Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-

Periorbital Emphysema Due to Traumatic Pneumothorax

Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a few days, but there are cases of orbital compartment syndrome that can lead to loss of vision. Here we present the case of a 55-year-old male who came to the emergency department for bilateral periorbital edema associated with non-steroidal anti-inflammatory drug (NSAID) usage, for pain following a fall from a ladder. He was treated with antihistamines and corticosteroids, for presumed allergic reaction, but without response, and subsequently developed acute onset dyspnea. Chest x-ray revealed a left pneumothorax in the context of chest trauma. Chest CT scan after drain placement shows extensive subcutaneous emphysema. In the differential diagnosis of periorbital edema, in addition to allergic, inflammatory, and systemic causes, the traumatic ones should not be excluded.

Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air

Tracheostomy can lead to various complications, one of which is ectopic air in different compartments of the body. Here, we present a rare case of tracheostomy-induced ectopic air: a combination of subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. This case also presents a literature review on some of the common mechanisms responsible for pneumomediastinum following tracheostomy and the mechanism of pneumoperitoneum following pneumomediastinum. Tracheal injury, tube-related complications, and alveolar rupture are common mechanisms that can lead to pneumomediastinum and subcutaneous emphysema after tracheostomy. Air can then dissect into the abdomen leading to pneumoperitoneum. Knowledge of the anatomic or embryologic development of the thoracoabdominal continuum can help understand the spread of air from one compartment to another. Investigation as simple as a chest X-ray, along with clinical features, can help identify these complications and be used to monitor the course.

Extensive Subcutaneous Emphysema Associated With Pneumothorax, Pneumomediastinum, and Pneumoperitoneum: A Case Report

Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes.

The Legend of the Buffalo Chest

Background

The “buffalo chest” is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or idiopathic fenestration of the mediastinum. This rare condition is known by many clinicians because of a particular anecdote which stated that Native Americans could kill a North American bison with a single arrow in the chest by creating a simultaneous bilateral pneumothorax, due to the animal’s peculiar anatomy in which there is one contiguous pleural space due to an incomplete mediastinum.

Research Question

What evidence is there for the existence of buffalo chest?

Study Design and Methods

The term “buffalo chest” and its anecdote were first mentioned in a ‘‘personal communication’’ by a veterinarian in the Annals of Surgery in 1984. A mixed method research was performed on buffalo chest and its etiology. A total of 47 cases of buffalo chest were identified in humans.

Results

This study found that all authors were referring to the article from 1984 or to each other. Evidence was found for interpleural communications in other mammal species, but no literature on the anatomy of the mediastinum of the bison was found. The main reason for this research was fact-checking the origin of the anecdote and search for evidence for the existence of buffalo chest. Autopsies were performed on eight bison, and four indeed were found to have had interpleural communications.

Interpretation

We hypothesize that humans can also have interpleural fenestrations, which can be diagnosed when a pneumothorax occurs.

Occurrence of bilateral pneumothorax during tracheostomy in a patient with deep neck infection

Infection that progresses to deep areas of the neck requires appropriate assessment of the airway, and securing of the airway is critical in patients with deep neck infection. In the patient in our case report, bilateral pneumothorax occurred while performing tracheostomy to the airways of a patient with deep neck infection, and therefore, this paper details the method used to secure the airway of patients with deep neck infection.

Case Reports of Two Unusual Donor Site Complications of the Pectoralis Major Myocutaneous Flap and Literature Review

The pectoralis major myocutaneous flap (PMMF), once considered a workhorse flap for head and neck reconstruction, is still used for a wide range of head and neck reconstruction in the era of microvascular free tissue transfer flap (MFTF) for many reasons including low donor site morbidity. Numerous studies have reported the flap-related complications of PMMF in depth but have seldom discussed the donor site complications in detail. This article reports 2 unusual donor site complications and reviews the published data on general donor site complications resulting from PMMF use.

Pneumopericardium, pneumomediastinum, pneumothorax and pneumoretroperitoneum complicating pulmonary metastatic carcinoma in a cat

This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.