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JAAPA : Official Journal of the... Nov 2021Since its discovery, COVID-19 has infected nearly 112 million people and caused about 2.5 millions deaths worldwide. Our understanding of the clinical presentation and...
Since its discovery, COVID-19 has infected nearly 112 million people and caused about 2.5 millions deaths worldwide. Our understanding of the clinical presentation and complications of COVID-19 is still evolving. Bilateral pulmonary ground-glass opacities on imaging have become characteristic in the diagnosis of COVID-19, but pneumomediastinum has now also been reported in some patients with COVID-19. Reports on the overall prognosis for these patients are conflicting and little information exists regarding long-term complications. This article describes the clinical course of a patient who did not need mechanical ventilation but developed spontaneous pneumomediastinum.
Topics: COVID-19; Humans; Mediastinal Emphysema; Prognosis; Respiration, Artificial; SARS-CoV-2
PubMed: 34593717
DOI: 10.1097/01.JAA.0000794992.99292.48 -
Chirurgia (Bucharest, Romania : 1990) Jun 2022Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections... (Review)
Review
Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections (pneumothorax, pneumomediastinum, and subcutaneous emphysema). We conducted an 8-months retrospective analysis of a single-center SARS-CoV-2 cases associating pneumothorax, pneumomediastinum, and subcutaneous emphysema, either alone or combined. All non-intubated patients with the complications cited above had a favorable outcome after pleural drainage, percutaneous drainage, and/or conservative treatment, while the intubated patients, with multiple comorbidities, have had an unfavorable outcome, regardless the chosen treatment. Pleural drainage was used for pneumothorax cases; pneumomediastinum with subcutaneous emphysema required insertion of subcutaneous needles or angio-catheters with manual decompressive massage. Conservative methods of treatment were used for patients with pneumomediastinum and medium or severe respiratory disfunction. Etiopathogenic classification of pneumothorax should include SARS-CoV-2 infection as a possible cause of secondary spontaneous pneumothorax due to COVID-19 pneumonia. Survival rate after the occurrence of these complications was small (18,75%), 4 of the patients were cured, 2 had a favorable outcome and 26 have died. Pleural drainage which is mandatory to do for patients with pneumothorax complication in COVID -19 pneumonia, doesn't change the prognosis for those with severe affecting lungs, because the prolonged ventilation and the other comorbidities have led to death in most of these cases.
Topics: COVID-19; Humans; Mediastinal Emphysema; Pneumothorax; Retrospective Studies; SARS-CoV-2; Subcutaneous Emphysema; Treatment Outcome
PubMed: 36049090
DOI: 10.21614/chirurgia.2719 -
Monaldi Archives For Chest Disease =... Sep 2020Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical...
Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.
Topics: Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Coronavirus Infections; Female; Humans; Incidence; Italy; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32990690
DOI: 10.4081/monaldi.2020.1399 -
The Israel Medical Association Journal... May 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 35598061
DOI: No ID Found -
Clinical Imaging Oct 2022To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To...
OBJECTIVES
To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To describe the chest radiography patterns of barotrauma and understand the development in relation to mechanical ventilation and patient mortality.
METHODS
We performed a retrospective study of 363 patients with COVID-19 from March 1 to April 8, 2020. Primary outcomes were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. The secondary outcomes were length of intubation and death. In patients with pneumomediastinum and/or subcutaneous emphysema, we conducted an imaging review to determine the timeline of barotrauma development.
RESULTS
Forty three out of 363 (12%) patients developed barotrauma radiographically. The median time to development of either pneumomediastinum or subcutaneous emphysema was 2 days (IQR 1.0-4.5) after intubation and the median time to pneumothorax was 7 days (IQR 2.0-10.0). The overall incidence of pneumothorax was 28/363 (8%) with an incidence of 17/43 (40%) in the barotrauma cohort and 11/320 (3%) in those without barotrauma (p ≤ 0.001). In total, 257/363 (71%) patients died with an increase in mortality in those with barotrauma 33/43 (77%) vs. 224/320 (70%). When adjusting for covariates, barotrauma was associated with increased odds of death (OR 2.99, 95% CI 1.25-7.17).
CONCLUSION
Barotrauma is a frequent complication of mechanically ventilated COVID-19 patients. In comparison to intubated COVID-19 patients without barotrauma, there is a higher rate of pneumothorax and an increased risk of death.
Topics: Barotrauma; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Prognosis; Retrospective Studies; Subcutaneous Emphysema
PubMed: 35926316
DOI: 10.1016/j.clinimag.2022.06.014 -
Journal of Medical Case Reports Mar 2021Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The therapeutic options also differ by the cause. This systematic review was done to provide, as far as we know, the first attempt to broadly assess the clinical feature, predisposing factors, possible management, and outcome of spontaneous primary pneumomediastinum.
METHODS
In addition to the two patients treated at our hospital, a Pub Med Search for literature on case reports of spontaneous pneumomediastinum published in English up to November 2018 was done. We extracted data on patients' demographic characteristics, symptoms, timing, diagnosis, management, and outcome of the treatment were analyzed based on the preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) RESULT: A total of 339 cases were reviewed. 71.7% of them were male. The Mean age affected was 22.4 ± 11.3 years. Chest pain, 196 (57.8%), is the most common presenting symptom, followed by dyspnea, 156 (46%), cough 95 (28%), neck swelling 92 (27.13%), cervical pain 88 (25.9%), dysphagia 39 (11.5%), odynophagia 37 (10.9%), and Dysphonia 14 (4.1%). Fifty-seven patients (16.8%) had a prior history of Asthma, 19 (5.6%) had Connective Tissue Disorders, and 12 (3.5%) had associated malignancy as an identified risk factor. In 35 (10.3%) patients, spontaneous pneumomediastinum was found incidentally. The mean number of days before the clinical resolution of spontaneous pneumomediastinum was 6.65 ± 11.8 days and the average hospital stay was 4.15 ± 1.93 days. Nineteen (5.6%) patients have died as a result of the underlying disease not related to SPM.
CONCLUSION
Spontaneous pneumomediastinum is uncommon, usually benign, a self-limited disorder that commonly occurs in a young adult without any apparent precipitating factor or disease. Spontaneous pneumomediastinum usually responds very well to conservative treatment without recurrence. However, secondary causes should be ruled out to minimize the unfavorable outcome.
Topics: Adolescent; Adult; Chest Pain; Child; Cough; Dyspnea; Female; Humans; Male; Mediastinal Emphysema; Neoplasm Recurrence, Local; Young Adult
PubMed: 33761988
DOI: 10.1186/s13256-021-02701-z -
The American Journal of Case Reports Jun 2023BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication...
BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication is tracheal insertion; cervical emphysema and pneumomediastinum are rare. There are several methods for confirming the location of the NGT, but a single method of confirmation is often inadequate. Confirmation by air insufflation into the NGT is currently not recommended and is highly invasive. Here, we report a case of cervical emphysema and pneumomediastinum caused by an NGT. CASE REPORT A 94-year-old woman experienced a stroke and was hospitalized for neurosurgery. The nurse inserted an NGT and performed insufflation, but air sounds were not detected. Chest radiography did not reveal the tip of the NGT. Computed tomography (CT) revealed cervical emphysema, pneumomediastinum, an NGT bent in the esophagus, and the distal end of the NGT in the nasopharynx. Nasopharyngeal endoscopy revealed damaged nasopharyngeal mucosa and the distal end of the NGT. The patient was diagnosed with insufflated air passing through the damaged nasopharynx, which had spread to the cervical area and mediastinum. The NGT was removed, and the patient was treated with antibiotics. CT showed cervical emphysema, and the pneumomediastinum resolved after 20 days. CONCLUSIONS It is important to recognize that there are numerous serious and unexpected complications associated with NGT. Different methods should be considered and used to confirm the location of an NGT. Further studies on the confirmation methods and dissemination of such knowledge are required to reduce NGT complications.
Topics: Female; Humans; Aged, 80 and over; Mediastinal Emphysema; Emphysema; Intubation, Gastrointestinal; Radiography; Tomography, X-Ray Computed; Pulmonary Emphysema
PubMed: 37269087
DOI: 10.12659/AJCR.939836 -
Drug Safety - Case Reports Feb 2019A 70-year-old Japanese man with mantle cell lymphoma underwent extensive chemotherapy and radiation because of the relapse of mantle cell lymphoma. He developed...
A 70-year-old Japanese man with mantle cell lymphoma underwent extensive chemotherapy and radiation because of the relapse of mantle cell lymphoma. He developed mediastinal emphysema and a pneumothorax 14 days after treatment with 560 mg of ibrutinib. The mediastinal emphysema and the right pneumothorax disappeared after the ibrutinib treatment was tapered off. The patient developed interstitial pneumonia without any infection and new lesions of mantle cell lymphoma in the lungs after restarting treatment with 560 mg of ibrutinib. In this case, the patient developed pneumonia after retreatment with ibrutinib, suggesting the small lung fibrosis that penetrated the mediastinum might have caused the emphysema and pneumothorax.
PubMed: 30790080
DOI: 10.1007/s40800-019-0098-3 -
Journal of Otolaryngology - Head & Neck... Aug 2020Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. (Review)
Review
BACKGROUND
Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.
CASE PRESENTATION
We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.
CONCLUSION
As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
Topics: Aged; Dental Care; Dental Instruments; Dental Restoration, Permanent; Diagnosis, Differential; Fasciitis, Necrotizing; Humans; Male; Mediastinal Emphysema; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 32811562
DOI: 10.1186/s40463-020-00455-0 -
Tidsskrift For Den Norske Laegeforening... Oct 2021
Topics: Humans; Mediastinal Emphysema; Punctures
PubMed: 34641662
DOI: 10.4045/tidsskr.21.0330