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Patel V, Carey N, Briatico D, VanHouwelingen L. Management of Pediatric Patients With Spontaneous Pneumomediastinum: A Retrospective Chart Review. J Pediatr Surg 2024; 59:930-934. [PMID: 38519387 DOI: 10.1016/j.jpedsurg.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm. METHODS Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data. RESULTS We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission. DISCUSSION There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vivek Patel
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Nathalie Carey
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lisa VanHouwelingen
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada
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Aghajanzadeh M, Alavi Foumani A, Tangestaninejad A, Haghighi M, Pourahmadi Y, Jafroudi EH, Mousazadeh M, Asli RH. Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID-19 disease. Clin Case Rep 2023; 11:e7570. [PMID: 37434962 PMCID: PMC10332258 DOI: 10.1002/ccr3.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID-19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID-19 patients. PT and SE may present after PTM in COVID-19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID-19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID-19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID-19 and mild pulmonary damage may have a favorable outcome.
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Affiliation(s)
| | - Ali Alavi Foumani
- Department of PulmonologyGuilan University of Medical SciencesRashtIran
| | | | - Mohammad Haghighi
- Department of AnesthesiologyGuilan University of Medical SciencesRashtIran
| | - Yousha Pourahmadi
- Department of Thoracic SurgeryGuilan University of Medical SciencesRashtIran
| | | | - Mahsa Mousazadeh
- Department of Internal Medicine, Inflammatory Lung Diseases Research CenterGuilan University of Medical SciencesRashtIran
| | - Rastin Hosseinzadeh Asli
- Department of Internal Medicine, Inflammatory Lung Diseases Research CenterGuilan University of Medical SciencesRashtIran
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3
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Yong N, Olowu O. Spontaneous pneumomediastinum: A report of two cases at a district general hospital. Obstet Med 2023; 16:134-137. [PMID: 37441656 PMCID: PMC10334040 DOI: 10.1177/1753495x211019231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 06/04/2024] Open
Abstract
Spontaneous pneumomediastinum is a rare condition thought to be caused by excessive Valsalva manoeuvre during the second stage of labour. Women with pneumomediastinum typically presents with chest pain or tightness, dyspnoea, and a tearing sensation around the neck. It is commonly diagnosed with a chest radiograph but further imaging may be necessary to exclude more sinister conditions with similar clinical features. We describe two cases of pneumomediastinum and the different management approaches with different multi-disciplinary input. It is often a self-limiting condition. We propose a management algorithm for women suspected to have pneumomediastinum during the intrapartum and postpartum period.
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Affiliation(s)
- Nathanael Yong
- Department of Obstetrics and Gynecology, Frimley Park Hospital, Camberley, UK
| | - Oladimeji Olowu
- Department of Obstetrics and Gynecology, Broomfield Hospital, Chelmsford, UK
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4
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Gunawardene A. Mackler's triad in spontaneous pneumomediastinum. ANZ J Surg 2023; 93:437. [PMID: 36660864 DOI: 10.1111/ans.18147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Ashok Gunawardene
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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5
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Halitim P, Weisenburger G, Bunel-Gourdy V, Godet C, Salpin M, Mouren D, Thibaut de Menonville C, Goletto T, Medraoui C, Tran Dinh A, Mordant P, Messika J, Mal H. [Spontaneous pneumomediastinum]. Rev Mal Respir 2022; 39:228-240. [PMID: 35331625 DOI: 10.1016/j.rmr.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pneumomediastinum, which can be spontaneous or secondary, is defined by the presence of free air in the mediastinum as shown on a chest X-ray and/or chest CT, with or without subcutaneous emphysema. Secondary pneumomediastinum develops in various contexts (thoracic traumatism, perforation of central airway or digestive tract, pneumothorax, barotraumatism complicating mechanical ventilation…). Spontaneous pneumomediastinum , which will be the focus of this review, develops without any of the above-mentioned conditions. STATE OF ART Spontaneous pneumomediastinum is a rare entity which usually occurs in young people either without medical history or with an history of asthma. A trigger event is detected in 40% to 60% of cases. Positive diagnosis is made on chest radiographt but thoracic CT is more sensitive. Distinction between spontaneous pneumomediastinum and secondary pneumomediastinum is in general easy but may sometimes be more difficult, particularly in case of oesophageal perforation. The evolution of spontaneous pneumomediastinum is most often benign but, rare complications may occur. Management is most often conservative. PERSPECTIVES There is no consensual management of spontaneous pneumediastinum because of the lack of randomized prospective studies. This may be explained by the rarity of the disease. The actual trend is to offer to the patients a conservative treatment, which could be ambulatory in some cases. CONCLUSIONS Spontaneous pneumomediastinum is a rare entity developing mainly in young subjects. The evolution is in general benign, justifying a conservative approach.
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Affiliation(s)
- P Halitim
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - G Weisenburger
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - V Bunel-Gourdy
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France; Service de chirurgie vasculaire, thoracique et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - C Godet
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M Salpin
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - D Mouren
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - C Thibaut de Menonville
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - T Goletto
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - C Medraoui
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Tran Dinh
- Service d'anesthésie et réanimation chirurgicale, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - P Mordant
- Service de chirurgie vasculaire, thoracique et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France
| | - J Messika
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMR1152, université Paris7 Denis Diderot, 75018 Paris, France
| | - H Mal
- Service de pneumologie B et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMR1152, université Paris7 Denis Diderot, 75018 Paris, France.
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6
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Barbosa PNVP, Stefanini FS, Bitencourt AGV, Gross JL, Chojniak R. Computed tomography-guided percutaneous drainage of tension pneumomediastinum. Radiol Bras 2022; 55:62-63. [PMID: 35210666 PMCID: PMC8864686 DOI: 10.1590/0100-3984.2021.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
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7
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Çetin M, Türk İ, Fındık G, Aydoğdu K, Gülhan SŞE, Bıçakçıoğlu P, Kaya S. Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-021-00106-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up.
Results
Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case.
Conclusion
Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.
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8
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Reindl S, Al-Wheibi S, Umlauf J, Girdauskas E, Raab S. [Pneumomediastinum in Severe COVID-19-disease: a Case Series of Eight Patients]. Zentralbl Chir 2021; 146:612-616. [PMID: 34872115 DOI: 10.1055/a-1666-8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The most common cause of pneumomediastinum is trauma. However, in the context of COVID-19 pneumonia, this clinical picture is more often found in patients without underlying exogenous injury. Pathophysiologically, a cause analogous to the Macklin effect is suspected here, in which tears at the alveolar level lead to emphysema along the tracheobronchial tree with concentrating in the mediastinum. Here we present a case series of eight patients who were treated in our intensive care unit. In all patients, mediastinal emphysema could already be seen in the chest X-ray. Five patients also received a computed tomography scan of the thorax. Six patients had invasive ventilation. All patients received corticosteroids, anticoagulation and antibiotics. Pleural drainage was applied only in patients with an additional pneumothorax (n = 5). Bronchoscopy was performed only if there was a suspicion of iatrogenic injury to the tracheobronchial tree in relation to the appearance of the pneumomediastinum (n = 2). Three patients died during intensive care as part of the COVID-19 disease. A prognostic relationship between the occurrence of a pneumomediastinum and a fatal course of the disease is discussed.
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Affiliation(s)
- Sebastian Reindl
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Saja Al-Wheibi
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Julian Umlauf
- Klinik für Anästhesiologie und operative Intensiv-Medizin, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Evaldas Girdauskas
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Stephan Raab
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
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9
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Coexistence of Emphysematous Pyelonephritis and Cystitis in a Patient with COVID-19 Complicated with Spontaneous Pneumomediastinum. Case Rep Infect Dis 2021; 2021:3115644. [PMID: 34621552 PMCID: PMC8492261 DOI: 10.1155/2021/3115644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
We report the first case of a 52-year-old nondiabetic male admitted for management of uremic syndrome associated with emphysematous pyelonephritis (EPN), renal and perinephric abscess, and emphysematous cystitis (EC) on a single functional kidney with a large abundance of spontaneous pneumomediastinum (SP) complicating a SARS-CoV-2 pneumonia. The patient has benefited from several dialysis sessions, intravenous antibiotics, and percutaneous drainage. His clinical course was complicated by acute respiratory distress syndrome, and unfortunately, he died nine days following admission.
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10
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Shaikh N, Al Ameri G, Shaheen M, Abdaljawad WI, Al Wraidat M, Al Alawi AAS, Ali HS, Mohamed AS, Daeri H, Khatib MY, Elshafei MS, Nashwan AJ. Spontaneous pneumomediastinum and pneumothorax in COVID-19 patients: A tertiary care experience. Health Sci Rep 2021; 4:e339. [PMID: 34355063 PMCID: PMC8323772 DOI: 10.1002/hsr2.339] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION COVID-19 can occasionally complicate into spontaneous pneumothorax (SP) and/or spontaneous pneumomediastinum (SM). This study aims at exploring the occurrence of SP and or SM, risk factors, and outcomes in COVID-19 patients. MATERIALS AND METHODS All patients with COVID-19, which complicated into SP and/or SM at Hamad Medical Corporation (the principal public healthcare provider in Qatar) from March to September 2020, were retrospectively enrolled. The clinical diagnosis was confirmed by CXR and CT. Between-group comparisons were performed by using Chi-square and t-test. Differences were considered statistically significant at P ≤ .05. RESULTS A total of 1100 patients were admitted, and 43 patients developed SP, SP + SM, or SM. Most patients were males (42/97.9%), and the most common comorbidity was diabetes mellitus (13/30.2%). All patients had acute respiratory distress syndrome (ARDS), and most patients had low lung compliance at the time of developing SP or SM. Twenty-two of the patients developed SP (51.2%), 11 patients had both SP and SM (25.6%), and 10 patients had SM only (23.3%). There was no significant difference in the development of SP or SM and patients' gender or blood group or whether patients were on invasive or noninvasive ventilation or even the mortality (P > .05). Lung compliance was significantly (P < .05) lower in patients complicated with SP and or SM. Patients with SP required significantly higher (P < .001) chest drain insertion. CONCLUSION Patients with severe COVID-19 pneumonia can complicate into SP and SM. These complications are more common in male diabetic patients. Patients with ARDS and having low lung compliance are at a higher risk of developing SP, SP + SM, or SM.
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Affiliation(s)
- Nissar Shaikh
- Surgical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Gamal Al Ameri
- Surgical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Muhsen Shaheen
- Medical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Wael I. Abdaljawad
- Medical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Mohammad Al Wraidat
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Abdul Aziz S. Al Alawi
- Medical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Husain S. Ali
- Medical Intensive Care DepartmentHamad General Hospital (HGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Ahmed S. Mohamed
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Hazem Daeri
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Mohamad Y. Khatib
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Moustafa S. Elshafei
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
| | - Abdulqadir J. Nashwan
- Critical Care DepartmentHazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC)DohaQatar
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11
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Oshimizu M, Yamaguchi Y, Tsuboi S, Sugawara Y, Hayami H, Tobias JD, Inagawa G. Combined Spinal-Epidural Anesthesia for Subtotal Colectomy in a Patient With Hamman Syndrome and Epidural Pneumatosis: A Case Report. A A Pract 2021; 15:e01511. [PMID: 34415243 DOI: 10.1213/xaa.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It remains unclear how epidural pneumatosis affects the efficacy of neuraxial anesthesia. Spontaneous pneumomediastinum (Hamman syndrome) with epidural pneumatosis is rare. Regardless of its etiology, general anesthesia with positive pressure ventilation in patients with pneumomediastinum carries the risk of pneumothorax. We present a 19-year-old patient with Hamman syndrome and epidural pneumatosis who required emergency laparotomy. Effective analgesia was obtained using neuraxial anesthesia with a combined spinal-epidural anesthesia technique.
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Affiliation(s)
- Mio Oshimizu
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yoshikazu Yamaguchi
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Sayaka Tsuboi
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yoh Sugawara
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hajime Hayami
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Gaku Inagawa
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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12
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Lin KP, Stefaniak C, Bunch CM, March R, Zamlut M, Raza S, Osorio W, Korzan J, Show J, Mjaess N, Patel S, Zackariya S, Sualeh A, Wiarda G, Al‐Fadhl H, Thomas AV, Khan RZ, Gillespie L, Walsh MM. Tension pneumomediastinum and diffuse subcutaneous emphysema with severe acute respiratory syndrome coronavirus 2 infection requiring operative management for impending airway collapse: A case report. Clin Case Rep 2021; 9:e04656. [PMID: 34430018 PMCID: PMC8364998 DOI: 10.1002/ccr3.4656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/08/2022] Open
Abstract
Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS-CoV-2 infection.
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Affiliation(s)
- Kevin P. Lin
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | | | - Connor M. Bunch
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | - Robert March
- Department of Cardiothoracic SurgerySt. Joseph Regional Medical CenterMishawakaINUSA
| | - Mahmud Zamlut
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Syed Raza
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Walter Osorio
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Josh Korzan
- Department of Intensive Care MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Jeffery Show
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Nicolas Mjaess
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Shivani Patel
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Sufyan Zackariya
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Ali Sualeh
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Grant Wiarda
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Hamid Al‐Fadhl
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
| | - Rashid Z. Khan
- Department of HematologyMichiana Hematology OncologyMishawakaINUSA
| | - Laura Gillespie
- Department of Quality Assurance and Performance ImprovementSt. Joseph Regional Medical CenterMishawakaINUSA
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend CampusNotre DameINUSA
- Departments of Emergency Medicine and Internal MedicineSt. Joseph Regional Medical CenterMishawakaINUSA
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13
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Akhlaq S, Ejaz T, Aziz A, Ahmed A. Spontaneous pneumomediastinum in accidental chlorine gas inhalational injury: case report and review of literature. BMJ Case Rep 2021; 14:14/7/e236549. [PMID: 34330735 PMCID: PMC8327745 DOI: 10.1136/bcr-2020-236549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
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Affiliation(s)
- Safia Akhlaq
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Taymmia Ejaz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil Aziz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Arslan Ahmed
- Medicine, Aga Khan University, Karachi, Pakistan
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14
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Belarbi Z, Brem FL, Nasri S, Imane S, Noha EO. An uncommon presentation of COVID-19: concomitant acute pulmonary embolism, spontaneous tension pneumothorax, pneumomediastinum and subcutaneous emphysema (a case report). Pan Afr Med J 2021; 39:26. [PMID: 34394817 PMCID: PMC8348285 DOI: 10.11604/pamj.2021.39.26.29178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023] Open
Abstract
The presenting symptoms and features of COVID-19 are non-specific and may be extrapulmonary complications such as thrombotic disorders but also pneumothorax, pneumomediastinum and subcutaneous emphysema; which are well-known complications of mechanical ventilation. Nevertheless, pneumothorax and/or pneumomediastinum, could complicate the course of a COVID-19 disease even in the absence of barotrauma involved. Herein, we report the case of a 55-year-old man with a previous history of erythroblastopenia due to thymoma admitted for COVID-19-related acute respiratory distress syndrome (ARDS) who simultaneously developed spontaneous tension pneumothorax, pneumomediastinum, subcutaneous emphysema and acute bilateral pulmonary embolism as presenting features of COVID-19 while on high-flow nasal cannula. This rare case highlights the importance of screening for other coexisting alternative diagnoses at the initial presentation of a patient suspected of COVID-19.
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Affiliation(s)
- Zakariae Belarbi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Falmata Laouan Brem
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Skiker Imane
- Department of Radiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - El Ouafi Noha
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Oujda, Morocco
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15
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Clinical analysis of 71 spontaneous pneumomediastinum cases: an observational study from a tertiary care hospital in Japan. Respir Investig 2021; 59:530-534. [PMID: 33849781 DOI: 10.1016/j.resinv.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any underlying disease. Some cases of spontaneous pneumomediastinum have been reported in the past, although only few reports are available, and its management remains uncertain. This study reviewed our experience in the diagnosis and treatment of spontaneous pneumomediastinum. METHODS A retrospective study of 71 cases treated for spontaneous pneumomediastinum at the Yodogawa Christian Hospital between April 2005 and March 2020 was conducted. RESULTS The patients' mean age was 19.3 years (range, 7-48 years). A triggering event was noted in 69% of the cases. Seventy-six percent of the patients were admitted to the hospital, and 24% were outpatients. Treatment included analgesia, rest, antibiotics, and/or oxygen therapy. Thirty-six patients (51%) were treated with antibiotics. None of the cases presented any complications, including mediastinitis or worsening respiratory condition. Two patients (3%) had a recurrence of spontaneous pneumomediastinum. CONCLUSIONS All the patients, with or without antimicrobial treatment and hospitalization, had favorable outcomes. We should therefore reconsider the need for hospitalization and antimicrobial therapy for patients with mediastinitis prophylaxis.
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16
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Melbouci K, Baghous H, Azzoug S. Pneumomediastinum Complicating Diabetic Ketoacidosis in Type 1 Diabetes Patient with COV-19 Reinfection: A Case Report. Indian J Endocrinol Metab 2021; 25:167-168. [PMID: 34660247 PMCID: PMC8477743 DOI: 10.4103/ijem.ijem_173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Houssam Baghous
- Department of Diabetes, Mustapha Hospital, Algiers
- Laboratory of Endocrinology and Metabolism, Algiers 1 University, Algeria
| | - Saïd Azzoug
- Department of Diabetes, Mustapha Hospital, Algiers
- Laboratory of Endocrinology and Metabolism, Algiers 1 University, Algeria
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17
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Alnofal WY, Alshadely MR, Khatib MA. Spontaneous Subcutaneous Emphysema and Pneumomediastinum Associated With Influenza B Virus in a Young Male Adult: A Case Report. Cureus 2021; 13:e13077. [PMID: 33680617 PMCID: PMC7931777 DOI: 10.7759/cureus.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In this report, we present a case of influenza B-associated spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) in a young male patient. Although there are several causes responsible for this condition, it is considered extremely rare to occur spontaneously with no prior trauma or predisposing factors, especially in older age groups. Rare cases of SPM and SE, as described in several case reports worldwide, have been reported to have a benign course for the most part. Nevertheless, implementing unified management guidelines with clear protocols is highly recommended to prevent the potential unfavorable complications associated with these conditions.
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Affiliation(s)
- Wafa Y Alnofal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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18
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Recurrent Pneumomediastinum Treated With Endobronchial Valve Placement After Source Detection by Bilateral Medical Thoracoscopy. J Bronchology Interv Pulmonol 2021; 27:e24-e27. [PMID: 32209923 DOI: 10.1097/lbr.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Tsay CY, Chen YL, Chen CS, Lin PC, Wu MY. Pediatric Spontaneous Pneumomediastinum after a Push-Up Exercise: An Uncommon Complication of a Common Exercise. CHILDREN-BASEL 2020; 7:children7120287. [PMID: 33322294 PMCID: PMC7763168 DOI: 10.3390/children7120287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022]
Abstract
Pediatric spontaneous pneumomediastinum is an uncommon condition associated with infection, trauma, or coexisting structural lung pathology. Exercise-related spontaneous subcutaneous emphysema and pneumomediastinum are rarely reported. However, severe pneumomediastinum may coexist with pneumothorax, pneumorrhachis, and subcutaneous emphysema, which can potentially lead to serious complications, including airway obstruction and pneumorrhachis. Therefore, early diagnosis and timely management are important for physicians to determine the etiology and prevent further damage. Here, we present a case of exercise-related spontaneous subcutaneous emphysema and pneumomediastinum to highlight the pathogenesis and suggest therapeutic strategies.
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Affiliation(s)
- Chih-Yi Tsay
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (C.-Y.T.); (Y.-L.C.); (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (C.-Y.T.); (Y.-L.C.); (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chien-Sheng Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (C.-Y.T.); (Y.-L.C.); (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (C.-Y.T.); (Y.-L.C.); (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (C.-Y.T.); (Y.-L.C.); (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +88-626-628-9779
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20
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Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg 2020; 103:1170-1176. [PMID: 32705978 PMCID: PMC7470555 DOI: 10.4269/ajtmh.20-0815] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023] Open
Abstract
As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumothorax and pneumomediastinum. Recent evidence suggested that these can occur in the context of COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present two patients with COVID-19 pneumonia complicated by pneumomediastinum. The first patient was a 55-year-old woman who developed COVID-19 pneumonia. Her clinical course was complicated by pneumothorax and pneumomediastinum, and, unfortunately, she died 2 days following the admission. The second patient was a 31-year-old man who developed a small pneumomediastinum and was managed conservatively. He had a spontaneous resolution of the pneumomediastinum and was discharged 19 days later. None of our patients required invasive or noninvasive positive pressure ventilation. We performed a literature review of COVID-19 pneumonia cases that developed pneumothorax, pneumomediastinum, or both. The analysis showed that the latter had high mortality (60%). Thus, it is necessary to pay attention to these complications as early identification and management can reduce the associated morbidity and mortality.
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Affiliation(s)
- Alvaro Quincho-Lopez
- San Fernando Medical School, Universidad Nacional Mayor de San Marcos, Lima, Peru
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21
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Chekkoth SM, Supreeth RN, Valsala N, Kumar P, Raja RS. Spontaneous pneumomediastinum in H1N1 infection: uncommon complication of a common infection. J R Coll Physicians Edinb 2020; 49:298-300. [PMID: 31808456 DOI: 10.4997/jrcpe.2019.409] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
H1N1 viral infection leads to complications, such as pneumonia, respiratory failure, myocarditis and encephalitis. Spontaneous pneumomediastinum (SPM) is an extremely rare consequence of H1N1 infection and such cases have been sparsely reported. SPM is identified only by a careful clinical examination and obtaining a timely roentgenogram. We report a case of a young male admitted with H1N1 infection complicated by pneumomediastinum. He was treated successfully with oseltamivir, high-flow oxygen and prompt care in the intensive care unit.
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Affiliation(s)
| | - R N Supreeth
- C/o M.N Ramesh, 30-276/14/21&22, Dwarakamayee Colony, Old Safilguda, Secunderabad - 500056, Telangana state, India,
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22
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Zhang K, Shi B, Zhai Q, Jiang L, Wang X, Jiang S, Sun H. Clinical and imaging characteristics of hematologic disease complicated by air leak syndrome: A STROBE-compliment observational study. Medicine (Baltimore) 2020; 99:e19948. [PMID: 32443296 PMCID: PMC7254183 DOI: 10.1097/md.0000000000019948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are limited systematic studies on hematologic disease complicated by air leak syndrome (ALS). Physicians in radiology departments and hematology departments have a limited awareness of ALS.The aim of this study was to explore the similarities and differences in clinical data between the clinical group and imaging group in patients with hematologic disease complicated by ALS.Clinical and CT data for 59 patients with hematologic disease complicated by ALS in our hospital were retrospectively reviewed. Patients were assessed by clinical grouping and image grouping. Data were compared between groups, and P < .05 was considered statistically significant.Dyspnea occurred more often in the allo-HSCT (allogeneic hematopoietic stem cell transplantation) group than that in the non-allo-HSCT group (68.8% vs 4.7%, P < .001), there were statistically significant differences in inducing factors between groups, and differences in other aspects were not statistically significant. Chest tightness and dyspnea occurred more often in the allo-HSCT with BO/BOOP (bronchiolitis Obliteran/bronchiolitis obliterans organizing pneumonia) group than those in the allo-HSCT without BO/BOOP group (80.0% vs 9.1%, P = .013), and differences in other aspects were not statistically significant. Chest pain occurred more often in the HPT (hydropneumothorax) group than that in the other 3 groups (pure pneumothorax [PT], pulmonary interstitial emphysema [PIE], complex ALS) (71.4% vs 11.1%, 0.0%, and 26.5%, P = .005); ALS thickness in the HPT group was greater than that in the other 2 groups (PIE and complex ALS) (19.7 vs 3.5 cm and 9.5 cm, P = .001); catheter drainage occurred more often in the HPT group than that in the other three groups (PT, PIE, complexALS) (64.3% vs 22.2%, 0.0%, and 2.9%, P = .001).ALS is a high risk in male patients who have a low BMI, have leukemia as a basic disease, and have basic lung diseases (eg, BO/BOOP). CT types are mainly complex ALS, HPT, and pure PT. In addition, clinical symptoms for patients in the HPT group are severe, and there is a high prevalence of catheter drainage.
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Affiliation(s)
- Kemin Zhang
- Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Bing Shi
- Department of radiology, Binhai New Area Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Qiang Zhai
- Department of radiology, Binhai New Area Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Lihui Jiang
- Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoxue Wang
- Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Shan Jiang
- Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hongyan Sun
- Department of Radiology, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
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23
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Zhou M, Ye Y, Yan N, Lian X, Bao C, Guo Q. Noninvasive positive pressure ventilator deteriorates the outcome of pneumomediastinum in anti-MDA5 antibody-positive clinically amyopathic dermatomyositis. Clin Rheumatol 2020; 39:1919-1927. [PMID: 31942657 DOI: 10.1007/s10067-019-04918-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/09/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive clinically amyopathic dermatomyositis (CADM) with pneumomediastinum (PNM) is a life-threatening condition. We aim to determine the prognostic factors affecting survival of patients with anti-MDA5 Ab-positive CADM complicated with PNM. METHODS We retrospectively established a cohort of patients with anti-MDA5 Ab-positive CADM complicated with PNM from April 2013 to July 2019. Demographic data and clinical characteristics from medical records were analyzed and variables were compared between survivors and nonsurvivors. We performed univariate and multivariate survival analyses by Cox regression. Survival curves were depicted by the Kaplan-Meier method. RESULTS Among 133 patients with anti-MDA5 Ab-positive CADM, 20 were diagnosed with PNM. The cumulative estimated Kaplan-Meier survival rate was 85% at 1 week, 55% at 1 month, and 40% at 1 year. Univariate analysis indicated several factors associated with survival. Worse liver function (AST, p = 0.043; LDH, p = 0.002; TBIL, p = 0.038), higher CRP level (p = 0.044), higher HRCT score (p = 0.022), and using noninvasive positive pressure ventilation (NPPV) (p < 0.01) were associated with poor prognosis. In a multivariate Cox regression model, AST level and using NPPV were indicated to be independent predictors of poor prognosis. CONCLUSION In this research, we found that the incidence rate of PNM in anti-MDA5 Ab-positive CADM was 15.5%, obviously higher than in classical DM. The application of noninvasive positive pressure ventilator (NPPV) and higher AST level were independent risk factors for survival.Key Points• Anti-MDA5 Ab-positive CADM complicated with PNM is a life-threatening condition with an incidence rate of 15.5%.• The application of NPPV and worse liver function were independent risk factors for survival of anti-MDA5 Ab-positive CADM patients complicated with PNM.
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Affiliation(s)
- Mengmeng Zhou
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| | - Yan Ye
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| | - Ninghui Yan
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| | - Xinyue Lian
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China
| | - Chunde Bao
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China.
| | - Qiang Guo
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China.
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24
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Alnamlah M, Abdulkarim LS, AlFakhri L, Alali A. Spontaneous Pneumomediastinum in a Healthy Young Male: A Case Report from Riyadh, Saudi Arabia. Cureus 2019; 11:e4442. [PMID: 31245228 PMCID: PMC6559696 DOI: 10.7759/cureus.4442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumomediastinum is defined as the presence of air in the mediastinum. Trauma to the nearby organs can cause air to escape into surrounding tissues that may manifest clinically as severe chest pain, voice change, or shortness of breath. However, pneumomediastinum can present spontaneously in healthy individuals with no inciting factors in which case the condition is termed spontaneous pneumomediastinum (SPM). Pneumomediastinum can be challenging to manage due to the absence of clear guidelines for the diagnosis and management. We present the case of a 21-year-old with no previous medical history who presented with chest pain that was aggravated by speech and breath. The pain was of sudden onset preceded by smoking at 2:00 am. The patient was tachycardic, tachypnoeic with crepitation on palpation and a crunch sound (Hamman’s sign) on auscultation. The patient rated the pain as 5/10 on a 11-point numerical pain rating scale, which then evolved to 10/10. The patient did not have fever, loss of consciousness (LOC), diaphoresis, history of trauma, or previous similar presentation. There were no other associated symptoms. A chest X-ray (posteroanterior (PA) and lateral view) showed pneumomediastinum, but laboratory tests results were otherwise normal. The patient was observed in the emergency room overnight. He remained stable, his tachycardia settled, and there was no leukocytosis or desaturation; however, tachypnea was observed. His pain symptoms were treated with analgesia as needed and the patient was discharged home in a stable condition, to be followed on an outpatient basis. Spontaneous pneumomediastinum can be challenging to manage due to the lack of reliable incidence data as well as the absence of clear management guidelines. Further research will aid in understanding the true incidence of SPM in Saudi Arabia and help in establishing a consensual approach and treatment guidelines to deal with SPM in otherwise healthy individuals. To the best of our knowledge, this is the first case of SPM in a young male reported from a tertiary hospital in Riyadh, Saudi Arabia.
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Affiliation(s)
- Mohammed Alnamlah
- Emergency Medicine, College of Medicine at Alfaisal University, Riyadh, SAU
| | | | - Lama AlFakhri
- Miscellaneous, College of Medicine at Alfaisal University, Riyadh, SAU
| | - Abdulaziz Alali
- Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
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25
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Weiss ZF, Gore S, Foderaro A. Pneumomediastinum in marijuana users: a retrospective review of 14 cases. BMJ Open Respir Res 2019; 6:e000391. [PMID: 30956805 PMCID: PMC6424304 DOI: 10.1136/bmjresp-2018-000391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Inhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques. Methods We performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause. Results We identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%). Discussion Inhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.
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Affiliation(s)
- Zoe Freeman Weiss
- Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sara Gore
- Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA
| | - Andrew Foderaro
- Division of Pulmonary and Critical Care and Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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26
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Affiliation(s)
- João Filipe Alves Mesquita Rosinhas
- . Internato de Formação Específica em Medicina Interna, Serviço de Medicina Interna, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Sara Maria Castelo Branco Soares
- . Internato de Formação Específica em Medicina Interna, Serviço de Medicina Interna, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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27
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Cherrez-Ojeda I, Felix M, Vanegas E, Mata VL. Pneumomediastinum, Tracheal Diverticulum, and Probable Asthma: Coincidence or Possible Association? A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1267-1271. [PMID: 30356031 PMCID: PMC6213822 DOI: 10.12659/ajcr.911413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 25 Final Diagnosis: Spontaneous pneumomediastinum Symptoms: Chest discomfort • exertional dyspnea • wheezing Medication: — Clinical Procedure: — Specialty: Pulmonology
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Valeria L Mata
- Universidad Espíritu Santo (UEES) (Holy Spirit University), Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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28
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Guck D, Munyon R. Bilateral spontaneous pneumothoraces with spontaneous pneumomediastinum: An intravenous methamphetamine complication. Respir Med Case Rep 2018; 25:4-5. [PMID: 29872631 PMCID: PMC5986159 DOI: 10.1016/j.rmcr.2018.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To present an unusual case and proposed mechanism of bilateral spontaneous pneumothoraces with pneumomediastinum in a patient with intravenous methamphetamine use. Case report Thin white man presented with confusion and chest pain after intravenous methamphetamine use. Initial workup found bilateral pneumothoraces with pneumomediastinum. Conservative management was initiated and subsequent radiographs and physical examination revealed subsequent improvement in pneumothoraces and pneumomediastinum. Conclusion Intravenous methamphetamine use increases a wide number of inflammatory markers that can increase the risk of spontaneous pneumothoraces and pneumomediastinum. In patients with known risk factors, methamphetamine use can promote an increased incidence of spontaneous pneumothorax and pneumomediastinum.
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Affiliation(s)
- Daniel Guck
- Department of Internal Medicine, Penn State Hershey Medical Center, USA
| | - Ryan Munyon
- Department of Internal Medicine, Penn State Hershey Medical Center, USA
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29
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Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F, Boal L, Bárbara C. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. ACTA ACUST UNITED AC 2017; 43:101-105. [PMID: 28538776 PMCID: PMC5474372 DOI: 10.1590/s1806-37562016000000052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/15/2016] [Indexed: 02/04/2023]
Abstract
Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.
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Affiliation(s)
- Patrícia Dionísio
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luís Martins
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Susana Moreira
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Alda Manique
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Rita Macedo
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Fátima Caeiro
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Luísa Boal
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Cristina Bárbara
- . Departamento de Pneumologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Irwin T, Rishi M, Upadhyay B. A peculiar case of asymptomatic spontaneous pneumomediastinum. Respir Med Case Rep 2017; 22:228-231. [PMID: 29201633 PMCID: PMC5702721 DOI: 10.1016/j.rmcr.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To present a case of asymptomatic spontaneous pneumomediastinum and review available evidence-based workup and management. CASE PRESENTATION A young Caucasian adult male with a history of inhalational drug use was admitted to the internal medicine service for evaluation of dehydration and mild rhabdomyolysis. Patient had been on the run from the police and had spent the last days prior to presentation without food, water, or shelter. On admission, patient had no complaints, except for thirst. It was detected on physical exam and chest x-ray that patient had subcutaneous emphysema and pneumomediastinum. The patient was treated conservatively and discharged after a period of observation. CONCLUSION Spontaneous pneumomediastinum is benign and seen primarily in young adults. It is more commonly associated with symptoms like chest pain and/or dyspnea, making an asymptomatic case particularly distinctive. The etiologies and precipitating factors are varied and often an apparent cause isn't identified. The diagnostic approach involves chest x-ray and/or computed tomography (CT) chest with further workup being largely unnecessary. The tenants of management include bedrest, analgesics, and supplemental oxygen as needed.
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Affiliation(s)
- Trent Irwin
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
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Shukla P, Dy P, Raj R, Alagusundaramoorthy SS, Nivera N. Pneumomediastinum and Mediastinal Hematoma Secondary to Right Brachiocephalic Vein Thrombectomy Mimicking STEMI. Case Rep Cardiol 2017; 2017:2796568. [PMID: 28804656 PMCID: PMC5540391 DOI: 10.1155/2017/2796568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/04/2017] [Accepted: 06/20/2017] [Indexed: 12/27/2022] Open
Abstract
A 50-year-old male with a history of hemodialysis dependent chronic kidney disease presented to our emergency department with acute midsternal crushing chest pain. Patient was diagnosed with acute anterolateral wall Myocardial Infraction due to the presence of corresponding ST segment elevations in EKG and underwent emergent cardiac catheterization which revealed normal patent coronaries without any disease. He continued to have chest pain for which CT of the chest was done which revealed pneumomediastinum with mediastinal hematoma, due to the recent attempted thrombectomy for thrombus in his right brachiocephalic vein.
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Affiliation(s)
- Prem Shukla
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | - Prudence Dy
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | - Rishi Raj
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | | | - Noel Nivera
- Department of Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
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Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg 2017; 65:280-284. [PMID: 28283793 DOI: 10.1007/s11748-017-0755-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/03/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to identify appropriate method of diagnosis and treatment of spontaneous pneumomediastinum (SPM) based on our experience. METHODS The medical records of patients who were diagnosed with SPM and treated at our hospital between April 2006 and July 2015 were, retrospectively, analyzed. The data included characteristics of the patients, method of diagnosis, treatment and clinical course. RESULTS Forty-five patients were diagnosed with SPM and treated at our hospital. The mean age of patients was 18.96 ± 4.65 years and 35 patients were male. The main symptoms expressed by these patients were chest pain, throat pain or discomfort, and dyspnea. Nine patients had a precipitating event leading to SPM. Twelve patients had normal chest X-ray findings but were subsequently diagnosed with SPM on chest computed tomography (CT). Additional procedures including esophagogram (n = 36), bronchoscopy (n = 14) and endoscopy (n = 1) were done but none of patients were found to have organ damage. All patients received oxygen inhalation therapy. Oral intake was restricted in 36 patients and 43 patients received prophylactic antibiotics. The mean time taken for symptomatic improvement was 1.73 ± 0.85 days from diagnosis. The mean hospital stay was 3.93 ± 1.44 days and no patient developed recurrence of SPM during the follow-up period. CONCLUSIONS In addition to chest X-ray, chest CT is recommended for accurate diagnosis of SPM. However, further invasive investigations, restriction of oral intake and the use of prophylactic antibiotics have minimal role in the diagnosis and treatment of SPM.
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Tortajada-Girbés M, Moreno-Prat M, Ainsa-Laguna D, Mas S. Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review. Ther Adv Respir Dis 2016; 10:402-9. [PMID: 27585598 PMCID: PMC5933618 DOI: 10.1177/1753465816657478] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely
reported in paediatric patients and may be accompanied by subcutaneous
emphysema. It is usually benign and self-limiting, with only supportive
therapy being needed, but severe cases may require invasive measures. Asthma
exacerbations have classically been described as a cause of SPM. However,
detailed descriptions in asthmatic children are scarce. We aimed at
improving the current understanding of the features of SPM and subcutaneous
emphysema, and outcomes, by means of a case report and a systematic
review. Methods: For the systematic review a literature search was performed in PubMed to
identify reported cases of SPM in asthmatic children. Results: The case a 10-year-old asthmatic girl with SPM is reported. The patient
received an inhaled corticosteroid and long-acting beta2 agonist, in
addition to sublingual immunotherapy (SLIT) with eventual control of asthma
symptoms. Review: A total of 114 published cases were found since 1995, most
of them in teenagers; no sex differences were observed. Clinical
presentation was associated with an asthma exacerbation in a number of
cases. Other presenting features were chest pain, dyspnoea, cough, and
particularly acute swelling of the face, neck, and upper chest. Subcutaneous
emphysema was present in most patients. Overall, three cases of pneumothorax
and two cases of pneumorrhachis were reported. Therapy was mainly based on
supportive care, rest, oxygen therapy, analgesics, steroids, and
bronchodilators. All patients recovered spontaneously, in spite of a small
initial increase in SPM in a few cases. Conclusions: Early identification of patients at risk of SPM would avoid the high number
of under-diagnosed cases. Patients should be treated not only with
supportive therapy but also with measures to achieve control of the
underlying cause (such as poorly controlled asthma).
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Affiliation(s)
- Miguel Tortajada-Girbés
- Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Av. Gaspar, Aguilar, 90. 46017 Valencia, Spain
| | - Miriam Moreno-Prat
- Luis Oliag Health Centre Valencia, Departament of Valencia Dr. Peset, Valencia, Spain
| | - David Ainsa-Laguna
- Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain
| | - Silvia Mas
- Universitat Pompeu Fabra, Barcelona, Spain
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Park SJ, Park JY, Jung J, Park SY. Clinical Manifestations of Spontaneous Pneumomediastinum. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:287-91. [PMID: 27525238 PMCID: PMC4981231 DOI: 10.5090/kjtcs.2016.49.4.287] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/26/2015] [Accepted: 09/30/2015] [Indexed: 12/17/2022]
Abstract
Background Spontaneous pneumomediastinum (SPM) is an uncommon disorder with only a few reported clinical studies. The goals of this study were to investigate the clinical manifestations and the natural course of SPM, as well as examine the current available treatment options for SPM. Methods We retrospectively reviewed 91 patients diagnosed with SPM between January 2008 and June 2015. Results The mean age of the patients was 22.7±13.2 years, and 67 (73.6%) were male. Chest pain (58, 37.2%) was the predominant symptom. The most frequent precipitating factor before developing SPM was a cough (15.4%), but the majority of patients (51, 56.0%) had no precipitating factors. Chest X-ray was diagnostic in 44 patients (48.4%), and chest computed tomography (CT) showed mediastinal air in all cases. Esophagography (10, 11.0%), esophagoduodenoscopy (1, 1.1%), and bronchoscopy (5, 5.5%) were performed selectively due to clinical suspicion, but no abnormal findings that implicated organ injury were documented. Twelve patients (13.2%) were discharged after a visit to the emergency room, and the others were admitted and received conservative treatment. The mean length of hospital stay was 3.0±1.6 days. There were no complications related to SPM except for recurrence in 2 patients (2.2%). Conclusion SPM responds well to conservative treatment and follows a benign natural course. Hospitalization and aggressive treatment can be performed in selective cases.
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Affiliation(s)
- Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Ji Ye Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine
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Three Simultaneous Cases of Spontaneous Pneumomediastinum With Epidural Pneumatosis During Vocal Training. J Voice 2016; 31:263.e1-263.e3. [PMID: 27423821 DOI: 10.1016/j.jvoice.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe a case series of three simultaneous cases of spontaneous pneumomediastinum (SPM) with epidural pneumatosis during vocal training. METHODS A report of three cases with chart review was performed. Literature review was carried out using PubMed. RESULTS This was an extremely rare case series where at least three of the 20 participants of a vocal training in a self-development seminar developed SPM, epidural pneumatosis, pneumothorax, and subcutaneous emphysema. All cases improved with bed rest. Simultaneous cases of SPM have been reported in the past. However, the cause of simultaneous occurrence has not been explained clearly. In our cases, continuous excessive vocal training may have caused intrathoracic pressure to rise, causing SPM at a high prevalence. Epidural pneumatosis is a rare finding. Studies on epidural pneumatosis complicating SPM are limited. Air is said to easily pass through the cervical region owing to the close proximity between the mediastinum and the upper spine, resulting in epidural pneumatosis. Elevated intrathoracic pressure while the glottis is closed may worsen the risk for epidural pneumatosis. In this seminar, continuous effortful vocal training at full pitch with few pauses for breath may have contributed to this simultaneous occurrence. CONCLUSIONS We report three simultaneous cases of SPM and epidural pneumatosis due to demanding vocal training. Further research on this subject is desired to identify risk factors.
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Procacci P, Zanette G, Nocini PF. Blunt maxillary fracture and cheek bite: two rare causes of traumatic pneumomediastinum. Oral Maxillofac Surg 2016; 20:91-96. [PMID: 26134477 DOI: 10.1007/s10006-015-0516-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/23/2015] [Indexed: 06/04/2023]
Abstract
Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury. In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum. This clinical entity is known as pneumomediastinum and represents a severe and, sometimes, life-threatening condition. Other reported causes of pneumomediastinum are esophageal and tracheal traumatic or iatrogenic rupture. Finally, the so-called spontaneous pneumomediastinum is caused by a sudden increase in alveolar pressure and is usually seen in young men. We present two cases of pneumomediastinum as a consequence of unusual traumatic damage of orofacial tissues, followed by repeated sneezing and Valsalva maneuver.
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Affiliation(s)
- Pasquale Procacci
- Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 1037134, Verona, Italy.
| | - Giovanni Zanette
- Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 1037134, Verona, Italy
| | - Pier Francesco Nocini
- Department of Surgery, Section of Oral and Maxillofacial Surgery, University of Verona, Policlinico "Giovanni Battista Rossi" Piazzale Ludovico Antonio Scuro, 1037134, Verona, Italy
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Kira K, Inokuchi R, Maehara H, Tagami S. Spontaneous pneumomediastinum. BMJ Case Rep 2016; 2016:bcr-2015-213550. [PMID: 26786530 DOI: 10.1136/bcr-2015-213550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kei Kira
- Department of Emergency and Critical Care Medicine, JR General Hospital, Shibuya-ku, Japan Department of Emergency and Critical Care Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, Shibuya-ku, Japan Department of Emergency and Critical Care Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiromu Maehara
- Department of Emergency and Critical Care Medicine, JR General Hospital, Shibuya-ku, Japan Department of Emergency and Critical Care Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Shunsuke Tagami
- Department of Emergency and Critical Care Medicine, JR General Hospital, Shibuya-ku, Japan Department of Emergency and Critical Care Medicine, The University of Tokyo, Bunkyo-ku, Japan
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Biçer EN, Öztürk AB, Ozyigit LP, Erus S, Tanju S, Dilege Ş, Tabak L. A case of uncontrolled severe asthma patient with coexisting carcinoid tumor presenting as pneumomediastinum. J Asthma 2015; 52:1095-8. [PMID: 26291136 DOI: 10.3109/02770903.2015.1054402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Patients with inadequately controlled or uncontrolled asthma are at a greater risk of attacks for asthma requiring emergency room visits or hospital admissions. There is a significant correlation between the severity of the disease and the severity of exacerbations. Patients with poorly controlled asthma are at a higher risk for complications. CASE STUDY We present a 24-year-old aspirin-intolerant, uncontrolled asthma patient with the complication of pneumomediastinum. RESULTS Severe symptoms persisted after the resolution of the pneumomediastinum despite intense anti-inflammatory and anti-obstructive therapy. A bronchoscopy revealed an endobronchial lesion and she was diagnosed with a carcinoid tumor. CONCLUSION This case is an example of the importance of re-evaluating asthma patients who do not respond to standard medical treatment. Clinicians should be aware of the complications associated with asthma attacks such as pneumomediastinum and the possibility of a differential diagnosis that worsen asthma symptoms such as a carcinoid tumor.
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Affiliation(s)
- Elif Nur Biçer
- a School of Medicine, Koç University , Istanbul , Turkey
| | - Ayse Bilge Öztürk
- b Department of Allergy and Immunology , Koç University Hospital , Istanbul , Turkey
| | - Leyla Pur Ozyigit
- c Department of Allergy and Immunology , School of Medicine, Koç University , Istanbul , Turkey
| | - Suat Erus
- d Department of Thoracic Surgery , Koç University Hospital , Istanbul , Turkey
| | | | | | - Levent Tabak
- f Department of Pulmonary Medicine , School of Medicine, Koç University , Istanbul , Turkey
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Lo X, Kwong WH, Leong HT. Pneumomediastinum: Can we tell prognosis upon presentation? SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Xina Lo
- Department of Surgery; North District Hospital; Hong Kong
| | | | - Heng-Tat Leong
- Department of Surgery; North District Hospital; Hong Kong
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Zachariah S, Gharahbaghian L, Perera P, Joshi N. Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. West J Emerg Med 2015; 16:321-4. [PMID: 25834681 PMCID: PMC4380390 DOI: 10.5811/westjem.2015.1.24514] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/22/2022] Open
Abstract
Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.
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Affiliation(s)
- Sybil Zachariah
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Laleh Gharahbaghian
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Phillips Perera
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Nikita Joshi
- Stanford University, Department of Emergency Medicine, Palo Alto, California
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