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Chang YT, Kao CN, Huang YL, Chiang HH, Lee JY, Li HP, Chang PC, Chou SH, Liu YW. Pneumorrhachis with spontaneous pneumomediastinum in pediatric patients: An 11-year retrospective study in Southern Taiwan. Pediatr Neonatol 2023; 64:667-673. [PMID: 37301660 DOI: 10.1016/j.pedneo.2023.03.008] [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: 12/11/2022] [Revised: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM. METHODS Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed. RESULTS In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n = 24) and SPM plus PR (n = 6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5 mg/L), identified predisposing factors, and those with more severe grade of SPM (p = 0.005, 0.001 and < 0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p < 0.001). All patients were successfully treated without morbidity and mortality. CONCLUSION Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.
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Affiliation(s)
- Yu-Tang Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Chieh-Ni Kao
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Yu-Ling Huang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Hung-Hsing Chiang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Jui-Ying Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Hsien-Pin Li
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Po-Chih Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan
| | - Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80756, Taiwan; PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, 80756, Taiwan.
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2
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Zhao CZ, Poci N, Niewodowski D, Baker A, McDonald C. Pneumorrhachis secondary to exacerbation of asthma: A case report and literature review. Respirol Case Rep 2023; 11:e01228. [PMID: 37822866 PMCID: PMC10562609 DOI: 10.1002/rcr2.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
Pneumorrhachis is defined by the presence of air within the spinal cord. Spontaneous pneumorrhachis secondary to exacerbation of asthma is rare, and its management is rarely discussed. We present a case of spontaneous pneumorrhachis in the context of a viral exacerbation of asthma, followed by a systematic literature review of all available cases of pneumorrhachis in asthma exacerbation. A total of 25 case studies reported pneumorrhachis in 28 asthma patients, all of whom presented with concomitant pneumomediastinum. Investigation and exclusion for other potential aetiologies of pneumorrhachis such as trauma or infection occurred to varying extents and may depend on clinical presentation and degree of suspicion. No other contributing aetiologies were demonstrated in this review, and no patients required specific intervention for pneumorrhachis. Whilst pneumorrhachis is generally benign, management should revolve around standard care of asthma exacerbation, attention to potentially life-threatening differential diagnoses, and supportive care.
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Affiliation(s)
- Chris Zi‐Fan Zhao
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
| | - Nadia Poci
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
| | - Daniel Niewodowski
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
| | - Amy Baker
- Department of RadiologyAustin HealthHeidelbergVictoriaAustralia
| | - Christine McDonald
- Department of Respiratory and Sleep MedicineAustin HealthHeidelbergVictoriaAustralia
- Institute for Breathing and SleepHeidelbergVictoriaAustralia
- Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
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3
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Hirata A, Yonezawa N, Fukasawa M, Fujisawa M. Extensive epidural pneumatosis and pneumomediastinum combined with diabetic ketoacidosis. Clin Case Rep 2023; 11:e7356. [PMID: 37215962 PMCID: PMC10196409 DOI: 10.1002/ccr3.7356] [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: 03/17/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Key Clinical Message Epidural pneumatosis and pneumomediastinum are rare, benign complications of diabetic ketoacidosis. As they can mimic serious conditions including esophageal rupture, diagnostic evaluation, and attentive monitoring are crucial. Abstract Diabetic ketoacidosis can rarely present with epidural pneumatosis and pneumomediastinum, possibly due to forceful vomiting and Kussmaul breathing. Recognizing these pneumocomplications is crucial, as they can mimic severe conditions, including esophageal rupture. Consequently, diagnostic workup and vigilant monitoring are critical, even though these pneumocomplications are typically benign and self-resolving.
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Affiliation(s)
- Akiko Hirata
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaKanagawaJapan
| | - Naoki Yonezawa
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaKanagawaJapan
| | - Miho Fukasawa
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaKanagawaJapan
| | - Michiko Fujisawa
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaKanagawaJapan
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4
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Serindere M, Ersen M, Balyemez U. Spontaneous pneumomediastinum and macklin effect: Three rare case reports with computed tomography findings. Niger J Clin Pract 2023; 26:528-530. [PMID: 37203121 DOI: 10.4103/njcp.njcp_901_22] [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: 05/20/2023]
Abstract
Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results from acutely elevated intra-alveolar pressure: The high-pressure gradient between the distal alveoli and the pulmonary interstitium leads to alveolar rupture. This causes free gas to separate through the peribronchovascular fascial sheaths (interstitial emphysema) into the hilum and then into the mediastinum. Once the gas is in the mediastinum, it can travel up to the cervical soft tissues (even the retroperitoneum) producing subcutaneous emphysema. The Macklin effect appears on thoracic computed tomography (CT) as linear air collections adjacent to bronchovascular sheaths. This case report presents CT findings of SPM due to the Macklin effect in three cases and a brief literature review on this subject.
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Affiliation(s)
- M Serindere
- Department of Radiology, Hatay Education and Research Hospital, Hatay, Turkey
| | - M Ersen
- Department of Radiology, Burdur Bucak State Hospital, Burdur, Turkey
| | - U Balyemez
- Department of Radiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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5
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Ehret J, Powell TW, Lam P, Cluzet V. Emphysematous Cystitis Complicated by Pneumorrhachis. Cureus 2022; 14:e30401. [DOI: 10.7759/cureus.30401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
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6
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Ali S, Colaco LB, Trikkur S, Kumar G. Silent Dyspnea: Spontaneous Pneumomediastinum in a Heroin User. Cureus 2021; 13:e20496. [PMID: 35047308 PMCID: PMC8760011 DOI: 10.7759/cureus.20496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a relatively rare presentation that often follows a benign clinical course. It is mainly triggered by underlying bronchial asthma, respiratory tract infections, strenuous activities, or illicit drug use. We present a case of an isolated primary pneumomediastinum where the patient was a 24-year-old man with underlying bronchial asthma who presented with acute onset of shortness of breath and pleuritic chest pain following snorting of an opioid-heroin. Although the clinical exam and chest radiograph were both unremarkable, the multi-detector computed tomography of the chest revealed an isolated pneumomediastinum. The patient was managed conservatively in accordance with existing evidence as SPM is known for its spontaneous recovery.
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Affiliation(s)
- Saba Ali
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Lanson B Colaco
- Department of General Medicine, KVG Medical College & Hospital, Sullia, IND
- Department of Internal Medicine, JC Medical Center, Orlando, USA
| | - Sreekrishnan Trikkur
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, IND
| | - Gireesh Kumar
- Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, IND
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7
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Elhakim TS, Abdul HS, Pelaez Romero C, Rodriguez-Fuentes Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review. BMJ Case Rep 2020; 13:e239489. [PMID: 33310838 PMCID: PMC7735137 DOI: 10.1136/bcr-2020-239489] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/16/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.
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Affiliation(s)
- Tarig Sami Elhakim
- Department of Medical Education, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Department of Internal Medicine, Kendall Regional Medical Center, Miami, Florida, USA
| | - Haleem S Abdul
- Department of Medical Education, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Department of Internal Medicine, Kendall Regional Medical Center, Miami, Florida, USA
| | - Carlos Pelaez Romero
- Department of Medical Education, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Department of Internal Medicine, Kendall Regional Medical Center, Miami, Florida, USA
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8
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Bally K, Leikin S, Margetis K, Reynolds AS. Extensive Pneumorrhachis After Spontaneous Pneumomediastinum. World Neurosurg 2020; 142:392-395. [PMID: 32693226 DOI: 10.1016/j.wneu.2020.07.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pneumorrhachis is the presence of air within the spinal canal and is most often traumatic or iatrogenic in etiology. Rarely, a small amount of pneumorrhachis can be seen with spontaneous pneumomediastinum. Here we describe a case of asymptomatic longitudinally extensive pneumorrhachis associated with spontaneous pneumomediastinum. CASE DESCRIPTION A man in his mid-20s presented to the hospital with subcutaneous emphysema after a choking episode. On imaging of his neck and chest he was noted to have extensive pneumorrhachis with anterior displacement of the spinal cord. Out of concern for further accumulation of air, he was monitored in an intensive care setting for 48 hours but remained asymptomatic. He was discharged home after ruling out esophageal rupture as a cause for his pneumomediastinum. On follow-up 1 month after discharge he was doing well without symptoms. CONCLUSIONS In cases of spontaneous pneumomediastinum, air can be entrained within the spinal canal. Special attention should be paid to any patient with pneumomediastinum with neurologic symptoms, as this could be due to pneumorrhachis.
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Affiliation(s)
- Kerri Bally
- Department of Surgery, Mount Sinai Hospital System, New York, New York, USA
| | - Scott Leikin
- Department of Surgery, Mount Sinai Hospital System, New York, New York, USA
| | | | - Alexandra S Reynolds
- Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA.
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9
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Affiliation(s)
- Hsiang-Wen Liu
- Division of Emergency and Critical Care Medicine, Central Clinic, Taipei, Taiwan
| | - Pen-An Liao
- Department of Radiology, Cathay General Hospital, and the School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
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10
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Yaginuma K, Watanabe M, Saito Y, Takahashi N, Ohara Y, Kobayashi S, Mochizuki K, Suyama K, Sato M, Sano H, Hashimoto K, Kikuta A, Hosoya M. Pneumorrhachis in children: A report of two cases and review of the literature. Radiol Case Rep 2019; 14:1325-1329. [PMID: 31516647 PMCID: PMC6732755 DOI: 10.1016/j.radcr.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
Pneumorrhachis refers to the clinical presentation of air within the spinal canal, and it is rarely associated with pneumomediastinum, particularly in young children. Pneumorrhachis associated with pneumomediastinum is generally asymptomatic. Here we report 2 unusual cases involving very young children with pneumorrhachis secondary to pneumomediastinum and present a review of the relevant literature. Case 1 involved a 4-year-old girl who presented with wheezing, violent coughing, and dyspnea associated with bronchiolitis. Case 2 involved a 3-year-old boy who presented with wheezing, violent coughing, and dyspnea associated with interstitial pneumonia possibly caused by graft-versus-host disease with human herpesvirus 6 infection after allogeneic hematopoietic stem cell transplantation. In both cases, pneumorrhachis improved with oxygen inhalation therapy and treatment of the underlying disease. Pneumorrhachis is rarely associated with neurological problems; however, decompressive laminectomy may be indicated to relieve the air block. Because pneumorrhachis is rare in children and neurological sequelae may be difficult to identify, close clinical, and radiographic observations are necessary. Plain radiography is not sufficient, and computed tomography should be performed to rule out intraspinal air.
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Affiliation(s)
- Kazufumi Yaginuma
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Masahiro Watanabe
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Yasushi Saito
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Nobuhisa Takahashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoshihiro Ohara
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Masatoki Sato
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
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Brandão Silva J, Lira J, Ferreira G, Rodrigues J. Pneumorrhachis: A finding in spontaneous pneumomediastinum. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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12
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Brandão Silva J, Lira J, Ferreira G, Rodrigues J. Neumorraquis: un hallazgo en el neumomediastino espontaneo. An Pediatr (Barc) 2019; 90:323-324. [DOI: 10.1016/j.anpedi.2018.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022] Open
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13
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Valiyakath D, Al Busaidi T, Al Shamsi S, Al Sawafi Y. Pneumorrhachis with Spontaneous Pneumomediastinum: Should It Raise Special Concerns? Oman Med J 2018; 33:256-259. [PMID: 29896336 DOI: 10.5001/omj.2018.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare and benign condition predominantly seen in young males. Patients present with non-specific pleuritic chest pain, cough, and dyspnea. Hence, it is difficult to diagnose in the acute setting until other serious differential diagnoses involving the integrity of the aerodigestive tract have been excluded. This results in over investigation and overtreatment until a diagnosis has been confirmed. We report a case of a 21-year-old Omani female who presented with a complaint of cough. She was diagnosed based on clinical and radiological findings after exclusion of hollow viscous perforation to have SPM extending to the spinal canal (pneumorrhachis). Her condition improved following conservative management, and she was sent home after three days.
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Affiliation(s)
- Dina Valiyakath
- Department of General Surgery, Armed Forces Hospital, Muscat, Oman
| | | | - Salma Al Shamsi
- Department of General Surgery, Armed Forces Hospital, Muscat, Oman
| | - Yaqoob Al Sawafi
- Department of General Surgery, Armed Forces Hospital, Muscat, Oman
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14
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Abstract
Pneumorrhachis, the presence of air in the spinal canal, is an unusual and alarming radiographic finding. The etiology is most commonly traumatic or iatrogenic but it can occur as a spontaneous phenomenon in association with pneumomediastinum. We report the case of a 16 year old male who presented with throat discomfort and a feeling of altered voice after recreational drug use. Examination confirmed widespread subcutaneous emphysema above the clavicles and plain radiograph and computed tomography imaging confirmed the presence of extensive pneumomediastinum and pneumorrhachis. The patient was managed conservatively and made a full recovery. The clinical and imaging features of spontaneous pneumorrhachis are presented as well as a review of the literature with regard to pathogenesis, management and outcome. Knowledge and understanding of this unusual phenomenon is important to properly direct patient care.
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Affiliation(s)
- Bilal A Sethi
- Department of Radiology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Jamie G Cooper
- Department of Emergency Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
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15
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Wong OF, Kwan GWM, Tsang PHK, Lee HM, Yip KH. Pneumomediastinum, Surgical Emphysema and Pneumorrhachis after Insufflation of Ketamine. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We report a rare complication after ketamine abuse. A 26-year-old known ketamine abuser developed pneumomediastinum, extensive surgical emphysema and pneumorrhachis after ‘snorting’ ketamine. He also suffered from acute on chronic renal failure and liver function impairment due to ketamine use. His pneumomediastinum and subcutaneous emphysema resolved with conservative management. Pneumomediastinum is a well-reported complication after illicit drug use, particularly smoking ‘crack’ cocaine. This case illustrates that such complication may also occur in ketamine abuse.
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16
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Pneumothorax, Pneumomediastinum, and Pneumorrhachis: A Rare Presentation in a Neurological Patient. J Neurosurg Anesthesiol 2017; 29:185-187. [DOI: 10.1097/ana.0000000000000273] [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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17
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Sandstrom CK, Osman SF, Linnau KF. Scary gas: intravascular, intracranial, and intraspinal ectopic gas (part III). Emerg Radiol 2017; 24:411-416. [PMID: 28255931 DOI: 10.1007/s10140-017-1492-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/14/2017] [Indexed: 01/05/2023]
Abstract
While ectopic gas can be a sign of dangerous disease requiring immediate medical or surgical intervention, it can also be an incidental and benign finding. Intravenous gas and spinal vacuum gas are common and almost always benign. Intravascular gas is most often related to instrumentation and, if intraarticular, can cause end-organ ischemia; however, treatment is usually supportive. Pneumocephalus arises from a communication with paranasal sinuses or mastoids more often than from meningeal infection and can usually be managed nonoperatively. In part 3 of this series, the different causes of ectopic gas in the vessels, skull, and spine are reviewed, as are the imaging features that can help to narrow the differential diagnosis.
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Affiliation(s)
- Claire K Sandstrom
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA, 98104, USA.
| | | | - Ken F Linnau
- Department of Radiology, University of Washington, 325 Ninth Ave., Box 359728, Seattle, WA, 98104, USA
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18
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Oda K, Ikegami H, Ikushima I, Yatera K. Pneumomediastinum with Ascending Emphysema within the Spinal Canal. Intern Med 2017; 56:1117-1118. [PMID: 28458324 PMCID: PMC5478579 DOI: 10.2169/internalmedicine.56.8136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Keishi Oda
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Hiroaki Ikegami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Issei Ikushima
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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19
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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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20
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An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis. Case Rep Pulmonol 2016; 2016:5092157. [PMID: 27213070 PMCID: PMC4861796 DOI: 10.1155/2016/5092157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/07/2016] [Indexed: 11/17/2022] Open
Abstract
Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing.
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Ehmann MR, Paziana K, Stolbach AI. Case Series: Pneumorrhachis Secondary to Spontaneous Pneumomediastinum. J Emerg Med 2016; 50:e43-5. [DOI: 10.1016/j.jemermed.2015.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation. Case Rep Emerg Med 2015; 2015:134816. [PMID: 26236511 PMCID: PMC4510117 DOI: 10.1155/2015/134816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis) is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.
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Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography. World J Radiol 2014; 6:850-854. [PMID: 25431639 PMCID: PMC4241491 DOI: 10.4329/wjr.v6.i11.850] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/16/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM) is described as free air or gas located within the mediastinum that is not associated with any noticeable cause such as chest trauma. SPM has been associated with many conditions and triggers, including bronchial asthma, diabetic ketoacidosis, forceful straining during exercise, inhalation of drugs, as well as other activities associated with the Valsalva maneuver. The Macklin effect appears on thoracic computed tomography (CT) as linear collections of air contiguous to the bronchovascular sheaths. With the recent availability of multidetector-row CT, the Macklin effect has been seen in the clinical setting more frequently than expected. The aim of this review article is to describe the CT imaging spectrum of the Macklin effect in patients with SPM, focusing on the common appearance of the Macklin effect, pneumorrhachis, and persistent SPM with pneumatocele.
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Girard C, Khouatra C, Cordier JF, Cottin V. Spontaneous pneumomediastinum associated with pneumorachis. Am J Respir Crit Care Med 2014; 189:e69. [PMID: 24881951 DOI: 10.1164/rccm.201305-0900im] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Charlotte Girard
- Hôpital Louis Pradel, Claude Bernard Lyon 1 University, Lyon, France
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Abstract
Pneumomediastinum is a relatively uncommon occurrence in pediatric patients. After mediastinal air leak, air may dissect through a variety of tissue planes within the chest, neck, and abdomen. We report the case of a 16-year-old adolescent boy who presented with spontaneous pneumomediastinum accompanied by the presence of air within the spinal canal. We suggest use of the term "spontaneous pneumorrhachis" to distinguish this type of presentation from other potential causes.
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Pneumorrhachis associated with a spontaneous pneumomediastinum. Rev Neurol (Paris) 2012; 169:173-4. [PMID: 23079853 DOI: 10.1016/j.neurol.2012.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/06/2012] [Accepted: 06/14/2012] [Indexed: 11/23/2022]
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Sandhya P, Keshava SN, Danda D, Padhan P, Mathew J, Gibikote S. Pneumorrhachis and pneumomediastinum in connective tissue disease-related interstitial lung disease: case series from a tertiary care teaching hospital in South India. Rheumatol Int 2011; 32:1415-9. [PMID: 21442175 DOI: 10.1007/s00296-011-1862-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/18/2011] [Indexed: 12/01/2022]
Abstract
Pneumomediastinum has been described as a rare complication of connective tissue diseases. Here, we report four cases of pneumomediastinum: three of which are associated with dermatomyositis and one with mixed connective tissue disease. All our patients had interstitial lung disease. The first case of dermatomyositis described below was complicated by epidural emphysema (pneumorrhachis) in addition to pneumomediastinum. Pneumorrhachis is reported in many isolated case reports and series in the setting of asthma, pneumothorax, blunt chest trauma, etc. Less than 10% of pneumomediastinum cases develop this complication and vast majority of cases resolve spontaneously. The mechanism behind this has been postulated to be the passage of air through the intervertebral foramen. Others suggest entrapment of air which dissects between paraspinal soft tissues and along the vascular and nerve sheaths into the epidural space. This is the first ever reported case of epidural emphysema in connective tissue disease to the best of our knowledge.
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Affiliation(s)
- P Sandhya
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore 632004, India
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