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Talwar A, Rajeev A, Rachapudi S, Khan S, Singh V, Talwar A. Spontaneous pneumomediastinum: A comprehensive review of diagnosis and management. Intractable Rare Dis Res 2024; 13:138-147. [PMID: 39220281 PMCID: PMC11350202 DOI: 10.5582/irdr.2024.01020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/09/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Pneumomediastinum is a rare condition defined by the presence of air in the mediastinum. In the absence of traumatic injury, iatrogenic injury, or clear etiology, it is called spontaneous pneumomediastinum (SPM). Spontaneous pneumomediastinum most commonly occurs in younger individuals and has a self-limiting course with a good outcome. The purpose of the present manuscript is to systematically review the existing literature on SPM evaluation and management for updated clinical understanding of this condition. A literature search was conducted of publications about SPM on MEDLINE/PubMed and Google Scholar by identifying all the articles with key search terms "pneumomediastinum" and "spontaneous pneumomediastinum". Inclusion criteria were case series published in English between 1980 and 2023. In total, 24 case series were selected and reviewed to determine presenting symptoms, clinical signs and predisposing factors associated with spontaneous pneumomediastinum. Most patients were male; the average age at diagnosis was 26.3 years. The most common presenting symptoms were chest pain and dyspnea. The most common exam finding was subcutaneous emphysema, in 35.4% of patients. Only 5.9% had the classic Hamman's sign. Risk factors include history of asthma, history of smoking, and recent physical activity. This manuscript presents an extensive review of relevant literature highlighting the diagnosis and essential management of spontaneous pneumomediastinum.
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Affiliation(s)
- Ankoor Talwar
- Department of General Surgery, MedStar Georgetown University Hospital-Washington Hospital Center, Washington, DC, USA
| | - Athira Rajeev
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Shasank Rachapudi
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Sara Khan
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - Vijay Singh
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, Bayshore, NY, USA
| | - Arunabh Talwar
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
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Sanchez JC, Sanchez J, Farah FR. Spontaneous Pneumomediastinum Induced by a Combination of Flu-A Infection and E-cigarettes: A Case Report. Cureus 2024; 16:e61689. [PMID: 38975450 PMCID: PMC11226214 DOI: 10.7759/cureus.61689] [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: 03/31/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Pneumomediastinum (PM) and subcutaneous emphysema are characterized by extra-alveolar air within the mediastinum and subcutaneous tissue. PM may occur spontaneously or due to trauma or an underlying airway disease. Spontaneous pneumomediastinum (SPM) may be caused by intractable vomiting, forceful coughing, child birthing, or performing a Valsalva maneuver. However, there are limited studies or case reports that present a combination of influenza A infection and electronic cigarette (e-cigarette)-induced SPM. This case report presents SPM in a previously healthy 20-year-old female with untreated influenza A infection and a history of e-cigarette use who presented to the emergency department with fever, cough, chest pain, dyspnea, and vomiting. Her physical examination was significant for neck tenderness, subcutaneous neck crepitus, and increased respiratory effort. Diagnostic evaluation included a chest X-ray and chest computed tomography that revealed PM with subcutaneous emphysema extending into the neck, as well as a negative Gastrografin study. She was treated conservatively and discharged after two days, with a follow-up scheduled at a pulmonary clinic. This case report highlights the need for a detailed substance use history, particularly e-cigarette use, when determining the etiology of SPM in a previously healthy patient. Management for SPM is conservative and should include addressing underlying etiologies with special attention to cessation and education of e-cigarettes and illicit substances.
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Affiliation(s)
- Jason C Sanchez
- Hospital Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Jaron Sanchez
- Hospital Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Farah R Farah
- Hospital Medicine, Methodist Health System, San Antonio, USA
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Anwar MS, Khan AA, Dua R, Nawaz FK, Khalid F, Du D. Hamman Syndrome with a Rare Feature of Pneumorrhachis - An Unusual Complication of Polysubstance abuse and e-vaping. Eur J Case Rep Intern Med 2024; 11:004473. [PMID: 38846659 PMCID: PMC11152237 DOI: 10.12890/2024_004473] [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: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/09/2024] Open
Abstract
Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status. Given the concerning physical examination, a computed tomography of the chest was undertaken, which showed pneumothorax, pneumomediastinum and pneumorrhachis. The patient was closely monitored in the intensive care unit and improved after symptomatic management. The symptoms of pneumorrhachis depend on the volume and location of air in intracranial and intraspinal space. Although asymptomatic in our case, it is crucial for clinicians to be aware that pneumorrhachis with Hamman syndrome can potentially cause neurological deficits and cardiopulmonary arrest in severe cases due to increased intraspinal and intracranial hypertension, emphasising the need for close monitoring. LEARNING POINTS Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.
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Affiliation(s)
| | - Anosh Aslam Khan
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Richa Dua
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Fatima Kausar Nawaz
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Farhan Khalid
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Doantrang Du
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
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Kartiko M, Miller A. A Case Report of Secondary Spontaneous Pneumomediastinum Induced by Vaping. Cureus 2023; 15:e35153. [PMID: 36949981 PMCID: PMC10027423 DOI: 10.7759/cureus.35153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
We present a rare case of vaping-induced spontaneous pneumomediastinum in a young healthy female. The patient presented to the emergency department with the chief complaint of acute onset chest pain. Imaging studies, chest X-ray, and computed tomography of the chest showed findings of pneumomediastinum. The patient was counseled on vaping cessation and discharged after 48 hours.
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Affiliation(s)
- Michael Kartiko
- Internal Medicine, Piedmont Macon Medical Center, Macon, USA
- Radiology, Creighton University School of Medicine, Omaha, USA
| | - Aisha Miller
- Internal Medicine, Piedmont Macon Medical Center, Macon, USA
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Muacevic A, Adler JR, Chillag SA. Pneumomediastinum and Pneumorrhachis Associated With Cannabinoid Hyperemesis Syndrome. Cureus 2022; 14:e32380. [PMID: 36632263 PMCID: PMC9828796 DOI: 10.7759/cureus.32380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
More complications continue to be reported with the increasing use of marijuana (MJ) in the United States, including the increasing prevalence of Cannabinoid Hyperemesis Syndrome (CHS). To our knowledge, based on a thorough review of the literature, we present the third case of CHS with associated pneumomediastinum (PM) and the first case of pneumorrhachis (PR) in a young healthy patient. The main objective of this paper is to heighten awareness of CHS and its potential complications. A brief discussion of a focused history is essential for diagnosis, proper evaluation, and treatment.
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Mir M, Rauf I, Goksoy S, Khedr A, Jama AB, Mushtaq H, Jain NK, Khan SA, Surani S, Koritala T. Electronic Cigarettes: Are They Smoking Cessation Aids or Health Hazards? Cureus 2022; 14:e25330. [PMID: 35761921 PMCID: PMC9232181 DOI: 10.7759/cureus.25330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/14/2022] Open
Abstract
The US Food and Drug Administration (FDA) recently approved the marketing of an electronic cigarette (e-cig) brand called Vuse (RJ Reynolds Vapor Company, US) to help aid in smoking cessation for adult smokers. It was believed that the consumption of traditional cigarettes and their harmful effects would be reduced given the availability of newer e-cigarettes. However, adolescent use of tobacco and nicotine products rather increased with the availability of the same e-cigarettes, and the FDA-approved market boom only worsened this problem. Although the FDA underlines the importance of marketing e-cigarettes as a possible solution for adult traditional smoking, its consequences on adolescents' health raise many concerns, which we narrated in this review article.
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Gutierrez-Ariza JC, Rodriguez Yanez T, Martinez-Ávila MC, Almanza Hurtado A, Dueñas-Castell C. Pneumomediastinum and Pneumothorax Following Non-invasive Respiratory Support in Patients With Severe COVID-19 Disease. Cureus 2021; 13:e18796. [PMID: 34796074 PMCID: PMC8590743 DOI: 10.7759/cureus.18796] [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: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic led to an increased number of patients with pneumothorax and pneumomediastinum owing to complications attributed to viral pneumonia regardless of the use of mechanical invasive ventilation and the elapsed time of infection. The pathophysiology remains unknown. However, the Macklin effect is shown as the most plausible mechanism along with possible barotrauma secondary to a high-flow nasal cannula and noninvasive mechanical ventilation. We present two cases of patients who developed pneumomediastinum and tension pneumothorax. One of the patients was studied during infection and the other after recovery. Both received appropriate and timely treatments with successful outcomes. It is important to be aware of these potentially fatal complications as early management can reduce the associated morbidity and mortality.
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