-
La Tunisie Medicale Feb 2023Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019...
INTRODUCTION
Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood.
OBSERVATIONS
we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases.
CONCLUSIONS
Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.
Topics: Humans; Female; Adult; Middle Aged; Aged; Mediastinal Emphysema; COVID-19; Pneumonia; Oxygen; Hospitalization
PubMed: 37682278
DOI: No ID Found -
Acta Bio-medica : Atenei Parmensis Sep 2022A 62-year-old man with COVID-19 had PS for fever, coughing, and breathlessness. Two days after therapy, the patient's clinical condition worsened. X-ray and CT showed...
A 62-year-old man with COVID-19 had PS for fever, coughing, and breathlessness. Two days after therapy, the patient's clinical condition worsened. X-ray and CT showed pneumomediastinum, emphysema and pneumothorax. The patient was intubated and subjected to conservative therapy. The patient was discharged after about 20 days. Radiological imaging plays a key role in the proper diagnosis and treatment of COVID-19 patients with related complications.
Topics: COVID-19; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; Tomography, X-Ray Computed
PubMed: 36134719
DOI: 10.23750/abm.v93iS1.13061 -
The American Journal of Case Reports Nov 2021BACKGROUND Mediastinal emphysema, also called pneumomediastinum, is a very infrequent condition in patients reporting to an Emergency Department. Mediastinal emphysema...
BACKGROUND Mediastinal emphysema, also called pneumomediastinum, is a very infrequent condition in patients reporting to an Emergency Department. Mediastinal emphysema is the pathologic presence of free air enclosing the mediastinal structures. In the case of chest pain in a young healthy adult, pneumomediastinum as a differential diagnosis will undoubtedly be omitted. This would be especially likely if the symptoms are not preceded by an injury, intense vomiting, or an infection in this area. CASE REPORT We present a case in which a previously healthy 39-year-old woman experienced painless progressive face and neck swelling, dyspnea, and retrosternal pain several hours after a dental procedure. Physical examination revealed crackles on palpation of the skin on the right part of the face, neck, and chest. Neck and chest computed tomography confirmed subcutaneous neck and upper chest emphysema and pneumomediastinum. The patient was transferred to the thoracic surgery ward. After 2 days of prophylactic intravenous administration of antibiotics, she was discharged for further scheduled treatment at the Maxillofacial Surgery Clinic. CONCLUSIONS This report presented a rare case of a woman who reported to the Emergency Department with subcutaneous and mediastinal emphysema following routine molar dental extraction. Emergency Department physicians should be aware of the possibility of delayed complications after standard dental procedures. A detailed medical history and clinical examination will enable making a correct diagnosis so as not to jeopardize the health of a patient, and in the case of the development of mediastinitis, even the patient's life.
Topics: Adult; Face; Female; Humans; Mediastinal Emphysema; Neck; Subcutaneous Emphysema; Tooth Extraction
PubMed: 34739477
DOI: 10.12659/AJCR.931793 -
American Journal of Surgery Dec 2015Spontaneous pneumomediastinum (SPM) data in children are limited. We investigated the management of SPM at our institution.
BACKGROUND
Spontaneous pneumomediastinum (SPM) data in children are limited. We investigated the management of SPM at our institution.
METHODS
We reviewed children with pneumomediastinum treated from January 2011 to October 2014. Primary (no precipitating factors) and secondary (underlying respiratory disease) SPM patients were included. Admission data and clinical outcomes were recorded.
RESULTS
A total of 129 patients were included. Average age was 11.6 ± 4.6 years; 90 males (70%). Frequent presenting symptoms were chest pain (n = 76) and dyspnea (n = 51). Of the total, 89 patients (69%) were admitted. No patient required additional interventions. Of those, 85 patients (65.9%) had follow-up. Patients with secondary SPM (n = 58) were more likely than primary (n = 71) to be admitted (84% vs 56%, P = .001), receive oxygen (69% vs 35%, P = .04), and have longer stays (2 days [interquartile range, 1 to 3] vs 1 day [interquartile range, 0 to 1], P < .001). Readmission rates were equivalent.
CONCLUSIONS
Differentiating types of SPM is important as clinical course differs. Secondary SPM patients are more frequently admitted than primary SPM patients.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Mediastinal Emphysema; Retrospective Studies
PubMed: 26467078
DOI: 10.1016/j.amjsurg.2015.08.002 -
Journal of Clinical Rheumatology :... Sep 2019Spontaneous pneumomediastinum (SP) is an uncommon disorder but has been described in cases with connective tissue diseases (CTDs), most commonly dermatomyositis and...
BACKGROUND
Spontaneous pneumomediastinum (SP) is an uncommon disorder but has been described in cases with connective tissue diseases (CTDs), most commonly dermatomyositis and polymyositis. We aimed to explore this relationship by analyzing the characteristics of CTD patients with SP.
METHODS
Using a computer-assisted search, we identified 25 patients with CTD and SP evaluated between January 1997 and December 2016 at our institution. Clinicoradiologic characteristics, treatment, and outcomes were extracted and chest computed tomography studies analyzed.
RESULTS
We identified 25 patients with CTD and SP. Median (range) age at SP occurrence was 55 (18-82) years, and 60% of the patients were women. Smoking history was present in 37%. Spontaneous pneumomediastinum was symptomatic in 56% of patients. Eighteen patients (72%) had a known CTD diagnosis, and 20 patients (80%) manifested radiologic evidence of interstitial lung disease. Spontaneous pneumomediastinum diagnosis was achieved with chest radiography in 20% of cases and chest computed tomography in the other cases. Spontaneous pneumomediastinum was managed with expectant observation alone in 22 cases (88%). Four patients (16%) had concomitant pneumothorax, 1 of whom required chest tube drainage. There were no deaths attributable to SP during the median (range) follow-up of 13 (0-174) months. Cumulative survival was 52% at 1 year and 40% at 2 years.
CONCLUSIONS
Spontaneous pneumomediastinum is an uncommon manifestation of CTD and usually occurs in the presence of interstitial lung disease. Although SP seems to be associated with a relatively benign short-term course, occurrence of SP in CTD patients may be a poor prognostic factor.
Topics: Chest Tubes; Connective Tissue Diseases; Female; Humans; Lung Diseases, Interstitial; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; Prognosis; Radiography, Thoracic; Survival Analysis; Tomography, X-Ray Computed
PubMed: 29916965
DOI: 10.1097/RHU.0000000000000835 -
Journal of Radiology Case Reports Oct 2022Spontaneous pneumomediastinum is characterized by the accumulation of air in the mediastinum with no identified cause. It is a rare and self-limiting condition. We...
Spontaneous pneumomediastinum is characterized by the accumulation of air in the mediastinum with no identified cause. It is a rare and self-limiting condition. We report the case of a 32-year-old female patient with controlled bronchial asthma, who presented with spontaneous pneumomediastinum, with no precipitating event. The evolution is generally benign and the treatment is conservative. Symptomatic medication may be instituted.
Topics: Young Adult; Female; Humans; Adult; Mediastinal Emphysema; Tomography, X-Ray Computed
PubMed: 36353291
DOI: 10.3941/jrcr.v16i10.4565 -
British Journal of Hospital Medicine... Feb 2021
Topics: Chest Pain; Dyspnea; Humans; Male; Mediastinal Emphysema
PubMed: 33646030
DOI: 10.12968/hmed.2020.0426 -
Pulmonology 2021
Topics: Diving; Humans; Mediastinal Emphysema
PubMed: 32788058
DOI: 10.1016/j.pulmoe.2020.07.004 -
The Journal of Emergency Medicine Feb 2016Pneumorrhachis (PR) describes the clinical finding of air within the spinal canal and rarely has been associated with spontaneous pneumomediastinum. There is little... (Review)
Review
BACKGROUND
Pneumorrhachis (PR) describes the clinical finding of air within the spinal canal and rarely has been associated with spontaneous pneumomediastinum. There is little medical literature addressing the evaluation and management of these patients in the emergency department.
CASE REPORT
We present a series of patients with PR secondary to a spontaneous pneumomediastinum and briefly review the available literature on the topic to discuss reasonable management strategies for patients presenting with this rare finding. In both cases, the patients had excellent outcomes with expectant management despite the worrisome finding of air in the spinal canal. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must be able to promptly recognize and appropriately assess even uncommon pathology. As with other rare conditions, there are no published guidelines for the ED management of PR, necessitating the use of case presentations to educate providers as to the complications and plan of care of this diagnosis.
Topics: Adult; Cough; Humans; Male; Mediastinal Emphysema; Pneumorrhachis; Tomography, X-Ray Computed; Young Adult
PubMed: 26589562
DOI: 10.1016/j.jemermed.2015.09.047 -
Therapeutic Advances in Respiratory... Oct 2016Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually... (Review)
Review
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).
Topics: Anti-Asthmatic Agents; Asthma; Child; Cough; Dyspnea; Female; Humans; Mediastinal Emphysema; Subcutaneous Emphysema; Treatment Outcome
PubMed: 27585598
DOI: 10.1177/1753465816657478