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Clinical Medicine (London, England) Jul 2020A case is presented highlighting the emerging association of COVID-19 with pneumomediastinum, even in patients who have never received mechanical ventilation or positive...
A case is presented highlighting the emerging association of COVID-19 with pneumomediastinum, even in patients who have never received mechanical ventilation or positive airway pressure.
Topics: Betacoronavirus; COVID-19; Computed Tomography Angiography; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32628129
DOI: 10.7861/clinmed.2020-0247 -
Acta Medica (Hradec Kralove) 202074 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation...
74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5-11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.
Topics: Aged; Continuous Positive Airway Pressure; Humans; Male; Mediastinal Emphysema; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Rib Fractures; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 33355081
DOI: 10.14712/18059694.2020.63 -
Tidsskrift For Den Norske Laegeforening... Jun 2018
Topics: Adult; Chest Pain; Humans; Male; Mediastinal Emphysema; Radiography, Thoracic; Tomography, X-Ray Computed; Young Adult
PubMed: 29947201
DOI: 10.4045/tidsskr.18.0132 -
Jornal Brasileiro de Pneumologia :... 2018
Topics: Adult; Cough; Humans; Male; Mediastinal Emphysema; Neck; Subcutaneous Emphysema; Syndrome
PubMed: 30517342
DOI: 10.1590/S1806-37562018000000180 -
Deutsches Arzteblatt International Feb 2022
Topics: Humans; Mediastinal Emphysema; Skin; Subcutaneous Emphysema
PubMed: 35438627
DOI: 10.3238/arztebl.m2022.0016 -
Diagnostic and Interventional Imaging Sep 2022
Topics: Humans; Mediastinal Emphysema; Neck; Subcutaneous Emphysema; Tooth Extraction
PubMed: 35760727
DOI: 10.1016/j.diii.2022.06.005 -
Lakartidningen Jan 2018A previously healthy 21-year old man presented to the emergency department with sudden onset central chest pain exacerbated by breathing. A plain chest X-ray showed air...
A previously healthy 21-year old man presented to the emergency department with sudden onset central chest pain exacerbated by breathing. A plain chest X-ray showed air within the mediastinum and pericardium confirmed by a CT scan with contrast. The patient history did not raise suspicion of any concomitant disease and the diagnosis of spontaneous pneumomediastinum with pneumopericardium was made. The patient recovered completely over the next few days with bed rest and analgesics. Spontaneous pneumomediastinum is an uncommon disease caused by rupture of perivascular alveoli causing air leakage to the mediastinum. The condition is benign and self-resolving in most cases. Pneumopericardium, a rare complication to spontaneous pneumomediastinum, is also usually self-resolving but may cause cardiac tamponade requiring intervention. Spontaneous pneumomediastinum must be differentiated from secondary pneumomediastinum caused by an underlying condition, such as esofageal rupture, trauma or infection, which may require specific treatment.
Topics: Acute Pain; Algorithms; Chest Pain; Humans; Male; Mediastinal Emphysema; Pneumopericardium; Radiography; Tomography, X-Ray Computed; Young Adult
PubMed: 29319833
DOI: No ID Found -
Annals of Thoracic Medicine 2022Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)....
INTRODUCTION
Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a universal pandemic in March 2020 by the World Health Organization and is a severe health issue with unprecedented morbidity and mortality rates. Both surgical and mediastinal emphysema have been seen in cases of critically ill COVID-19 patients in several hospitals in the Eastern Province of Saudi Arabia.
METHODS
This was a retrospective, cross-sectional, multicentric study involving several hospitals in the Saudi Arabian Eastern Province. Data were collected from intensive care units (ICUs) in these hospitals from March 2 to August 2, 2020. The inclusion criteria consisted of all patients who tested positive for SARS-CoV-2 and were admitted to a critical care unit.
RESULTS
Thirty patients required thoracic consultation and management, including 26 males (81.3%) and 4 females (12.5%) (1:0.15) who developed surgical and mediastinal emphysema requiring thoracic surgery intervention. Most of the patients were on high ventilation settings, and the mean duration of ventilator support was 16.50 ± 13.98 days. Two patients (6.3%) required reintubation. The median positive end-expiratory pressure (PEEP) was 12 ± 2.80 cmHO with a median FiO2 of 70% ± 19.73. On average, thoracic complications occurred on day 3 (±6.29 days) postintubation. Ten patients (33.33%) experienced a pneumothorax associated with surgical emphysema (SE), 1 patient (3.33%) presented with only mediastinal emphysema; 17 patients (56.66%) with only SE, and 1 (3.33%) had mediastinal emphysema associated with SE. We noted a correlation between the duration of ventilator support, the length of ICU stay ( < 0.001), and the total length of stay (LOS) in the hospital ( < 0.001). Total length of hospital stay showed significant association with the onset of complications ( = 0.045) and outcomes ( = 0.006). A significant association between PEEP and the duration of ventilator support was also evident with a value = 0.009 and the onset of complications ( = 0.043). In addition, we found a significant association between the group with pneumothorax in combination with SE, and their outcomes, with a = 0.002.
CONCLUSION
Surgical and mediastinal emphysema in the critically ill patients are usually attributed to barotrauma and high ventilations settings. During COVID-19 pandemic, these entities were seen and the pathogenesis was revisited and some attributed its presence to the disease process and destruction on lung parenchyma. The associated with extended LOS and delayed recovery in addition to poor prognosis were seen. Their presence is an indicator to higher morbidity and mortality.
PubMed: 35198049
DOI: 10.4103/atm.atm_600_20 -
Deutsches Arzteblatt International Aug 2023
Topics: Humans; Mediastinal Emphysema
PubMed: 37721139
DOI: 10.3238/arztebl.m2022.0394 -
The Eurasian Journal of Medicine Feb 2022Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal...
Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal layer. More than half of the esophageal perforations are iatrogenic and most occur during endoscopy. Around 55% of esophageal injuries occur in the intrathoracic region, 25% in the cervical region, and 20% in the abdominal region. Clinical manifestations and mortality are related to various components such as the etiology, localization, type of injury, severity of contamination, injury to adjacent mediastinal structures, and time from perforation to treatment. When perforation occurs in the esophagus, saliva, stomach contents, bile fluid, and other secretions may pass into the mediastinum causing mediastinal emphysema, inflammation followed by mediastinal necrosis, and chemical mediastinitis. Early clinical suspicion and imaging are essential for successful treatment. Despite advances in technology and treatment, the morbidity and mortality rate due to esophageal perforation is still higher than 20% according to the reported studies. Until now, the main treatment of esophageal perforation was the surgical approach. Nowadays, endoluminal procedures such as endoscopic vacuum therapy, endoscopic stent placement, endoscopic clip closure, endoscopic suturing, and tissue adhesives have started to be applied more. In this review, the minimally invasive and endoscopic approach methods suitable for esophageal perforation according to the characteristics of the patients and the structure of the perforation were examined.
PubMed: 35307640
DOI: 10.5152/eurasianjmed.2022.21135