM-ILD patients with SE/ME, six (46.2%) developed SE/ME within 1 month of being diagnosed and 53.8% of patients underwent positive pressure ventilation prior to the onset of SE/ME. CONCLUSIONS We found that SE/ME is not uncommon in anti-MDA5-positive DM-ILD and is an important factor associated with poor patient prognosis. The occurrence of SE/ME is correlated with high levels of serum ferritin and is not related to anti-Ro-52 antibodies. Rheumatologists should pay close attention to SE/ME caused by positive pressure ventilation in anti-MDA5-positive DM-ILD patients.
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Affiliation(s)
- Wenhan Huang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dandan Chen
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feifeng Ren
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Luo
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhou
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongmei Huang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengxue Tian
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kechen Qian
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanqiu Jiang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Tang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Klamfoth J, Koroscil M. Spontaneous Pneumomediastinum Secondary to Undiagnosed Asthma in Military Adult. Mil Med 2024; 189:e433-e438. [PMID: 37525947 DOI: 10.1093/milmed/usad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence.
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Affiliation(s)
- Jeanette Klamfoth
- Internal Medicine Residency Program, Wright-Patterson AFB Medical Center, Dayton, OH 45433, USA
| | - Matthew Koroscil
- Pulmonary and Critical Care, Wright-Patterson AFB Medical Center, Dayton, OH 45433, USA
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Li W, Wang Y, Xu L, Yuan F. High-Altitude Pulmonary Edema Combined with Spontaneous Pneumomediastinum: A Case Report. Curr Med Imaging 2024; 20:e15734056234694. [PMID: 38087298 DOI: 10.2174/0115734056234694230922101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 12/18/2023]
Abstract
Background High-altitude pulmonary edema (HAPE) is a serious life-threatening disease that occurs after rapid ascent to high altitude; its main early-stage presentations include fatigue, headache, low-grade fever, dyspnea, and cough. X-ray and computed tomography (CT) images show pulmonary shadows and patches, which may be localized (initial right lung field predomination) or generalized to the bilateral lung base. Case Presentation In this report, we present a case of a 25-year-old man diagnosed with HAPE combined with spontaneous pneumomediastinum. After a quick descent and effective medical treatment, this patient made a full recovery. The case may provide helpful information for the prevention and treatment of this disease since an increased number of people, especially young men, currently travel and work at high altitudes. Conclusion After accurate clinical diagnosis with the help of CT or X-ray, immediate descent and appropriate oxygen supplementation are the most effective treatments for HAPE at high altitude.
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Affiliation(s)
- Wenzhe Li
- Department of Radiotherapy, General Hospital of Xinjiang Military Command, Wulumuqi, China
| | - Yajing Wang
- Department of Chemistry, No.54 Senior High School, Wulumuqi, China
| | - Li Xu
- Department of Radiotherapy, General Hospital of Xinjiang Military Command, Wulumuqi, China
| | - Fang Yuan
- Department of Radiotherapy, General Hospital of Xinjiang Military Command, Wulumuqi, China
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Mastroianni A, Mauro MV, Manfredi R, Greco S. Spontaneous pneumomediastinum associated with subcutaneous emphysema, pneumopericardium and pneumothorax: a rare association complicating measles. Recenti Prog Med 2024; 115:25-29. [PMID: 38169357 DOI: 10.1701/4169.41642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications from measles have been reported in every organ system and they may vary by age and underlying conditions. Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, subcutaneous neck and chest region emphysema, and pneumothorax, in a 19-year-old girl with measles. A review of the literature has documented only one previous report of spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in the course of measles, and no previous cases reported the association of pneumomediastinum, subcutaneous emphysema, pneumopericardium and pneumothorax complicating measles.
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Affiliation(s)
- Antonio Mastroianni
- Infectious Diseases & Tropical Diseases Unit, "Annunziata" Hub Hospital, Cosenza, Italy
| | | | - Roberto Manfredi
- Infectious Diseases Institute, Alma Mater Studiorum University of Bologna, Italy
| | - Sonia Greco
- Infectious Diseases & Tropical Diseases Unit, "Annunziata" Hub Hospital, Cosenza, Italy
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Gowa MA, Abidi SMA, Chandio B, Nawaz H. Case report of a child with spontaneous pneumomediastinum and subcutaneous emphysema. J Int Med Res 2023; 51:3000605231200269. [PMID: 37747498 PMCID: PMC10524063 DOI: 10.1177/03000605231200269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and pregnant women, and is rare in children. We report the case of a female toddler who presented to an emergency department with fever, cough and shortness of breath. Imaging studies revealed subcutaneous emphysema and pneumomediastinum. The patient was diagnosed with Hamman's syndrome after ruling out other possibilities. We discuss the underlying mechanisms of the disease, the diagnostic criteria and the treatment options. The purpose of this case report is to improve clinicians' awareness of the existence of this rare clinical entity in paediatric patients.
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Affiliation(s)
- Murtaza Ali Gowa
- Paediatric Critical Care Medicine, National Institute of Child Health, Karachi, Pakistan
- Paediatric Intensive Care Unit , National Institute of Child Health, Karachi, Pakistan
| | | | - Bakhtawer Chandio
- Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
| | - Hira Nawaz
- Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
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Yamakawa H, Sato S, Ohta H, Takatsuka M, Kusano K, Kawabe R, Oba T, Akasaka K, Amano M, Araya J, Sasaki H, Matsushima H. Clinical significance of para-carinal air cysts in patients with pleuroparenchymal fibroelastosis: The relationship with pneumomediastinum and pneumothorax. Clin Respir J 2023; 17:805-810. [PMID: 37515360 PMCID: PMC10435950 DOI: 10.1111/crj.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Para-tracheal or para-carinal air cysts (PACs) are often asymptomatic and usually detected incidentally by methods such as computed tomography. Their clinical significance is unclear in patients with pleuroparenchymal fibroelastosis (PPFE). METHODS We evaluated the clinical significance of PACs in PPFE and their relationship with pneumomediastinum or pneumothorax. RESULTS In total, 50 patients had PPFE and 34 (68%) had PACs. Most PACs were para-carinal (n = 30). A para-tracheal air cyst was detected in only nine patients, which included five patients having both para-carinal and para-tracheal air cysts. Overall median survival was 24.7 months. Survival was not significantly different between the patients with [PACs(+)] and without PACs (P = 0.268). A high frequency (64%) of the complication of pneumomediastinum or pneumothorax occurred in the overall population during follow-up. Pneumomediastinum/pneumothorax occurred significantly more frequently in patients with PACs(+) than in those without (76.5% vs. 37.5%; P = 0.012). PACs(+) was the only significant risk factor for pneumomediastinum/pneumothorax. CONCLUSIONS Our data showed that PACs commonly occur in patients with PPFE, and most PACs were para-carinal air cysts. Additionally, PACs(+) was a significant risk factor for pneumomediastinum/pneumothorax; therefore, clinicians should be more aware of these complications during follow-up examination, particular in PACs(+) patients with PPFE.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
| | - Shintaro Sato
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Hiroki Ohta
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Makiko Takatsuka
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
| | - Kenji Kusano
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Rie Kawabe
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Tomohiro Oba
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Keiichi Akasaka
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Masako Amano
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Jun Araya
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
| | - Hiroki Sasaki
- Department of RadiologySaitama Cross HospitalSaitamaJapan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Søe-Jensen P. [Asymptomatic mediastinal and neck emphysema after Kussmaul's respiration and purging]. Ugeskr Laeger 2022; 184:V03220177. [PMID: 36178181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This is a case report of a young woman with diabetes mellitus type 1. She was admitted with severe diabetic ketoacidosis. Asymptomatic "surgical emphysema", pneumomediastinum and bilateral pneumothoraces were accidently discovered. The emphysema had probably occurred due to laboured breathing and groaning during her diabetic ketoacidosis. No treatment was needed.
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Affiliation(s)
- Peter Søe-Jensen
- Intensiv Afdeling, Københavns Universitetshospital - Herlev Hospital
- Anæstesiologisk Afdeling, Københavns Universitetshospital - Herlev Hospital
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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.)
- Correspondence: ; Tel.: +39-3495838248
| | - 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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14
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Tung Chen Y, de la Herrán P, Villén Villegas T, Carballo-Cardona C. Usefulness of clinical ultrasound to evaluate an emergency in a cocaine user: beyond acute coronary syndrome. Emergencias 2020; 31:442-443. [PMID: 31777220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Yale Tung Chen
- Servicio de Urgencias, Hospital Universitario La Paz, Madrid, España
| | - Patricia de la Herrán
- Servicio de Atención Primaria y Comunitaria. Unidad Docente ESTE, Hospital Universitario Ramón y Cajal, Madrid, España
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15
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Abstract
The novel coronavirus (COVID-19) has emerged as a new pathogen responsible for an atypical viral pneumonia, with severe cases progressing to an acute respiratory distress syndrome. In our practice, we have observed patients admitted with COVID-19 pneumonia developing worsening hypoxaemic respiratory failure prompting the need for urgent endotracheal intubation. Here, we present a case of a patient admitted with severe COVID-19 pneumonia who required continuous positive airway pressure support following acute deterioration. However, with the patient requiring an increasing fraction of inspired oxygen (FiO2), a prompt CT pulmonary angiogram scan was performed to exclude an acute pulmonary embolism. Surprisingly, this revealed a pneumomediastinum. Following a brief admission to the intensive care unit, the patient made a full recovery and was discharged 18 days post admission.
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Affiliation(s)
- Rajan Pooni
- Gastroenterology, Barts Health NHS Trust, London, UK
| | - Gargi Pandey
- Gastroenterology, Barts Health NHS Trust, London, UK
| | - Saniath Akbar
- Gastroenterology, Barts Health NHS Trust, London, UK
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16
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Yee D, Fu D, Hui C, Dharmadhikari N, Carino G. A Rare Case of 4 Ps: Bilateral Pneumothoraces and Pneumomediastinum in Pneumocystis Pneumonia. R I Med J (2013) 2020; 103:52-54. [PMID: 32481782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report a case of Pneumocystis jirovecii pneumonia (PCP) complicated by bilateral pneumothoraces and pneumomediastinum in a non-human immunodeficiency virus (HIV)- infected patient. This unusual presentation exemplifies the differences in clinical course and presentation in non-HIV versus HIV-infected individuals, and the poor prognosis associated with PCP complicated by pneumothorax or pneumomediastinum. Providers should be aware of the high mortality in patients who develop one, and especially both complications.
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Affiliation(s)
- Daniel Yee
- Lifespan/Brown University Internal Medicine Resident
| | - Danni Fu
- Lifespan/Brown University Internal Medicine Resident
| | - Channing Hui
- Brown University Critical Care Fellow at The Miriam Hospital
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17
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Minomo S, Arai T, Higo H, Tsuji T, Tachibana K, Akira M, Inoue Y. Characteristics and prognosis of interstitial pneumonias complicated with pneumomediastinum. Respir Investig 2020; 58:262-268. [PMID: 32278605 DOI: 10.1016/j.resinv.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical characteristics and prognostic impact of complication with pneumomediastinum in patients with interstitial pneumonias (IPs) are not well studied due to the relatively limited nature of available reports. The purpose of this study was to clarify the characteristics and prognostic factors of IPs complicated with pneumomediastinum. METHODS Consecutive patients with IPs complicated with pneumomediastinum detected by computed tomography (CT) between July 1, 2011, and April 30, 2014 were retrospectively reviewed. Clinical data including symptoms associated with pneumomediastinum, laboratory data, lung function tests, treatments, and mortality were collected from medical records. RESULTS Forty-five patients (25 males, 20 females), including 32 with idiopathic IP (IIPs) and 13 connective tissue disease-associated interstitial lung diseases (CTD-ILDs) were identified. The median age of onset of pneumomediastinum was 72 years (interquartile range [IQR] 68-79 years). The most common symptom associated with occurrence of pneumomediastinum was appearance or worsening of dyspnoea. No specific treatment was performed for most (84%) of the cases. The median period between occurrence and improvement of pneumomediastinum was 29 days (IQR 5-69 days). Multivariate analysis revealed that IIPs and no improvement of pneumomediastinum were associated with poor prognosis. CONCLUSIONS Patients with IIPs complicated with pneumomediastinum and those without improvement of pneumomediastinum had poor prognosis.
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Affiliation(s)
| | - Toru Arai
- Department of Internal Medicine, Osaka, Japan; Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Hisao Higo
- Department of Respiratory and Allergy Medicine, Okayama University Hospital, Okayama, Japan
| | - Taisuke Tsuji
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, Osaka, Japan; Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Yoshikazu Inoue
- Department of Internal Medicine, Osaka, Japan; Clinical Research Center, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan.
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18
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Miller A, Mann Ben Yehuda T. Spontaneous pneumomediastinum presententing as nasal voice. Eur J Intern Med 2019; 67:e5-e6. [PMID: 31138480 DOI: 10.1016/j.ejim.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Asaf Miller
- Medical intensive care unit, Rambam Health Care Campus, Haifa, Israel.
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19
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Opstelten JL, Zwinkels JR, van Velzen E. [Sudden dyspnoea and facial swelling during labour]. Ned Tijdschr Geneeskd 2019; 163:D3044. [PMID: 31305033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 25-year-old woman was in the hospital to give birth to her first child. During labour, she suddenly experienced dyspnoea and facial swelling. Palpation revealed crepitus around the face, neck and chest. A chest radiograph showed a continuous diaphragm sign with subcutaneous emphysema, consistent with a spontaneous pneumomediastinum (Hamman's syndrome).
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Affiliation(s)
- Jorrit L Opstelten
- Meander Medisch Centrum, afd. Interne Geneeskunde, Amersfoort
- Contact: J.L. Opstelten
| | - Jos R Zwinkels
- Meander Medisch Centrum, afd. Gynaecologie en Obstetrie, Amersfoort
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20
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Murzabdillaeva A, Zhao B. Poorly Differentiated Biliary Adenocarcinoma Leading to Boerhaave syndrome: A Case Report and Review of the Literature. Ann Clin Lab Sci 2019; 49:395-399. [PMID: 31308042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Boerhaave syndrome is a transmural disruption of the esophagus, due to an increase in esophageal pressure and is associated with high morbidity and mortality. There are cases reported secondary to bowel obstructions such as incarcerated hernias and gallstone ileus. Here, we describe an unusual autopsy case of Boerhaave syndrome, due to bowel obstruction secondary to biliary adenocarcinoma, which has never been reported in the literature. The patient was an 87-year old male presenting with severe chest and epigastric pain. Computed tomography showed fluid-filled esophagus, gastric distention and an ill-defined mass within the liver. Patient underwent esophagogastroduodenoscopy, which revealed esophageal rupture. Patient expired within 20 hours of admission. On autopsy, the decedent was found to have an esophageal perforation and an inferior hepatic mass, which morphologically and immunohistochemically was consistent with a biliary adenocarcinoma.
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Affiliation(s)
- Albina Murzabdillaeva
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
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21
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Abstract
Adult-onset measles is rare in the UK, particularly in patients with a complete vaccination history.We present a case of a UK-born patient who received all childhood vaccinations, had no history of recent travel or unwell contacts who was diagnosed with measles complicated by pneumomediastinum. This case highlights the need to consider measles in any patient presenting with a constellation of a macular rash, fever and conjunctivitis, regardless of vaccination status. The nature of the rash can provide an important clue to the diagnosis. Liaison with infection specialists facilitates early diagnosis, allowing for appropriate initial investigations, improving clinical management and early infection control precautions being instituted.
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Affiliation(s)
| | - Aula Abbara
- Imperial College Healthcare NHS Trust, London, UK
| | - Rohma Ghani
- Imperial College Healthcare NHS Trust, London, UK
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22
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Vasko R, Anton Müller G. A 27-Year-Old Man With Abruptly Occurring Chest Pain on Swallowing. Dtsch Arztebl Int 2018; 115:652. [PMID: 30375328 PMCID: PMC6224540 DOI: 10.3238/arztebl.2018.0652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Radovan Vasko
- *Klinik für Nephrologie und Rheumatologie, Georg-August-Universität Göttingen,
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23
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Wengse C, Bolinder G, Aman E. [Not Available]. Lakartidningen 2018; 115:ETD4. [PMID: 29319833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A previously healthy 21-year old man presented to the emergency department with sudden onset central chest pain exacerbated by breathing. A plain chest X-ray showed air within the mediastinum and pericardium confirmed by a CT scan with contrast. The patient history did not raise suspicion of any concomitant disease and the diagnosis of spontaneous pneumomediastinum with pneumopericardium was made. The patient recovered completely over the next few days with bed rest and analgesics. Spontaneous pneumomediastinum is an uncommon disease caused by rupture of perivascular alveoli causing air leakage to the mediastinum. The condition is benign and self-resolving in most cases. Pneumopericardium, a rare complication to spontaneous pneumomediastinum, is also usually self-resolving but may cause cardiac tamponade requiring intervention. Spontaneous pneumomediastinum must be differentiated from secondary pneumomediastinum caused by an underlying condition, such as esofageal rupture, trauma or infection, which may require specific treatment.
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Affiliation(s)
- Carl Wengse
- Danderyds Sjukhus AB - Medicinkliniken Stockholm, Sweden - Stockholm, Sweden
| | - Gustav Bolinder
- Röntgenkliniken - Danderyds sjukhus Stockholm, Sweden Röntgenkliniken - Danderyds sjukhus Stockholm, Sweden
| | - Emil Aman
- Danderyds Sjukhus AB - Cardiology Stockholm, Sweden Danderyds Sjukhus AB - Cardiology Stockholm, Sweden
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24
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Kourounis G, Lim QX, Rashid T, Gurunathan S. A rare case of simultaneous pneumoperitoneum and pneumomediastinum with a review of the literature. Ann R Coll Surg Engl 2017; 99:e241-e243. [PMID: 29022798 PMCID: PMC5696937 DOI: 10.1308/rcsann.2017.0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 12/17/2022] Open
Abstract
Simultaneous pneumoperitoneum and pneumomediastinum is a rare clinical occurrence. It has been reported in the literature as a complication of various medical and dental procedures. To our knowledge, we present the first case of a non-iatrogenic and traumatic simultaneous pneumoperitoneum and pneumomediastinum in a previously independent 91-year-old man who presented to hospital with back and chest wall pain following mechanical fall from standing. A new radiological diagnosis of diverticular disease with possible perforation was made following admission. Despite appropriate management and supportive measures, the patient died 12 days after admission from a kidney injury.
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Affiliation(s)
- G Kourounis
- Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries , Scotland , UK
- University of Edinburgh, Edinburgh , Scotland , UK
| | - Q X Lim
- University of Glasgow, Glasgow , Scotland , UK
| | - T Rashid
- Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries , Scotland , UK
| | - S Gurunathan
- Department of General Surgery, Dumfries and Galloway Royal Infirmary, Dumfries , Scotland , UK
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25
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Pearmain L, Krysiak P, Blaikley J, Alaloul M. Persistent air leak after pulmonary transplantation. BMJ Case Rep 2017; 2017:bcr-2017-220176. [PMID: 28751430 PMCID: PMC5614144 DOI: 10.1136/bcr-2017-220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/03/2022] Open
Abstract
A 59-year-old man with bilateral apical emphysema underwent a double lung transplant for end-stagechronic obstructive pulmonary disease leaving remnant right apical native tissue due to pleural adhesions. Initial postoperative course was uneventful until the chest drains were removed. This revealed a small pneumomediastinum, which progressively increased in size causing gross surgical emphysema. Re-insertion of the chest drain stabilised the patient so that the cause could be identified and corrected. Two bronchoscopies excluded anastomotic dehiscence as a cause. Therefore the subcostal wound was refashioned under video-assisted thoracoscopic surgery in case there was a defect. Unfortunately this also failed to halt the air leak; therefore another cause was sought. A multidisciplinary team meeting review of the radiology revealed that the patient's native bullous tissue was still inflated. Subsequent bronchoscopy revealed a native bronchial communication, due to variant anatomy, proximal to the surgical anastomosis. This was subsequently occluded using a bronchial valve allowing the patient to make a swift recovery.
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Affiliation(s)
- Laurence Pearmain
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Piper Hanley Group, University of Manchester Institute of Human Development, Manchester, UK
| | - Piotr Krysiak
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - John Blaikley
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Division of infection, Immunity and Respiratory medicine, University of Manchester, Manchester, UK
| | - Mohamed Alaloul
- Department of Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Jennane S, Haidouri S, Zine Filali K, Ahchouch S, Mahtat EM, Doghmi K, Mikdame M. [Fatal bleomycin induced pneumomediastinum and bilateral pneumothorax]. Rev Pneumol Clin 2017; 73:153-156. [PMID: 28365047 DOI: 10.1016/j.pneumo.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/03/2017] [Indexed: 06/07/2023]
Affiliation(s)
- S Jennane
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc.
| | - S Haidouri
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
| | - K Zine Filali
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
| | - S Ahchouch
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
| | - E M Mahtat
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
| | - K Doghmi
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
| | - M Mikdame
- Service d'hématologie clinique, hôpital militaire d'instruction Mohammed V, Hay Riad BP 10100, Rabat, Maroc
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Iwasa T, Nakamura K, Ihara E, Aso A, Ito T. The Effective Treatment with Cyclosporine of a Ulcerative Colitis Patient with Concurrent Idiopathic Thrombocytopenic Purpura Who Subsequently Developed Spontaneous Pneumomediastinum. Intern Med 2017; 56:1331-1337. [PMID: 28566594 PMCID: PMC5498195 DOI: 10.2169/internalmedicine.56.7909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although extraintestinal manifestations of inflammatory bowel diseases are not uncommon, few reports have described concurrent idiopathic thrombocytopenic purpura (ITP). Spontaneous pneumomediastinum is also a rare complication of ulcerative colitis (UC). This report describes the case of a 14-year-old boy who experienced recurrent ulcerative colitis 3 months after temporary improvement following treatment with prednisolone (20 mg/day) and granulocyte/monocyte adsorption apheresis. His platelet counts decreased, suggesting ITP. The dosage of prednisolone was increased to 60 mg/day; however, his thrombocytopenia did not improve and he suddenly developed pneumomediastinum. A continuous infusion of cyclosporine increased his platelet counts and improved his ulcerative colitis. Cyclosporine should be considered when steroid-resistant ITP accompanies UC.
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Affiliation(s)
- Tsutomu Iwasa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazuhiko Nakamura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akira Aso
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tetsuhide Ito
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Japan
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Oks M, Mayo P, Koenig S. A Man in His 60s With Sudden Decompensation After Percutaneous Tracheostomy. Chest 2016; 150:e125-e127. [PMID: 27832895 DOI: 10.1016/j.chest.2016.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/21/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Margarita Oks
- Hofstra Northwell School of Medicine, Manhasset, NY.
| | - Paul Mayo
- Hofstra Northwell School of Medicine, Manhasset, NY
| | - Seth Koenig
- Hofstra Northwell School of Medicine, Manhasset, NY
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Kounis NG, Zavras GM, Papadaki PJ, Kouni SN, Batsolaki M, Gouvelou-Deligianni GV, Koutsojannis CC. Pneumomediastinum and Cervical Emphysema Associated with Unusual Clinical and Electrocardiographic Manifestations. Angiology 2016; 54:631-5. [PMID: 14565642 DOI: 10.1177/000331970305400516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is the first case reported of combined cervical emphysema and pneumomediastinum asso ciated with unusual electrocardiographic and local neurologic findings. These may be the result of an increase in intracervical and intrathoracic pressure induced by the dissecting air.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medicine, Agios Andreas General Hospital, Patras, Greece
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30
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Lee SS. An unusual cause of chest pain in army trainee - spontaneous pneumomediastinum. Med J Malaysia 2016; 71:30-31. [PMID: 27130742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This is a case report of spontaneous pneumomediastinum that occurred in a 19-year-old army trainee during his 2.4km run. Spontaneous pneumomediastinum is a rare disorder. It is usually precipitated by activities related to Valsalva manoeuvres such as strenuous physical activities, retching and vomiting. Treatment is expectant and the disorder usually resolves spontaneously within a few days. However, one must be aware of the disorder so that additional advice such as avoiding activities that involve Valsalva manoeuvres can be given.
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Affiliation(s)
- S S Lee
- Singapore General Hospital Internal Medicine, Department of Internal Medicine, Singapore General Hospital, Academia, Level 4. 20 College Road. 169856 Singapore, Singapore.
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31
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Svedbrand C, Lange P, Nielsen K. [Spontaneous mediastinal emphysema]. Ugeskr Laeger 2016; 178:V08150653. [PMID: 26750190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Spontaneous mediastinal emphysema, also known as spontaneous pneumomediastinum, is defined as radiologically detected free air in the mediastinum, without preceding trauma. It is a rare condition, mainly affecting young adults. It can be caused by coughing, strenuous sports or cocaine inhalation, however, 40% are idiopatic. Common symptoms are chest pain and dyspnoea. 75-90% can be diagnosed with a chest X-ray, and 100% with a computed tomography. Treatment is symptomatic and complications are rare, however, pneumothorax and pneumorrachis have been reported.
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Tokumitsu K, Hatoyama K, Kubota Y, Asami K, Ohsato M, Okamoto M, Takeuchi J, Yachimori K. [A Case of Recurrent Spontaneous Pneumomediastinum with Anorexia Nervosa]. Seishin Shinkeigaku Zasshi 2016; 118:275-280. [PMID: 30620481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29 kg in approximately 5 months. In January 20XX, the subject was first examined as an outpatient at our psychiatric department at the recommendation of her eldest son. Upon diagnosis of anorexia nervosa, the subject underwent outpatient treatment ; however, there was no improvement in the disturbance in self-per- ceived weight or shape, and the subject voiced her desire to lose weight. In May 20XX, the subject complained of chest pain, pharyngeal pain, and respiratory distress after self-induced vomiting and was, thus, examined at the psychiatric outpatient services. Chest X-ray and chest CT revealed pneumomediastinum and subcutaneous emphysema. Spontaneous oesophageal rupture, a fatal condition, was suspected and, therefore, the subject was transferred to a more advanced medical institution capable of esophageal surgery. After admission, spontane- ous oesophageal rupture was ruled out based on the results of upper gastrointestinal endos- copy with esophagography, and spontaneous pneumomediastinum was diagnosed. The pneu- momediastinum disappeared with conservative treatment ; however, after approximately 8 months, spontaneous pneumomediastinum recurred, following self-induced vomiting. For patients with eating disorders and who are involved in self-induce vomiting, we believe that the vomiting can cause pneumomediastinum, and it is assumed that continuation or recommencement of vomiting can potentially increase the risk that pneumomediastinum will recur. We, therefore, report recurring pneumoediastinum as a physical complication caused by self- induced vomiting that should be noted in clinical practice of the psychiatric department.
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Kim SH, Huh J, Song J, Kang IS. Spontaneous Pneumomediastinum: A Rare Disease Associated with Chest Pain in Adolescents. Yonsei Med J 2015; 56:1437-42. [PMID: 26256992 PMCID: PMC4541679 DOI: 10.3349/ymj.2015.56.5.1437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/04/2014] [Accepted: 11/12/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Spontaneous pneumomediastinum (SPM) is a rare entity, with only a few cases reported, especially in adolescents. We aimed to analyze the clinical characteristics of SPM in adolescents and the diagnostic implications of computed tomography (CT) and esophagography therein. MATERIALS AND METHODS This retrospective descriptive study was conducted as a review of medical records of 416 adolescents (10-18 years of age) with chest pain from March 2005 to June 2013. Information on clinical presentation, methods of diagnosis, hospital stay, and outcomes were collected and analyzed. RESULTS Among adolescents complaining of chest pain, 11 patients had SPM (11/416, 2.64%). All patients presented with pleuritic chest pain, and 54.5% reported neck pain as the most common associated complaint. Clinical findings were nonspecific, and initial chest X-ray assessment was diagnostic only in three of 11 patients. However, reassessment of chest X-ray revealed diagnostic findings of SPM in five of the remaining eight patients. CT was diagnostic in all patients, while esophagography and echocardiogram were uninformative. Symptomatic improvement was noted within 2.45±1.2 hours (range, 0.5 to 4) after supportive care; mean hospital stay was 4.54±0.99 days (range, 2 to 6). No recurrence was observed. CONCLUSION SPM is a rare disease that should be considered in adolescent patients with pleuritic chest pain. Careful reading of initial chest X-rays is important to avoiding further unnecessary investigations. SPM is self-limited and treatment is supportive; nevertheless, if there are no indications of esophageal rupture, urgent esophagography is not recommended.
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Affiliation(s)
- Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - June Huh
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jinyoung Song
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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34
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Zhou Y, Yang L, Shi J. [Successful treatment of one case after acute paraquat intoxication complicated with pulmonary fibrosis, mediastinal emphysema and subcutaneous emphysema]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015; 33:702-703. [PMID: 26832712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
We present a case of a 28-year-old primiparous woman with facial swelling followed by acute chest pain immediately after delivery. Chest radiograph revealed pneumomediastinum and surgical emphysema. She recovered well within 24 h of observation and conservative management. Postpartum spontaneous pneumomediastinum should be considered in the differential diagnosis of sudden-onset postpartum chest pain immediately or a few hours after delivery. It is a rare benign condition and usually resolves spontaneously without serious consequences. Chest X-ray is the single most important diagnostic test. It is important to rule out other serious and life-threatening conditions. Prolonged pushing, difficult labour and use of inhalational drugs place young primiparous women at higher risk. Recurrence is uncommon in subsequent pregnancy and management is unclear, although expectant management with epidural analgaesia to prevent recurrence in subsequent pregnancy is suggested.
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Affiliation(s)
- Cho Cho
- Department of Obstetrics and Gynaecology, Chesterfield Royal Hospital, Chesterfield, UK
| | - Jennifer Ruth Parratt
- Department of Obstetrics and Gynaecology, Chesterfield Royal Hospital, Chesterfield, UK
| | - Steve Smith
- Department of Obstetrics and Gynaecology, Chesterfield Royal Hospital, Chesterfield, UK
| | - Ramnik Patel
- Department of Surgery, PGICHR and KTCGH, Rajkot, Gujarat, India
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36
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Gawrys B, Shaha D. Pleuritic chest pain and globus pharyngeus. J Fam Pract 2015; 64:305-307. [PMID: 26009748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Breanna Gawrys
- Fort Belvoir Community Hospital, Family Medicine Residency, VA, USA.
| | - David Shaha
- Fort Belvoir Community Hospital, Family Medicine Residency, VA, USA
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37
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Kropp S, Vijverman A, Rinken C, Lismonde JL, Deflandre J. [When genetics spices up a severe flare of chronic inflammatory bowel disease]. Rev Med Liege 2014; 69:654-657. [PMID: 25796781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The simultaneous occurrence of pneumomediastinum, peridural emphysema, subcutaneous emphysema and pneumothorax is extremely rare. We report the case of a young man with severe chronic inflammatory bowel disease presenting with voluminous spontaneous pneumomediastinum complicated by subcutaneous emphysema as well as peridural emphysema and pneumothorax. A genetic disorder is suspected.
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38
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Han W, Zhi S, Zhao Q, Zhao G, Wu X, Hong G, Lu Z. [Accidental oral intake of potassiumpermanganate-induced acute lung injury combined pneumomediastinum: a case report]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2014; 32:852-853. [PMID: 25579037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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39
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Gupta DC, Jenaw RK, Koolwal S, Khippal N. A rare case of ulcerative colitis with diffuse parenchymal lung disease, spontaneous pneumomediastinum and subcutaneous emphysema. Indian J Chest Dis Allied Sci 2014; 56:109-111. [PMID: 25230552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.
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40
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Linden D, Courtney D, Shyamsundar M, Hewitt R. Chest pain and neck discomfort in a young man. BMJ 2014; 348:g1661. [PMID: 24569524 DOI: 10.1136/bmj.g1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dermot Linden
- Department of Intensive Care, Ulster Hospital, Belfast BT16 1RH, UK
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41
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Fırıncı F, Özgürler F, Doğan M, Koçyiğit A, Mete E. Spontaneous pneumomediastinum in childhood: report of an adolescent case diagnose with asthma. Tuberk Toraks 2014; 62:253-254. [PMID: 25492825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Fatih Fırıncı
- Department of Pediatrics, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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42
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Zhang XY, Zhang WX, Sheng AQ, Zhang HL, Li CC. [Diagnosis and prognosis of spontaneous pneumomediastinum in eighteen children]. Zhonghua Er Ke Za Zhi 2013; 51:849-851. [PMID: 24484561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze the diagnosis, treatment and prognosis of spontaneous pneumomediastinum (SPM) in children. METHOD A retrospective analysis of the clinical data of 18 children diagnosed with SPM in Yuying Children's Hospital Affiliated to Wenzhou Medical University from December 2007 to February 2013 was performed. Information of the sequelae and recurrence of SPM was obtained by telephone follow-up. SPM was diagnosed according to Versteegh's standard. SPM cases due to mechanical ventilation, trauma, inhaled foreign body or as a result of the underlying disease were not included. Also cases of secondary pneumothorax pneumomediastinum and neonatal mediastinal emphysema were excluded. RESULT Fifteen of 18 cases were boys and 3 were girls, the range of age was from 9 to 17 years. Predisposing factors included sport activities, severe cough or without a known cause. Clinical manifestations included chest pain, chest tightness, dyspnea, neck pain, back pain, foreign body sensation or pain on swallowing, throat pain of swelling. Chest CT of 18 cases showed pneumomediastinum, 8 cases displayed varied degrees of air in neck, chest; 18 cases of SPM responded well to bed rest, oxygen, antitussive and anti-infection treatment. Fifteen cases received chest CT or X-ray inspection after therapy, showing that the pneumomediastinum disappeared or significantly absorbed, 3 cases improved in clinical symptom. Among 18 patients, telephone follow-up of 14 were successful and 4 cases were lost. An average follow-up time was (24 ± 17) months. None of the cases had any serious consequences, and recurrence happened in one case. CONCLUSION Children's spontaneous pneumomediastinum is a benign disease. When a child has chest pain or chest tightness, SPM should be considered after excluding the common diseases. SPM can be diagnosed in association with clinical feature and chest CT examination. Patients respond well to conservative therapy and most of them had no severe sequelae.
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Affiliation(s)
- Xue-ya Zhang
- Department of Respiratory Diseases,Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou
| | - Wei-xi Zhang
- Department of Respiratory Diseases,Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou.
| | - An-qun Sheng
- Department of Respiratory Diseases,Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou
| | - Hai-lin Zhang
- Department of Respiratory Diseases,Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou
| | - Chang-chong Li
- Department of Respiratory Diseases,Yuying Children's Hospital Affiliated to Wenzhou Medical University, Wenzhou
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Dinçkal MH, Okuyan E, Sahin I, Avşar M, Turna F. Patient with nonechogenic chest and pleuritic chest pain. Anadolu Kardiyol Derg 2013; 13:715-736. [PMID: 24172817 DOI: 10.5152/akd.2013.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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44
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Tomizawa Y, Sohnen AE. Spontaneous pneumomediastinum originating from extensive subcutaneous emphysema. Intern Med 2013; 52:2291. [PMID: 24088772 DOI: 10.2169/internalmedicine.52.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yutaka Tomizawa
- Department of Medicine, University of Pittsburgh Medical Center, USA
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45
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Pronk SM, Clement SC, Weijer O. [A newborn with tachypnea]. Ned Tijdschr Geneeskd 2013; 157:A3963. [PMID: 23406636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A neonate developed a tachypnea 2 hours after his birth. Blood measurements showed low infectious parameters and a respirator acidosis. The x-ray showed a pneumomediastinum. A spontaneous pneumomediastinum is rare in newborns, causes can be underlying lung diseases or mechanical ventilation. The treatment prognosis is good; spontaneous recovery without treatment is common.
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46
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Maithani T, Dey D, Sharma C. Spontaneous cervicofacial subcutaneous emphysema secondary to pneumomediastinum in an otherwise asymptomatic child. Ear Nose Throat J 2012; 91:E9-E11. [PMID: 23076863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A 12-year-old boy presented with subcutaneous emphysema of the face, neck, and upper chest. He had no significant history that suggested any specific cause, and initial investigations revealed no underlying pathology. Computed tomography of the chest detected pneumomediastinum. The patient was managed conservatively, and he responded. He was discharged 7 days after admission with a complete resolution of the emphysema. To the best of our knowledge, this is the first reported case of spontaneous pneumomediastinum presenting as cervicofacial swelling in a child without any other symptoms.
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Affiliation(s)
- Tripti Maithani
- Department of ENT & Speech Therapy, Shri Guru Ram Rai Institute of Medical & Health Sciences, 1 Patel Nagar, Dehradun 248001, India.
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47
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Braam EAJE, Pijl MEJ, Groenen MJM, Kaasjager K. A young man with odynophagia, nausea and vomiting. Neth J Med 2012; 70:323-327. [PMID: 22961828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- E A J E Braam
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
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48
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Cremaschini G, Sassi G, Tedoldi S, Corna A, Vaccaro T, Cipolletta E, Santella L, Tramaloni G, Cappellaro E, Caccia P, Colombo M. [An unusual pneumomediastinum case in a child caused by spontaneous bronchial rupture]. Minerva Pediatr 2012; 64:243-249. [PMID: 22495198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of spontaneous pneumomediastinum (SPM) in a 3 year-old child, admitted to the emergency department because he presented dyspnea for a few hours, after a paroxysm of cough. The SPM is rare in children; the term "spontaneous" is reserved for cases of pneumomediastinum that haven't a traumatic cause. SPM is seen most commonly in asthmatics and in any patient who induces a Valsalva maneuver. The clinical diagnosis is confirmed by chest radiograph. When the diagnosis is uncertain, the chest CT scan is considered the gold standard of imaging tests, capable of detecting pneumomediastinum even in patients with small amounts of mediastinal air. In this case CT images showed the cause: spontaneous bronchial rupture. The direct sign of bronchial injury is the contiguity of the luminal air with that in the mediastinum. In the literature SPM cases are very rare, at least in health patients without tracheobronchial anomalies. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously, such as in our patient. In this article we want to explain the main clinical, diagnostic and therapeutic aspects of SPM, because, even if it's rare in children, it must be considered in the differential diagnosis of dyspnea; then we want to demonstrate as, in this case, a TC scan was important to identifying the SPM cause: a bronchial rupture.
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Affiliation(s)
- G Cremaschini
- Unità Operativa di Pediatria e Neonatologia, Presidio Ospedaliero di Manerbio, Manerbio, Brescia
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Abstract
Birt-Hogg-Dubé syndrome is a rare autosomal dominant condition caused by a germline mutation in the folliculin gene, which is characterized by skin fibrofolliculomas, multiple lung cysts and renal cancer. The clinical expression of the syndrome is highly variable, with recurrent pneumothoraces due to ruptured lung cysts in many cases. We report a patient with pneumomediastinum and cervico-facial emphysema after severe coughing without pneumothorax, skin lesions or renal tumour, but a striking family history of lung abnormalities.
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Affiliation(s)
- Guido Michels
- Department III of Internal Medicine, University of Cologne, Germany
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Bartela E, Mikołajczak M, Prech M. [Pneumomediastinum as a rare cause of retrosternal chest pain--report of two cases]. Pol Merkur Lekarski 2011; 31:360-363. [PMID: 22239007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pneumomediastinum (PM) is a rare cause (the rate varies from 1:8500 to 1:30000 patients) of pain in the chest. This is generally a benign entity resulting from alveolar rupture and propagation of the air into the mediastinum that affects mainly young adults. It may appear however as a complication of different procedures within the chest. Asthma, cough, vomiting, illicit drug use and all activities that require the Valsalva maneuver and/or intense breathing work or exercise were identified as predisposing factors of PM. We report cases of two patients admitted within some months to the emergency department due to chest pain. Due to acute onset of symptoms and a presence of a loud murmur along the left border of the sternum the acute pericarditis was suspected. However, after careful and detailed examination acute coronary syndrome and pericarditis were excluded. Radiologic examination and computed tomography of the chest revailed the presence of air in the mediastinum in both cases. After the diagnosis of pneumomediastinum antiinflammatory agents and antibiotics were administered. Recovery was uneventful, within two weeks form the onset a complete resolution of radiologic changes were observed.
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Affiliation(s)
- Ewa Bartela
- NZOZ Ośrodek Kardiologii Inwazyjnej w Lesznie.
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