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Theodorou DJ, Theodorou SJ, Kakitsubata Y. Pneumatosis: Appearances on CT Imaging. Cureus 2023; 15:e41927. [PMID: 37583727 PMCID: PMC10424766 DOI: 10.7759/cureus.41927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments. PURPOSE In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues. METHODS On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema. RESULTS Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum. CONCLUSION Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.
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Zhuang Y, Zou JL, Huang YF, Hu DX, Shen X, Mao XY. Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema in a patient with pneumonia: A case report and literature review. Pediatr Pulmonol 2023; 58:1257-1265. [PMID: 36596604 DOI: 10.1002/ppul.26305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/24/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema caused by acute pneumonia are rarely observed in clinical practice. CASE PRESENTATION Herein, we report a case of a 12-year-old boy with spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema caused by a severe cough due to mycoplasma pneumonia. This patient neither received invasive or noninvasive ventilator treatment nor surgical treatment before the onset of the disease. After treatment, the patient recovered smoothly and was discharged from the hospital. LITERATURE REVIEW We reviewed all cases of spontaneous pneumorrhachis in children and adolescents between 1988 and 2022 in the PubMed database. Twenty-seven cases met our inclusion criteria, and the data on demographic information, triggers, comorbidities, symptoms, imaging findings, treatment, and prognosis were extracted and analyzed. CONCLUSION Although spontaneous pneumorrhachis is a rare condition, it has been reported in children. Computed tomography scanning is the gold standard for its detection. Spontaneous pneumorrhachis is typically a benign disease. This condition usually does not require any special treatment and should be monitored as common types of air leaks, such as pneumothorax and pneumomediastinum.
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Affiliation(s)
- Yuan Zhuang
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jia Lin Zou
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yu Fu Huang
- No.1 Orthopedics Hospital of CHENGDU, Chengdu, Sichuan, China.,Southwest Medical University, Luzhou, Sichuan, China
| | - Dong Xu Hu
- Southwest Medical University, Luzhou, Sichuan, China
| | - Xing Shen
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xiao Yan Mao
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Yılmaz F, Zortuk Ö. Subcutaneous Emphysema, Pneumomediastinum and Spinal Epidural Emphysema As Complications of Violent Coughing: A Case Report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021141. [PMID: 33944825 PMCID: PMC8142765 DOI: 10.23750/abm.v92is1.10086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022]
Abstract
Spontaneous pneumomediastinum (SPM) is a rare condition characterized by chest pain of sudden- onset, difficulty breathing, dysphagia, dysphonia, and subcutaneous emphysema, which are some-times -accompanied by pain in the neck or back. This condition typically has a benign character that limits itself, and supportive therapy is all that is needed; however, life-threatening consequences may occur, such as upper respiratory tract obstruction, esophageal injury, and tracheal damage, requiring surgery. We report here a man aged 19 years who coughed vigorously due to acute allergic asthma, which lead to subcutaneous emphysema starting from the neck down to the chest, mediastinum and spinal epidural space. This case report stresses the importance of including SPM in the differential diagnosis of cough and chest pain in the young.
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Affiliation(s)
- Fevzi Yılmaz
- Health Sciences University, Antalya Education and Research Hospital; Department of Emergency Medicine.
| | - Ökkeş Zortuk
- Health Sciences University, Antalya Education and Research Hospital; Department of Emergency Medicine, Antalya /Turkey.
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Alemu BN, Yeheyis ET, Tiruneh AG. Spontaneous primary pneumomediastinum: is it always benign? J Med Case Rep 2021; 15:157. [PMID: 33761988 PMCID: PMC7992993 DOI: 10.1186/s13256-021-02701-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The therapeutic options also differ by the cause. This systematic review was done to provide, as far as we know, the first attempt to broadly assess the clinical feature, predisposing factors, possible management, and outcome of spontaneous primary pneumomediastinum. METHODS In addition to the two patients treated at our hospital, a Pub Med Search for literature on case reports of spontaneous pneumomediastinum published in English up to November 2018 was done. We extracted data on patients' demographic characteristics, symptoms, timing, diagnosis, management, and outcome of the treatment were analyzed based on the preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) RESULT: A total of 339 cases were reviewed. 71.7% of them were male. The Mean age affected was 22.4 ± 11.3 years. Chest pain, 196 (57.8%), is the most common presenting symptom, followed by dyspnea, 156 (46%), cough 95 (28%), neck swelling 92 (27.13%), cervical pain 88 (25.9%), dysphagia 39 (11.5%), odynophagia 37 (10.9%), and Dysphonia 14 (4.1%). Fifty-seven patients (16.8%) had a prior history of Asthma, 19 (5.6%) had Connective Tissue Disorders, and 12 (3.5%) had associated malignancy as an identified risk factor. In 35 (10.3%) patients, spontaneous pneumomediastinum was found incidentally. The mean number of days before the clinical resolution of spontaneous pneumomediastinum was 6.65 ± 11.8 days and the average hospital stay was 4.15 ± 1.93 days. Nineteen (5.6%) patients have died as a result of the underlying disease not related to SPM. CONCLUSION Spontaneous pneumomediastinum is uncommon, usually benign, a self-limited disorder that commonly occurs in a young adult without any apparent precipitating factor or disease. Spontaneous pneumomediastinum usually responds very well to conservative treatment without recurrence. However, secondary causes should be ruled out to minimize the unfavorable outcome.
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Affiliation(s)
- Berhanu N. Alemu
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephraim T. Yeheyis
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham G. Tiruneh
- Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Payne R, Sieg EP, Choudhary A, Iantosca M. Pneumorrhachis Resulting in Transient Paresis after PICC Line Insertion into the Ascending Lumbar Vein. Cureus 2016; 8:e833. [PMID: 27904815 PMCID: PMC5117705 DOI: 10.7759/cureus.833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obtaining intravascular access in the neonatal intensive care unit (NICU) is not only critical but also technically challenging. Malposition of the catheter tip is a known and well-documented complication. Specifically, peripherally inserted central venous catheter (PICC) line insertion into the ascending lumbar vein can lead to neurological dysfunction and, in some cases, even death. We present the first reported case of pneumorrhachis (PR) following PICC line insertion into the ascending lumbar vein. Our patient presented with lower extremity weakness and imaging confirmed the presence of air within the spinal canal. After conservative treatment, the strength deficit resolved and subsequent imaging revealed resolution of the air within the spinal canal. Insertion of central venous catheters into the ascending lumbar vein is a well-documented complication that can lead to neurologic injury and even death. This should be considered in the evaluation of any neonate presenting with an abnormal neurological examination or unexplained change in exam after line insertion.
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Affiliation(s)
- Russell Payne
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Emily P Sieg
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | - Mark Iantosca
- Department of Neurosurgery, Penn State Hershey Medical Center
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Moayedi S, Babin L. Pneumorrhachis Secondary to a Sacral Decubitus Ulcer. West J Emerg Med 2016; 17:466-8. [PMID: 27429699 PMCID: PMC4944805 DOI: 10.5811/westjem.2016.4.30296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/13/2016] [Accepted: 04/22/2016] [Indexed: 11/16/2022] Open
Abstract
An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergency physicians should know about the implication of gas in the spinal canal in the setting of sepsis.
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Affiliation(s)
- Siamak Moayedi
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Lisa Babin
- University of Maryland, School of Medicine, Baltimore, Maryland
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Saleem N, Parveen S, Odigwe C, Iroegbu N. Pneumomediastinum, pneumorrhachis, and subcutaneous emphysema in Pneumocystis jiroveci pneumonia in AIDS. Proc AMIA Symp 2016; 29:188-90. [PMID: 27034565 PMCID: PMC4790567 DOI: 10.1080/08998280.2016.11929412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pneumomediastinum, the presence of free air within the mediastinal cavity, is sometimes accompanied by subcutaneous emphysema and pneumorrhachis (air within the spinal canal). We report the case of a 28-year-old man with previously undiagnosed HIV who was diagnosed with extensive pneumomediastinum, pneumorrhachis, and subcutaneous emphysema secondary to Pneumocystis jiroveci pneumonia after presenting with chest pain, dyspnea, and central cyanosis. Surgical consultation was requested, but a conservative approach of observation proved sufficient as the free air was resorbed into the surrounding tissues.
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Affiliation(s)
- Nasir Saleem
- Department of Medicine, Presence St. Joseph Hospital, Chicago, Illinois
| | - Sanober Parveen
- Department of Medicine, Presence St. Joseph Hospital, Chicago, Illinois
| | - Chibuzo Odigwe
- Department of Medicine, Presence St. Joseph Hospital, Chicago, Illinois
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Symptomatic Pneumorrhachis After an Epidural Blood Patch. J Emerg Med 2015; 49:e49-52. [PMID: 25935894 DOI: 10.1016/j.jemermed.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/09/2015] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pneumorrhachis (PR), the presence of air within the spinal canal, is a rare, radiologic epiphenomenon arising from traumatic, nontraumatic, and iatrogenic causes. Often asymptomatic, PR is usually managed conservatively. However, PR can be associated with underlying serious pathology and can become symptomatic, requiring more aggressive diagnostic and treatment modalities from the treating physician. Although well known in the anesthesia literature, this case report is the first in the emergency medicine literature to describe iatrogenic, symptomatic PR presenting in the emergency department (ED). CASE REPORT A 34-year-old woman presented to the ED with a postural puncture headache after epidural anesthesia for a vaginal delivery. An epidural blood patch was administered, after which the patient acutely developed cervical radicular pain. Computed tomography angiography of the head and neck revealed epidural PR. Conservative treatment with analgesia, intravenous fluids, and bed rest was administered. Her pain improved significantly, and at 5-month follow-up, she remained symptom-free. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PR is a rare and usually benign disease, especially in the setting of an iatrogenic cause such as lumbar puncture. However, in traumatic settings, PR in the intradural space should alert the emergency physician to search for underlying serious pathology if it has not already been found. Finally, PR can become symptomatic, and treatment will depend on the severity of symptoms.
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Lostoridis E, Tourountzi P, Pouggouras K, Koutsouki S, Lampiri K, Nagy EO. Pneumoscrotum after tracheal intubation. ACTA ACUST UNITED AC 2015; 53:44-6. [PMID: 25617239 DOI: 10.1016/j.aat.2014.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/01/2014] [Indexed: 11/26/2022]
Abstract
Air in the scrotum is an unusual clinical finding and a thorough search should be done in order to locate the air leak or source of gas production. We report an 81-year-old patient who developed severe acute respiratory failure after fiberoptic bronchoscopy and was intubated immediately. After tracheal intubation, excessive subcutaneous emphysema from the head to the scrotum was obvious. Chest tube thoracostomies were placed to treat pneumothorax. The emphysema was absorbed after 13 days without any sequela. Air or gas inside the scrotum may originate from intraperitoneal, extraperitoneal, or local sources. The majority of the cases can be managed conservatively, but emergent intervention is needed in life-threatening situations.
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Affiliation(s)
- Eftychios Lostoridis
- 1st Department of Surgery, Kavala General Hospital, Agios Silas, Kavala, Greece.
| | - Paraskevi Tourountzi
- Department of Anesthesiology and Intensive Care Unit, Aristotle University of Thessaloniki, AHEPA University Hospital, St Kiriakidis, Thessaloniki, Greece
| | | | - Sotiria Koutsouki
- Intensive Care Unit, Kavala General Hospital, Agios Silas, Kavala, Greece
| | - Klairi Lampiri
- Intensive Care Unit, Kavala General Hospital, Agios Silas, Kavala, Greece
| | - Eva-Otilia Nagy
- Intensive Care Unit, Kavala General Hospital, Agios Silas, Kavala, Greece
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Jung H, Lee SC, Lee DH, Kim GJ. Spontaneous pneumomediastinum with concurrent pneumorrhachis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 47:569-71. [PMID: 25551085 PMCID: PMC4279841 DOI: 10.5090/kjtcs.2014.47.6.569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 12/03/2022]
Abstract
Spontaneous pneumomediastinum is a very uncommon entity that is defined as the presence of free air in the mediastinum without an obvious etiology. The presence of air in the spinal canal, known as concurrent pneumorrhachis, is an extremely rare epiphenomenon of spontaneous pneumomediastinum. We report a rare case of spontaneous pneumomediastinum with pneumorrhachis associated with influenza. The patient was diagnosed without invasive procedures, was managed with supportive treatment, and recovered without any complications.
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Affiliation(s)
- Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Sang Cjeol Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
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