A case of spontaneous pneumomediastinum and pneumopericardium in a young adult

Spontaneous Pneumomediastinum and Subcutaneous Emphysema Associated With Diabetic Ketoacidosis: A Case Report

Hamman's syndrome or Macklin phenomenon - spontaneous pneumomediastinum - is an uncommon condition that often gets missed due to the lack of awareness. It may rarely be associated with diabetic ketoacidosis (DKA) due to repeated vomiting or Kussmaul breathing associated with it. This condition is self-resolving, and improvement in symptoms is usually observed with appropriate management of DKA. Secondary pneumomediastinum is relatively more common, but spontaneous pneumomediastinum, which is rare, is often diagnosed incidentally. Here, we describe a case of a 24-year-old gentleman where this condition was found incidentally during the examination and was confirmed through imaging (X-ray and CT scans) and resolved with successful management of DKA.

Spontaneous pneumomediastinum and pneumopericardium in a young male with asthma

INTRODUCTION

Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity.

CASE STUDY

Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck.

RESULTS

The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home.

CONCLUSION

This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium.

Tracheal Hemangioma Causing Lung Emphysema and Pneumopericardium in a Rabbit—A Case Report

A pet rabbit (female, 8 years old, and mixed breed) with symptoms of dyspnea, apathy, and weight loss was treated for an acute respiratory infection. Due to the lack of improvement, it was referred to the Imaging Diagnostics Laboratory of the Department and Clinic of Surgery for a computer tomography scan of the thoracic cavity. The examination revealed the presence of air in the pericardial sac, a pneumopericardium, along with pulmonary emphysema. A few minutes after the examination, the rabbit developed circulatory and respiratory failure and died. Necropsy confirmed the presence of a pneumopericardium and pulmonary emphysema, and revealed, in the tracheal lumen, the presence of a tumor histologically consistent with hemangioma. A spontaneous pneumopericardium occurs when air from the respiratory system moves into the pericardial sac. This is the first case of the simultaneous occurrence of tracheal hemangioma and a pneumopericardium in a rabbit.

Air in the Wrong Place at the Wrong Time: A Case of Pneumomediastinum and Pneumopericardium in the Setting of COVID-19 Disease

Infection with SARS-CoV-2, commonly referred to as COVID-19 disease, has been noted to involve a systemic inflammatory reaction affecting multiple organ systems. Patients present with a spectrum of symptoms from mild to severe respiratory distress requiring supplemental oxygen and, at times, intubation and mechanical intubation. Pulmonary involvement causes diffuse alveolar wall damage leading to destruction and collapse of the alveolar walls causing air leakage and introduction of the air into the mediastinum, pericardium, and interstitial spaces. We present a case of a 71-year-old patient who presented with respiratory distress requiring supplemental oxygen with subsequent rapid decline and decompensation requiring intubation and mechanical ventilation who was found to have pneumomediastinum and pneumopericardium.

A Very Rare Case of Isolated Spontaneous Pneumopericardium Secondary to COVID-19

Coronavirus disease 2019(COVID-19) is currently a pandemic. In addition to respiratory symptoms, involvement of other organs such as the pericardium is also seen. Pneumomediastinum in COVID-19 patients has rarely been reported. Isolated pneumopericardium without pneumomediastinum is even more uncommon. We described a case of COVID-19 in association with pneumopericardium. To the best of our knowledge, no case with isolated pneumopericardium has been reported thus far.

Cycling‐induced recurrent spontaneous pneumomediastinum and pneumopericardium in a young female patient

We present an exceptional case of recurrent cycling‐induced spontaneous pneumomediastinum and pneumopericardium in a female patient without any trauma. Radiological and endoscopic examinations were carried out to exclude other differential diagnoses. Decision for in‐hospital observation and conservative treatment was made. No symptoms were reported 12 months after return to sports activity.

Pneumopericardium, pneumomediastinum and surgical emphysema in spontaneous pneumothorax

Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural pneumatosis is rare. We report a 19-year-old man who presented with dyspnoea and swelling of the chest wall following a bout of cough. Bilateral subcutaneous emphysema was palpated on the anterior chest wall from the sternum to the midaxillary regions. His chest X-ray revealed subcutaneous emphysema and pneumopericardium. His computed tomography of the thorax to rule out life-threatening conditions revealed bilateral subcutaneous emphysema, pneumomediastinum, pneumo-pericardium and pneumothorax. He was transferred to the intensive care unit. An intercostal drainage tube was inserted in the left pleural cavity. The patient was followed up with repeat chest X-rays. The patient's symptom got relieved and was discharged after day 9. Diagnosis of pneumomedia-stinum may not be as lamentable as it is seen. Close cardio-pulmonary monitoring is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management. In this case, the patient's symptoms and severe tachypnoea prompted the insertion of an intercostal drainage tube.

Hydropneumopericardium: A rare complication of pericardiocentesis

Hydropneumopericardium is defined as the presence of air and water in the pericardial cavity. Several causes have been postulated which can lead to hydropneumopericardium including trauma, infections secondary to gas-producing bacilli, fistula formation, positive pressure ventilation or even spontaneously without an underlying cause in healthy adults and rarely after pericardiocentesis. We report an uncommon instance of hydropneumopericardium after pericardiocentesis in a 35-year-old man, which developed due to a leaky drainage system. It was immediately drained through the subxiphoid approach under echocardiographic guidance, and the patient was relieved. Hydropneumopericardium is an uncommon but easily diagnosable and avoidable complication of pericardiocentesis. It should be suspected whenever the patient develops increasing dyspnoea following a temporary relief by pericardiocentesis.

Spontaneous pneumomediastinum and pneumopericardium in a young healthy adult with plans for air travel

Although rare, pneumomediastinum and pneumopericardium should be considered in patients presenting with sudden onset post-tussive chest discomfort.

Pneumomediastinum and pneumopericardium as rare complications after retroperitoneal transpsoas lateral lumbar interbody fusion surgery: A case report

RATIONALE

Pneumomediastinum and pneumopericardium refer to conditions in which air exists within the mediastinum and pericardium, respectively. There is the communication between the mediastinum, pericardium, and retroperitoneum. We present the first report of rare complications (pneumomediastinum and pneumopericardium) after retroperitoneal transpsoas lateral lumbar interbody fusion (LLIF) surgery.

PATIENT CONCERNS

A 73-year-old female who underwent LLIF using the retroperitoneal approach complained of dysphagia but no other abnormal symptom after surgery.

DIAGNOSIS AND INTERVENTIONS

A plain chest radiograph (CXR) taken immediately the following surgery did not show any unusual findings but CXR took on postoperative day (POD) 1 indicated pneumopericardium and pneumomediastinum with abnormal air density along the pericardium and mediastinum with subdiaphragmatic air density. A chest computed tomography revealed bilateral pleural effusion and abnormal air density (pneumopericardium and pneumomediastinum) connected to a large amount of air around the aorta and retroperitoneal space (pneumoretroperitoneum).

OUTCOMES

The patient complained of no unusual symptom and the CXR on POD 6 indicated that no air density surrounding the mediastinum and pericardium was found.

LESSONS

Pneumomediastinum and pneumopericardium should be considered possible complications of LLIF using retroperitoneal transpsoas approach. Such a condition may progress to fatal conditions without early recognition and rapid management.

Pneumopericardium after minimally invasive atrial septal defect closure

Minimally invasive atrial septal defect (ASD) closure is a commonly performed cardiac surgical procedure and has good outcome. We report an interesting chest X-ray showing pneumopericardium in a patient who underwent ASD closure using a minimally invasive approach.

Pneumomediastinum: An unusual complication after percutaneous nephrolithotomy

Pneumomediastinum is the presence of air within the mediastinum. It is usually caused by a respiratory tract disorder, esophageal erosion, bowel perforation, or gastrointestinal tract endoscopic procedure. Pneumomediastinum following urological endoscopic surgery is very uncommon. Here, we report an unusual case of pneumomediastinum in a 55-year-old female following percutaneous nephrolithotomy for renal and ureteral stones. The patient recovered well with supportive treatment with oxygen.

A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis

A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.

Pneumopericardium as a rare complication after esophagopericardial fistula

Pneumopericardium is a rare clinical entity which is often complicated by trauma. Pneumoperdicardium resulting after esophagopericardial fistula is much rarer. We present a case of pneumopericardium as the complication of esophagopericardial fistula in a 53-year-old man. After undergoing radiotherapy for 26 times, the patient got a fever and an unspecified thoracic pain. Echocardiography showed the rectilinear echoes in the pericardium. Chest computed tomography revealed pneumopericardium, pericardial effusion, recurrence of lung cancer, and pneumonia in right lower and left lung.

Spontaneous pneumomediastinum in a healthy young female: A case report and literature review

Spontaneous pneumomediastinum (SPM) is an uncommon finding in young adults presenting usually without any comorbidities or an underlying pathology. It is most commonly due to alveolar rupture in the setting of an inciting event such an underlying asthma, barotrauma, valsalva maneuver, or esophageal rupture. Individuals can have varying presentations, from chest pain, dyspnea and dysphagia, to anxiety, weakness, or facial and neck swelling. The majority of patients have subcutaneous emphysema on examination and can have abnormal laboratory findings such as an elevated C-reactive proteins and leukocytosis. Diagnostic modalities used include chest x-ray, CT scan, ultrasound and barium swallow or esophagram. Majority of individuals and treated conservatively with rest, analgesia and oxygen administration. The prognosis of SPM is usually good with resolution within several days in most cases and the recurrence rate is very low. We report the case of a 22-year-old female presented with SPM diagnosed by chest x-ray and chest CT scan who was treated conservatively with subsequent spontaneous resolution.

Pneumopericardium: A Rare Complication of Pericardiocentesis

Pneumopericardium is defined by the presence of air in the pericardial cavity. It is a rare entity occurring most commonly after trauma. Pneumopericardium resulting after pericardiocentesis is even rarer. We report a case of 46-year-old man, with end-stage renal disease on chronic hemodialysis and who developed a large circumferential pericardial effusion of 40 mm in diastole with swinging heart and diastolic right atrium collapse requiring pericardiocentesis. Few days after, the patient complained of pleuritic chest pain and echocardiogram revealed several tiny sparkling echogenic spots swirling in the pericardial sac. Computed tomography scans revealed a marked anterior pneumopericardium that was conservatively managed.

Spontaneous pneumomediastinum, pneumopericardium and epidural pneumatosis: insights on clinical management

Spontaneous pneumomediastinum is a benign condition that has been reported, however the association with epidural pneumatosis is much less common. A 27-year-old male presented with concomitant air in the epidural space, mediastinum and pericardium after illicit drug use and engagement in sexual activity. The patient was hemodynamically stable. Non-invasive tests ruled out aerodigestive injury. The patient was discharged after a short observation without intervention. Invasive and potentially risky diagnostic tests may be safely avoided in patients who remain asymptomatic with this unique presentation.

Pneumothorax and asthma

This review is focused on the relationship between asthma, pneumothorax and pneumomediastinum while presenting a number of case reports that include these conditions. The association between pneumothorax and asthma is not widely known. While asthma includes a common disorder and is prevalent worldwide, its morbidity and mortality is high when is associated with pneumothorax. Furthermore, the delayed diagnosis of pneumothorax while focusing on asthma includes the higher risk of coincidental pneumothorax in asthmatic patients. In addition, pneumomediastinum is considered benign and self-limiting condition that responds to conservative therapy. Although it is rare, the concurrence of pneumomediastinum with pneumothorax may prove fatal during a serious asthma attack. In conclusion, the symptoms of chest pain, dyspnea or focal chest findings when presented in asthmatic patients, must always create suspicion of pneumothorax or pneumomediastinum to the physician.

Spontaneous pneumomediastinum with pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis: A rare association

Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax and epidural pneumotosis. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, surgical emphysema, pneumothorax, and epidural pneumotosis in an 18-year-old gentleman in the absence of identifiable cause.

A case of pneumomediastinum and parapneumonic effusions following pharyngeal perforation caused by shouting

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.

Pneumopericardium as a complication of pericardiocentesis

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.