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Selvam S, Simha A, Nawaz RS, Sarmin A, Gangadharappa RC, Pannu AK. Occult paraquat poisoning causing pneumomediastinum and organizing pneumonia. Trop Doct 2024; 54:66-68. [PMID: 37674474 DOI: 10.1177/00494755231200042] [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] [Indexed: 09/08/2023]
Abstract
Pneumomediastinum is not an uncommon manifestation of lung toxicity in acute paraquat ingestion. The condition is almost invariably seen with other lung parenchymal abnormalities such as consolidations, ground-glass opacities and interlobular septal thickening. The diagnosis may be challenging in cases with no history of toxin exposure, presentation with a subacute illness and/or absence of typical local or systemic features of paraquat toxicity.
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Affiliation(s)
- Suresh Selvam
- Senior Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amar Simha
- Senior Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rana Sadaqat Nawaz
- MD Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aziza Sarmin
- MD Resident, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Ashok Kumar Pannu
- Associate Professor, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Inesse AA, Ilaria R, Camille O. Protracted Labor Complicated by Pneumomediastinum and Subcutaneous Emphysema: A Rare Case Report and Management Considerations. Am J Case Rep 2023; 24:e940989. [PMID: 37865817 PMCID: PMC10601972 DOI: 10.12659/ajcr.940989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/02/2023] [Revised: 09/05/2023] [Accepted: 08/25/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman's sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman's syndrome). CASE REPORT This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry's spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman's syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. CONCLUSIONS This report presents a rare association between protracted labor and Hamman's syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated.
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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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Wang D, Rao L, Xu S, Mo B. An unusual case of abdominal pain: psychogenic vomiting complicated by spontaneous pneumomediastinum. BMC Pulm Med 2023; 23:274. [PMID: 37480053 PMCID: PMC10362597 DOI: 10.1186/s12890-023-02459-8] [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] [Received: 12/01/2022] [Accepted: 04/28/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Spontaneous pneumomediastinum (SPM) was defined by the appearance of free air in the mediastinum that was not preceded by trauma, surgery, or other medical procedures. Among the numerous manifestations of SPM, abdominal pain had seldom been described. CASE PRESENTATION A 25-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain for 7 days. The presenting clinical features and the radiological results were suggestive of psychogenic vomiting with spontaneous pneumomediastinum in a patient who suffered from abdominal pain. CONCLUSIONS The special feature of this case was the elucidation of a rare cause of abdominal pain, which should be differentiated in patients with vomiting combined with abdominal pain. The importance of this case was that its recognition may prevent unnecessary procedures to rule out or treat other causes of abdominal pain.
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Affiliation(s)
- Decai Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Site of National Clinical Research Center for Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Lizong Rao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Shuyun Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Site of National Clinical Research Center for Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Biwen Mo
- Department of Respiratory and Critical Care Medicine, Guangxi Zhuang Autonomous Region Education Department Key Laboratory of Respiratory Diseases, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, Second Affiliated Hospital of Guilin Medical University, 212 Renmin Avenue, Guilin, 541004, Guangxi, China.
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Abid N, Nemsi E, Loukil M, Gader N, Ben Ali M, Ghrairi H. Spontaneous pneumomediastinum in patients with COVID-19 pneumonia. Tunis Med 2023; 101:313-316. [PMID: 37682278] [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] [Received: 02/12/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood. OBSERVATIONS we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases. CONCLUSIONS Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.
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Affiliation(s)
- Narjes Abid
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Ella Nemsi
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Manel Loukil
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Nada Gader
- Service de pneumologie-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Mechaal Ben Ali
- Service de réanimation médicale-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
| | - Hedia Ghrairi
- Service de réanimation médicale-CHU Mohamed Taher Maamouri Nabeul / Faculté de médecine de Tunis
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Hung SW, Liao YC, Chi IC, Lin TY, Lin YC, Lin HJ, Huang ST. Integrated Chinese herbal medicine and Western medicine successfully resolves spontaneous subcutaneous emphysema and pneumomediastinum in a patient with severe COVID-19 in Taiwan: A case report. Explore (NY) 2023; 19:147-152. [PMID: 34955379 PMCID: PMC8667518 DOI: 10.1016/j.explore.2021.12.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023]
Abstract
CASE Serious complications of severe coronavirus disease 2019 (COVID-19) include subcutaneous emphysema (SE) and pneumomediastinum, which are complicated to treat with conventional Western medicine. We report how combining Chinese herbal medicine (CHM) with Western medicine quickly resolved a patient's COVID-19-associated pulmonary complications, shortened hospital stay and improved quality of life. CLINICAL FEATURES AND OUTCOME A 59-year-old male with a history of smoking and tumors was diagnosed with COVID-19 in May 2021. At hospitalization, his oxygen saturation (SpO2) was 80%, he had a continuous severe cough, rapid shallow breathing, spontaneous SE and pneumomediastinum. By Day 4 of hospitalization, his condition was worsening despite standard care, so CHM was added. After 3-5 days, his coughing had lessened and supplementary oxygen therapy was de-escalated. Nine days after starting CHM, the SE had completely resolved and the patient avoided intubation. His WHO OS 10-point Scale score had fallen from 6 to 3 points and the modified Medical Research Council Dyspnea Scale score from 4 to 2 points. He was hospitalized for 19 days. At 1 week post-discharge, the patient could handle most of his daily activities and experienced minor shortness of breath only when performing labor-intensive tasks. At 1 month, his work output was restored to pre-COVID-19 levels. CONCLUSION CHM combined with standard Western medicine improved pulmonary function, respiratory rate, blood oxygen saturation and shortened the hospital stay of a patient with severe COVID-19 complicated by SE and pneumomediastinum.
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Affiliation(s)
- Shuo-Wen Hung
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Yuan-Ching Liao
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan
| | - I-Chang Chi
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Ting-Yen Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Department of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; Department of Chinese Medicine, School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung City 40402, Taiwan; Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404332, Taiwan; An-Nan Hospital, China Medical University, No. 66, Section 2, Zhanghe Road, Annan District, Tainan City 709, Taiwan.
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Pescaru CC, Marc MS, Costin EO, Pescaru A, Trusculescu AA, Maritescu A, Suppini N, Oancea CI. Massive Spontaneous Pneumomediastinum-A Form of Presentation for Severe COVID-19 Pneumonia. Medicina (B Aires) 2022; 58:medicina58111525. [PMID: 36363482 PMCID: PMC9692548 DOI: 10.3390/medicina58111525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
For COVID-19 pneumonia, many manifestations such as fever, dyspnea, dry cough, anosmia and tiredness have been described, but differences have been observed from person to person according to age, pulmonary function, damage and severity. In clinical practice, it has been found that patients with severe forms of infection with COVID-19 develop serious complications, including pneumomediastinum. Although two years have passed since the beginning of the pandemic with the SARS-CoV-2 virus and progress has been made in understanding the pathophysiological mechanisms underlying the COVID-19 infection, there are also unknown factors that contribute to the evolution of the disease and can lead to the emergence some complications. In this case report, we present a patient with COVID-19 infection who developed a massive spontaneous pneumomediastinum and subcutaneous emphysema during hospitalization, with no pre-existing lung pathology and no history of smoking. The patient did not get mechanical ventilation or chest trauma, but the possible cause could be severe alveolar inflammation. The CT results highlighted pneumonia in context with SARS-CoV-2 infection affecting about 50% of the pulmonary area. During hospitalization, lung lesions evolved 80% pulmonary damage associated with pneumomediastinum and subcutaneous emphysema. After three months, the patient completely recovered and the pneumomediastinum fully recovered with the complete disappearance of the lesions. Pneumomediastinum is a severe and rare complication in COVID-19 pneumonia, especially in male patients, without risk factors, and an early diagnosis can increase the chances of survival.
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Affiliation(s)
- Camelia Corina Pescaru
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Monica Steluța Marc
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence:
| | - Emanuela Oana Costin
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andrei Pescaru
- ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana-Adriana Trusculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Maritescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Noemi Suppini
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristian Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Lucas Rocha M, Gago L, Sepriano A, Saldanha T, Mourão AF, Costa M, André S, C Branco J. Spontaneous pneumomediastinum, a rare manifestation of clinically amyopathic dermatomyositis. ARP Rheumatol 2022; 1:251-254. [PMID: 36057086] [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: 06/15/2023]
Abstract
Clinically amyopathic dermatomyositis (CADM) is a rare condition characterized by dermatomyositis skin lesions without clinically apparent muscle involvement. Respiratory involvement is common, occurring in about half of the cases. Spontaneous pneumomediastinum (PnM) is a rare, and often fatal, complication of CADM. We report a case of a 61-year-old female patient who was diagnosed with anti-melanoma differentiation- associated gene 5 antibody-associated CADM and interstitial lung disease. She developed an extensive spontaneous PnM with subcutaneous emphysema. The patient was treated with a conservative approach which was, initially, successful in reducing the size of the PnM. However, the patient died from an eventual nosocomial pneumonia requiring mechanical ventilation. This case illustrates that improving the management of CADM associated PnM, remains a major unmet need.
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Affiliation(s)
- Margarida Lucas Rocha
- Rheumatology, Hospital de Faro - Centro Hospitalar Universitário do Algarve; Faro, Portugal
| | - Laura Gago
- Rheumatology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Alexandre Sepriano
- Rheumatology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Tiago Saldanha
- Radiology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Ana Filipa Mourão
- Rheumatology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Manuela Costa
- Rheumatology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Sandra André
- Pneumology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Jaime C Branco
- Rheumatology, Hospital Egas Moniz-Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
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Koníčková T, Puškáš F, Novotná E, Chrdle A. [Pneumothorax, pneumomediastinum and subcutaneous emphysema as complica-tions of COVID-19]. Klin Mikrobiol Infekc Lek 2022; 28:4-9. [PMID: 36183411] [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: 06/16/2023]
Abstract
Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema are serious complications of COVID-19 infection caused by SARS-CoV-2, occurring in approximately 1% of hospitalized patients. The risk increases with the accumulation of risk factors, namely moderate or severe illness, high-flow oxygen therapy and noninvasive ventilation. The pathophysiology may be contributed to by patient self-inflicted lung injury. Hypoxia-induced respiratory effort in patients with pneumonia puts an enormous load on certain parts of their lungs, leading to subsequent progression of lung tissue damage. These complications start with destruction of the alveolar membrane, accompanied by emergence of a pulmonary bulla. Rupture of the bulla results in air leaking to the pleural space (pneumothorax). In the case of pneumomediastinum, the air spreads within the peribronchial interstitium along the airways to the mediastinum and subcutaneous tissues (Macklin effect). While pneumomediastinum and subcutaneous emphysema resolve spontaneously in most cases, pneumothorax treatment depends on its magnitude. While small pneumothorax may be managed conservatively, large pneumothorax usually requires active treatment with an acute chest drain; the latter is also associated with worse prognosis and a higher chance of death. We report air-leak complications in nine COVID-19 patients, of whom seven had spontaneous pneumothorax and four of them died. Three patients developed spontaneous pneumomediastinum together with subcutaneous emphysema, with two of them surviving. One patient with combination of pneumothorax, pneumomediastinum and subcutaneous emphysema died. These complications may accompany moderate or severe COVID-19-associated pneumonia, mostly the late phase of the disease. They should be considered when patients complain of sudden chest or back pain or worsening respiratory insufficiency.
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Affiliation(s)
- Tereza Koníčková
- Infectious Diseases Department, Czech Budejovice Hospital, Czech Budejovice, Czech Repubic, e-mail:
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Kedia Y, Awad NT, Nair J, Patil D, Amin P, Vijayan S, Thorve S, Waghmare S. Spontaneous Pneumothorax in Patients of COVID 19 Pneumonia. J Assoc Physicians India 2022; 70:11-12. [PMID: 35436820] [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: 06/14/2023]
Abstract
COVID 19 pandemic has put a massive strain on healthcare all over the world. Every day new data is getting released and various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum. Both these conditions can lead to an increase in mortality and morbidity in patients with COVID 19 pneumonia. We studied 476 patients of COVID 19 pneumonia at our hospital, out of which 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (invasive/non-invasive), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothorax while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged.Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.
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Affiliation(s)
- Yash Kedia
- Resident Doctor, Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra; * Corresponding Author
| | - N T Awad
- Professor and HOD,Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Jairaj Nair
- Associate Professor, Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Dipak Patil
- Resident Doctor,Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Pranavi Amin
- Resident Doctor,Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Sruthi Vijayan
- Resident Doctor,Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Swapnil Thorve
- Assistant Professor, Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
| | - Siddharth Waghmare
- Assistant Professor, Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
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Torres Villagrán FJA, Cortés Jeanneret M, González Cornejo J, Lara Hernández BA. Pathophysiology of spontaneous pneumomediastinum in patients with SARS-CoV-2 infection: a case report. Emergencias 2022; 34:79-80. [PMID: 35103452] [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: 06/14/2023]
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Vega-Villanueva KI, Berrocal-Kasay A. Subcutaneous Emphysema and Spontaneous Pneumomediastinum in Systemic Lupus Erythematosus and Dermatomyositis Overlap Syndrome: A Case Report of Unusual Pulmonary Involvement. J Clin Rheumatol 2021; 27:S471-S473. [PMID: 31804255 DOI: 10.1097/rhu.0000000000001216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Küng E, Habrina L, Berger A, Werther T, Aichhorn L. Diagnosing pneumomediastinum in a neonate using a lung ultrasound. Lancet 2021; 398:e13. [PMID: 34481572 DOI: 10.1016/s0140-6736(21)01592-0] [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: 03/01/2021] [Revised: 03/19/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Erik Küng
- Medical University of Vienna, Comprehensive Center for Paediatrics, Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Vienna, Austria
| | - Lisa Habrina
- Medical University of Vienna, Comprehensive Center for Paediatrics, Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Vienna, Austria
| | - Angelika Berger
- Medical University of Vienna, Comprehensive Center for Paediatrics, Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Vienna, Austria
| | - Tobias Werther
- Medical University of Vienna, Comprehensive Center for Paediatrics, Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Vienna, Austria
| | - Lukas Aichhorn
- Medical University of Vienna, Comprehensive Center for Paediatrics, Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Vienna, Austria.
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14
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Nguyen D, Nguyen T, Castro Rodriguez J. "The flying thymus sign". Intern Emerg Med 2021; 16:1701-1702. [PMID: 33453009 DOI: 10.1007/s11739-020-02626-3] [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: 12/05/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Damien Nguyen
- Cardiology, Brugmann University Hospital, Bruxelles, Belgium.
| | - Thomas Nguyen
- Cardiology, Brugmann University Hospital, Bruxelles, Belgium
| | - José Castro Rodriguez
- Head of Department, Cardiology, Brugmann University Hospital, Place A.Van Gehuchten 4, 1020, Bruxelles, Belgium
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15
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Bozan Ö, Atiş ŞE, Çekmen B. A rare complication of Covid-19: Spontaneous pneumothorax following pneumomediastinum; case report. Am J Emerg Med 2021; 47:342.e1-342.e2. [PMID: 33750666 PMCID: PMC7923944 DOI: 10.1016/j.ajem.2021.02.067] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Öner Bozan
- Prof. Dr. Cemil Tascioğlu City Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Şeref Emre Atiş
- Mersin City Training Research Hospital, Department of Emergency Medicine, Mersin, Turkey
| | - Bora Çekmen
- Karabuk University Faculty of Medicine Department of Emergency Medicine, Karabuk, Turkey
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16
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Campisi A, Poletti V, Ciarrocchi AP, Salvi M, Stella F. Tension pneumomediastinum in patients with COVID-19. Thorax 2020; 75:1130-1131. [PMID: 32747475 PMCID: PMC7401578 DOI: 10.1136/thoraxjnl-2020-215012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, Forlì, Italy
| | - Venerino Poletti
- Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forli', Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, Forlì, Italy
| | - Maurizio Salvi
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, AUSL della Romagna Rimini, Forlì, Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, Forlì, Italy
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17
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Sohda M, Kuwano H, Sakai M, Miyazaki T, Kakeji Y, Toh Y, Matsubara H. A national survey on esophageal perforation: study of cases at accredited institutions by the Japanese Esophagus Society. Esophagus 2020; 17:230-238. [PMID: 32415409 DOI: 10.1007/s10388-020-00744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/04/2019] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To get a clear view of the current state of treatment for esophageal perforation in Japan. Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown. METHODS We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015. RESULTS We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm3, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others. CONCLUSION Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.
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Affiliation(s)
- Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshihiro Kakeji
- Division of Gastro-Intestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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18
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Santos S, Santos CR, Monteiro JR, Salgueiro S, Fernandes C. [Hamman's Syndrome (Spontaneous Pneumomediastinum)]. Rev Port Cir Cardiotorac Vasc 2020; 27:43-45. [PMID: 32239825] [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] [Received: 12/18/2019] [Indexed: 06/11/2023]
Abstract
The authors present the case of a previously healthy, 22-year-old male nonsmoker who sought emergency room treatment complaining of retrosternal pain. He reported a history of odynophagia two days before, followed by produc- tive cough, fever and dyspnea. On chest radiography, a line could be observed surrounding the heart and the continuous diaphragm sign. The chest computed tomography scan confirmed the presence of pneumomediastinum and soft tissue emphysema. The case was discussed in a multidisciplinary team, and the possibility of surgical intervention was rejected. Conservative treatment was decided with complete resolution of the pneumomediastinum.
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Affiliation(s)
- Sónia Santos
- Serviço de Medicina Interna 2, Centro Hospital de Leiria, Leiria, Portugal
| | | | | | - Sónia Salgueiro
- Serviço de Medicina Interna 2, Centro Hospital de Leiria, Leiria, Portugal
| | - Célio Fernandes
- Serviço de Medicina Interna 2, Centro Hospital de Leiria, Leiria, Portugal
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Barata R. Spontaneous Pneumomediastinum: Recognizing a Rare Encounter with a Benign Condition! Rev Port Cir Cardiotorac Vasc 2020; 27:15. [PMID: 32239820] [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] [Received: 11/18/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Rita Barata
- Thoracic Surgery Hospital Santa Marta, CHULC. Hospital Lusíadas, Lisboa Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
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20
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Castro Jiménez RA, García Alcaide I, Pascual Martínez N. Cocaine using patient who presents with dyspnoea. Rev Esp Sanid Penit 2020; 22:46-49. [PMID: 32406481 PMCID: PMC7307652 DOI: 10.18176/resp.0007] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/03/2019] [Indexed: 11/23/2022]
Abstract
We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the irruption of air in the mediastinal space, and is associated with different causes, including addiction to inhaled drugs. It occurs in people with predisposing factors and the presence of precipitating factors such as consumption of inhaled drugs. X-ray and computed tomography of the thorax are very useful tools in guiding the diagnosis. The low incidence of this pathology represents a difficult diagnosis for the doctor, although in some characteristic work environments a high level of suspicion is necessary.
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Affiliation(s)
- R A Castro Jiménez
- Medina Azahara Young Offenders Centre. Servicio de Urgencias A&E Service of Hospital San Juan de Dios. Córdoba
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21
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Covantev S, Mazuruc N, Uzdenov R, Corlateanu A. Spontaneous Pneumomediastinum – a Rare Asthma Complication. Folia Med (Plovdiv) 2019; 61:472-477. [PMID: 32337937 DOI: 10.3897/folmed.61.e39419] [Citation(s) in RCA: 2] [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] [Received: 08/24/2019] [Accepted: 02/28/2019] [Indexed: 02/08/2023] Open
Abstract
Asthma is the most common chronic respiratory disease worldwide and its prevalence is increasing. Acute asthma complications are often the reason for admission to emergency healthcare service. In our article we present a case of a rare asthma complication – spontaneous pneumomediastinum with a short review of its incidence, etiology, diagnosis and management. Spontaneus pneumothorax is important to differentiate with secondary pneumomediastinum as well as other conditions as cardiac diseases (acute coronary syndrome, pericarditis, cardiac tamponade, pneumopericardium), lung diseases (pneumothorax, pulmonary embolism, tracheobronchial tree rupture), musculoskeletal disorders, and diseases of the esophagus (rupture and perforation o the esophagus). A chest X-ray is often reliable for diagnosis of spontaneous pneumomediastinum and when inconclusive, can be followed by CT. The management is usually conservative with oxygen and analgesia. Surgery is required only in cases of tracheobronchial compression.
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Affiliation(s)
- Serghei Covantev
- Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chisinau, Moldova
| | - Natalia Mazuruc
- Universitatea de Stat de Medicina si Farmacie Nicolae Testemitanu, Chisinau, Moldova
| | - Rasul Uzdenov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Alexandru Corlateanu
- State University of Medicine and Pharmacy Nicolae Testemitanu in Chisinau, Chisinau, Moldova
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22
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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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23
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Heinz P, Steinborn MM, Krohn C. Pneumomediastinum in a Child Following Blunt Thoracic Trauma. Dtsch Arztebl Int 2019; 116:564. [PMID: 31554550 PMCID: PMC6794704 DOI: 10.3238/arztebl.2019.0564] [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: 06/10/2023]
Affiliation(s)
| | - Marc-Matthias Steinborn
- **Institut für Diagnostische und Interventionelle Radiologie und Kinderradiologie, München Klinik Schwabing
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24
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Abstract
A 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable.His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes.His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax.He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.
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25
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Abstract
A 19-year-old primigravida had a normal vaginal delivery after a 90-minute second stage of labour. Within two hours she complained of dyspnoea and was noticed to have unusual swelling of the face and neck. The diagnosis of subcutaneous emphysema was confirmed by chest X-ray and pneumomediastinum was also detected. Uneventful recovery over four days followed conservative management, administration of oxygen and use of simple analgesics.
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Affiliation(s)
- B L Duffy
- Obstetric Anaesthetic Services, Queen Elizabeth Hospital, Adelaide, South Australia
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26
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Steele A, Jabbour J, Fischer PD, O’Neill JG. A Case of Pneumomediastinum Due to Blunt Neck Trauma in a 23-Year-Old Male Rugby Player. Am J Case Rep 2018; 19:1279-1282. [PMID: 30367026 PMCID: PMC6223201 DOI: 10.12659/ajcr.911980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pneumomediastinum is an uncommon clinical condition that usually occurs spontaneously, or is caused by blunt thoracic or abdominal trauma. This report is of a rare case of pneumomediastinum caused by blunt neck trauma in an adult and describes the clinical and radiological features and the principles of clinical management. CASE REPORT A 23-year-old man presented with increased neck swelling, dysphonia and pain on swallowing (odynophagia) after blunt neck trauma during a rugby game. Chest X-ray and computed tomography (CT) showed features that were consistent with pneumomediastinum, including extensive subcutaneous emphysema. The patient was intubated and monitored in the intensive care unit (ICU) and managed with early stabilization of the airway and with conservative methods. He had no complications on clinical follow-up following hospital discharge. CONCLUSIONS Although pneumomediastinum is an uncommon condition, the complications can be fatal. This case highlights the importance of thoroughly investigating cases of subcutaneous emphysema and the importance of early stabilization of the airway.
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Affiliation(s)
- Amanda Steele
- Department of Otolaryngology, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Joe Jabbour
- Department of Otolaryngology, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Paul D. Fischer
- Department of Emergency, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - John G. O’Neill
- Department of Otolaryngology, The Tweed Hospital, Tweed Heads, New South Wales, Australia
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27
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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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28
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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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29
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Radhika Nair K, Kumar U K, Shetty B, Joseph S, Jameela S. Hamman's Syndrome - in Young Asthmatic Female. J Assoc Physicians India 2018; 66:70-72. [PMID: 30347960] [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: 06/08/2023]
Abstract
Spontaneous pneumomediastinum (SPM) is a rare condition where there is presence of air in the mediastinum without any precipitating trauma, surgery or other conditions. It usually develops after alveolar rupture and air penetration into the pulmonary interstitium, the hilum and the mediastinum. It is commonly seen in young males, asthmatics on inhalational drugs, or following severe vomiting, parturition, weight lifting. A young female, known case of bronchial asthma presented to us with history of breathlessness and cough of 3 days and mild swelling of the face and neck of 2 days duration. On examination, she was dyspneic, had subcutaneous swelling of the face, neck and chest bilaterally with palpable crepitus. Respiratory examination showed diffuse polyphonic rhonchi and crepitations. CT thorax showed pneumomediastinum, pneumoperitoneum, pneumothorax and pneumorrhachis. A diagnosis of Hamman’s syndrome was made and patient was treated symptomatically and recovered.
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Affiliation(s)
| | | | | | - Sanjana Joseph
- Post Graduate Student, Department of General Medicine, Yenepoya Medical College, Mangalore, Karnataka
| | - Shabnam Jameela
- Post Graduate Student, Department of General Medicine, Yenepoya Medical College, Mangalore, Karnataka
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30
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Hoversten P, Kamboj AK, Slostad J, Beachey J, Aakre C. Pneumomediastinum and pneumoperitoneum following partial sphincterotomy for choledocholithiasis. Intern Emerg Med 2018; 13:461-462. [PMID: 29110134 DOI: 10.1007/s11739-017-1767-9] [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: 10/19/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Patrick Hoversten
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amrit K Kamboj
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jessica Slostad
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joel Beachey
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher Aakre
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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31
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Barrett NK, McIvor J. Mediastinal Emphysema Simulating Aortic Rupture. J R Soc Med 2018; 81:670-1. [PMID: 3210204 PMCID: PMC1291854 DOI: 10.1177/014107688808101123] [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] [Indexed: 11/16/2022] Open
Affiliation(s)
- N K Barrett
- Department of Radiology, Charing Cross Hospital, London
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32
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Affiliation(s)
- J Monjardino
- Department of Diabetes, Endocrinology & Metabolism, Middlesex Hospital, London, UK
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33
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Spotts PH. Spontaneous pneumomediastinum: Case presentation to a college student health clinic. J Am Coll Health 2017; 65:575-578. [PMID: 28708045 DOI: 10.1080/07448481.2017.1350687] [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] [Indexed: 06/07/2023]
Abstract
The author describes a case of spontaneous pneumomediastinum (SPM) in a 19-year-old man presenting to a college student health clinic. The author also provides a review on SPM, including clinical manifestations, diagnostic evaluation, and management.
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Affiliation(s)
- P Hunter Spotts
- a Department of Family Medicine , Duke University Student Health , Durham , NC , USA
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34
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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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35
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Cervellin G, Bellini C, Tarasconi S, Bresciani P, Lippi G. Massive pneumomediastinum following orbital fracture. Am J Emerg Med 2017; 35:1585.e1-1585.e2. [PMID: 28734704 DOI: 10.1016/j.ajem.2017.07.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/27/2017] [Accepted: 07/16/2017] [Indexed: 11/20/2022] Open
Abstract
Pneumomediastinum is a rare complication of facial fractures, always persuading the physicians to search for other and potentially more serious injuries such as esophageal or tracheal rupture. A 75-year old man presented to the Emergency Department (ED) reporting an accidental fall while walking on the road. He did not report loss of consciousness (LOS), was not taking anticoagulant drugs, did not report chest, abdomen or limb trauma. On physical examination he only showed swelling of nose and right orbit. The patient underwent a Computed Tomography (CT) scan of head and facial bones, showing a complex fracture involving right nasal bone, ethmoid, right orbital lateral wall, and right maxillary sinus lateral wall. No intracranial lesions were found. Due to the finding of subcutaneous emphysema in the right cheek, the scan was extended to the whole neck and chest. The exam showed a massive pneumomediastinum, extending till the diaphragmatic hiatus. The patient thus underwent bronchoscopy and esophagogastroscopy, but no further lesions could be found. Antibiotics therapy was then administered, and was discharged in good conditions after a five-days observation. In our patient, air had probably escaped into the pharyngo-maxillary space from the right maxillary sinus and tracked into both the retropharyngeal space and, for contiguity, into the pre-tracheal space. As our case report shows, if the airway is secure, the pneumomediastinum does not necessarily require treatment other than clinical observation and management of the fracture. If no other injuries are present, resolution of the pneumomediastinum may be expected without further medical interventions.
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Affiliation(s)
| | | | - Sara Tarasconi
- Emergency Department, University Hospital of Parma, Italy
| | | | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Italy
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36
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Kiraly B. Neck Crepitus in a Runner. Am Fam Physician 2017; 95:113-115. [PMID: 28084710] [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: 06/06/2023]
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di Natale A, Descloux A, Schramm B, Schwendinger M, Nocito A. [Not Available]. Praxis (Bern 1994) 2017; 106:261-264. [PMID: 28253809 DOI: 10.1024/1661-8157/a002613] [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] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Bei 6–8 % der jungen Erwachsenen sind Thoraxschmerzen Anlass für eine notfallmässige Konsultation. Thoraxschmerzen sind bei jungen Patienten meist unspezifisch, in der Regel benigner Ätiologie und ohne vitale Bedrohung. Wir berichten von einem 16-jährigen Patienten mit thorakalen Schmerzen nach sportlicher Tätigkeit. Radiologisch zeigte sich freie Luft im Mediastinum ohne begleitenden Pneumothorax oder mediastinale Organpathologie. Nachfolgend konnte die Diagnose eines spontanen Pneumomediastinums (PM) gestellt werden. Das spontane oder primäre PM ist eine seltene klinische Entität, die ohne Therapie selbstlimitierend ist. Essenziell ist dabei die Differenzierung vom sekundären PM, dem gefährliche Organläsionen zugrundeliegen und das unbehandelt mit einer hohen Mortalität einhergeht.
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Affiliation(s)
- Anthony di Natale
- 1 Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Baden-Dättwil
| | - Alexandre Descloux
- 1 Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Baden-Dättwil
| | - Beate Schramm
- 2 Interdisziplinäres Notfallzentrum, Kantonsspital Baden, Baden-Dättwil
| | | | - Antonio Nocito
- 1 Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Baden-Dättwil
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Booms ZC, Barbee GA. Spontaneous Pneumomediastinum in a Pediatric Patient After a 1600-m Run: Case Report and Literature Review. J Osteopath Med 2016; 115:338-41. [PMID: 25938529 DOI: 10.7556/jaoa.2015.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pneumomediastinum occurs as a result of traumatic or iatrogenic causes or in patients with preexisting lung conditions such as interstitial lung disease, asthma, and chronic obstructive pulmonary disease. Spontaneous pneumomedi-astinum (SPM), however, is rarely seen in clinical practice. The authors report the case of a 14-year-old boy who presented to the emergency department with chest discomfort and shortness of breath after a 1600-m run as part of a physical education class. The patient was found to have SPM, was admitted to the pediatric service for monitoring and pain control, and made a full recovery within 24 hours. This case is notable because SPM occurred in the absence of identifable organic causes and as the result of sustained noncontact physical activity. A review of the literature provides background information and highlights pathophysiologic processes of SPM and suggested treatment. Physicians should consider pneu-momediastinum in young patients or runners presenting with chest pain even in the absence of any known inciting event.
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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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Affiliation(s)
- Arjun Gupta
- Department of Internal Medicine, University of Texas Southwestern Medical Centre, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
| | - Purav Mody
- Department of Internal Medicine, University of Texas Southwestern Medical Centre, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
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Germes-Piña F, Acosta-Orozco DM, Flores-Franco RA, Verdugo-Castro PN. [Pneumomediastinum associated with hyperemesis gravidarum: a case report]. Ginecol Obstet Mex 2016; 84:586-592. [PMID: 29424979] [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: 06/08/2023]
Abstract
BACKGROUND The hyperemesis gravidarum is a severe illness of nauseas and vomit that is present in the first trimester of the pregnancy, it has an incidence of 0.3 to 2%, it has been associated to weight loss, electrolytic disturbances, ketonuria, dehydration and in very seldom cases spontaneous pneumomediastinum. CLINICAL CASE A 21 years old female patient, primigest, in the first trimester of gestation, she started her disease with nauseas and vomiting more than 15 times during 6 hours period, odynophagia, dysphonia and pain in the cervical region, loss of 5 kilograms in the last month. The physical examination showed the patient in bad conditions, dehydration, neck with volume increased and emphysema subcutaneus, crakles until torax. Laboratory findings with hypokalemia, leukocytosis, acute kidney failure, and elevation of hepatic enzymes. The initial treatment was with intravenous fluids resuscitation, hydroelectrolytic balance restoration, antiemetic treatment and rest, it was taken TC of neck and torax, and was exclude any laryngeal and esophageal injury and perforation, but it showed air in the mediastinum. Conservative management with favorable evolution and completed resolution in 7 days. CONCLUSION It is very important that the medical doctor must keep in mind the different diagnosis of and take an opportune decision in case of present those complications potentially fatal to the mother.
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Szmygin-Milanowska K, Grzywa-Celińska A, Krusiński A, Cielma M, Wawrzecka A, Emeryk-Maksymiuk J, Milanowski J. [Pneumomediastinum - a case report]. Pol Merkur Lekarski 2016; 41:93-96. [PMID: 27591447] [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: 06/06/2023]
Abstract
UNLABELLED Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed. AIM The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica). A CASE REPORT Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous. CONCLUSIONS Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.
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Affiliation(s)
| | - Anna Grzywa-Celińska
- Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology
| | - Adam Krusiński
- Medical University of Lublin, Poland: Students Scientific Association at Department of Pneumonology, Oncology and Allergology
| | - Magdalena Cielma
- Medical University of Lublin, Poland: Students Scientific Association at Department of Pneumonology, Oncology and Allergology
| | - Agnieszka Wawrzecka
- Medical University of Lublin, Poland: Chair and Department of Otolaryngology and Laryngological Oncolog
| | - Justyna Emeryk-Maksymiuk
- Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology; Chair of Internal Medicine and Department of Internal Medicine in Nursing
| | - Janusz Milanowski
- Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology
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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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Eguchi Y, Sugitani A, Nishida K, Shinokil M, Uraokal N, Nakatsuji Y, Kureya Y, Kawamotol T, Miki Y, Shinyamal M, Tsukioka T, Minami K. latrogenic Mediastinal Emphysema and Subcutaneous Emphysema Induced by Bronchoscopic Examination. Indian J Chest Dis Allied Sci 2016; 58:185-187. [PMID: 30152653] [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: 06/08/2023]
Abstract
A 79-year-old man presented with fever of unknown origin with interstitial shadows in the bilateral lung fields. A bronchoscopic examination did not indicate any malignancy or specific interstitial disease. After the bronchoscopic examination, the patient gradually developed subcutaneous and mediastinal emphysema. As the subcutaneous emphysema and mediastinal emphysema were mild, the patient was not administered any specific treatment. However, he eventually developed severe subcutaneous emphysema and mediastinal emphysema, and did not show any transient improvement. The patient underwent another bronchoscopic examination at another centre and a lacerated wound was detected. Thereafter, emergent operation was performed.
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Cichocki BN, Dugat DR, Snider TA. Traumatic lung injury attributed to tornadic activity-induced barometric pressure changes in two dogs. J Am Vet Med Assoc 2016; 248:1274-9. [PMID: 27172344 DOI: 10.2460/javma.248.11.1274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 7-year-old castrated male Italian Greyhound (dog 1) and an approximately 1-year-old female Labrador Retriever (dog 2) were evaluated because of respiratory distress 8 and 10 days, respectively, after a tornado. CLINICAL FINDINGS No obvious external injuries were identified auscultation revealed decreased bronchovesicular sounds in the affected hemithorax of both dogs. Clinicopathologic changes were mild, with evidence of inflammation in both dogs. Thoracic radiography of both dogs revealed pneumothorax and pleural effusion with effacement of the diaphragm; findings on CT included severe pulmonary atelectasis of affected lung lobes with normal bronchial tree configurtion and no evidence of diaphragmatic hernia. TREATMENT AND OUTCOME Exploratory thoracotomy of both dogs confirmed CT findings Pulmonary parenchymal damage consistent with a large rupture was found in both patients. A large hematoma was adhered to the ruptured lung lobe of dog 1. Grossly affected lung tissue was removed; histologic examination revealed atelectasis, pulmonary fib osis, thrombosis, and minimal (dog 1) to marked (dog 2) inflammation Microbial culture of lung tissue yielded no growth for dog 1 and Streptococcus spp and Escherichia coli susceptible to amoxicillin-clavulanic acid for dog 2. Dog 1 had a recurrence of pneumothorax treated by drainage with a thoracostomy tube 1 month after surgery. Eighteen months after surgery, both dogs were reportedly doing well. CLINICAL RELEVANCE Development of clinical signs after a tornado, together with clinical, diagnostic imaging, surgical, and histologic findings led to a presumptive diagnosis of pulmonary barotrauma for both dogs. Long-term outcome for these dogs, treated at a referral hospital, was good.
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Go PH, Alvelo-Rivera M. An unusual manifestation of diabetic ketoacidosis. Spontaneous pneumomediastinum. Neth J Med 2016; 74:138-139. [PMID: 27020997] [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: 06/05/2023]
Affiliation(s)
- P H Go
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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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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Chassagnon G, Favelle O, Derogis V, Cottier JP. Spontaneous pneumomediastinum due to the Macklin effect: less is more. Intern Emerg Med 2015; 10:759-61. [PMID: 25804499 DOI: 10.1007/s11739-015-1229-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 03/05/2015] [Accepted: 03/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology, University Hospital of Tours, 2 Boulevard Tonnelle, 37000, Tours, France,
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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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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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