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Pulmonology 2021
Topics: Diving; Humans; Mediastinal Emphysema
PubMed: 32788058
DOI: 10.1016/j.pulmoe.2020.07.004 -
Ugeskrift For Laeger Sep 2022This is a case report of a young woman with diabetes mellitus type 1. She was admitted with severe diabetic ketoacidosis. Asymptomatic "surgical emphysema",...
This is a case report of a young woman with diabetes mellitus type 1. She was admitted with severe diabetic ketoacidosis. Asymptomatic "surgical emphysema", pneumomediastinum and bilateral pneumothoraces were accidently discovered. The emphysema had probably occurred due to laboured breathing and groaning during her diabetic ketoacidosis. No treatment was needed.
Topics: Chest Pain; Diabetic Ketoacidosis; Female; Humans; Mediastinal Emphysema; Pneumothorax; Pulmonary Emphysema; Respiration; Subcutaneous Emphysema
PubMed: 36178181
DOI: No ID Found -
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 -
The Lancet. Infectious Diseases Apr 2020
Topics: Adult; COVID-19; China; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Pandemics; Pneumonia, Viral
PubMed: 32164830
DOI: 10.1016/S1473-3099(20)30156-0 -
Academic Radiology Nov 2021Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic injury. Although the... (Review)
Review
BACKGROUND
Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in the absence of traumatic or iatrogenic injury. Although the imaging findings and complications of SARS-CoV-2 infection have been reported many times, there are few reports of the prevalence and outcomes of patients with SPM.
PURPOSE
In this paper, we aimed to illustrate the different manifestations, management, and outcome of three cases of SPM in COVID-19 patients and provide an extensive review available literature.
MATERIALS AND METHODS
Detailed report of patients' demographics, clinical presentation, management, and outcome of three cases of COVID-19 induced SPM seen in our institution was provided. Additionally, literature search was employed through March 2021 using Pubmed and Google scholar databases where a total of 22 articles consisting of 35 patients were included.
RESULTS
Statistical analysis of the reviewed articles showed that SPM in COVID-19 occurs in patients with a mean age of 55.6 ± 16.7 years. Furthermore, 80% of the 35 patients are males and almost 60% have comorbidities. Intriguingly, SPM in COVID-19 is associated with a 28.5% mortality rate. These findings are consistent with our case series and are different from previous reports of SPM in non-COVID-19 cases where it most commonly occurs in younger individuals and has a self-limiting course with a good outcome.
CONCLUSION
Therefore, SPM in COVID-19 patients occurs in older patients and is potentially associated with a higher mortality rate. Further studies are necessary to assess its role as a prognostic marker of poor outcome.
Topics: Adult; Aged; COVID-19; Humans; Male; Mediastinal Emphysema; Mediastinum; Middle Aged; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 34391638
DOI: 10.1016/j.acra.2021.07.013 -
Critical Care Research and Practice 2021Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic...
INTRODUCTION
Iatrogenic pneumothoracis, barotraumas, and tracheoesophageal fistulae, especially after prolonged intubation, and tracheal stenosis are all entities involving thoracic surgeons' consultation and management. With the surge of COVID-19 cases particularly in the critical care settings, various types of complications have been observed that require intervention from thoracic surgeons.
METHODS AND MATERIALS
A retrospective study was conducted in an academic healthcare institute in the Eastern Province of Saudi Arabia. We included all COVID-19 cases admitted to ICU in the period between March 15, 2020, and August 15, 2020, requiring thoracic surgery consultation and management. Non-COVID-19 critical cases and iatrogenic pneumothorax were excluded.
RESULTS
Of 122 patients who were admitted to ICU with COVID-19, 18 patients (14.75%) required thoracic surgery consultation and management. We discovered a significant association between the outcomes and reintubation rates and the rate of pneumothorax occurrence. The survival analysis showed improvement in patients who had thoracostomy tube insertion as a management than the group who were treated conservatively. On the other hand, there was a significant difference between the COVID ICU group who had thoracic complication and those who did not regarding the length of hospital stay.
CONCLUSION
Noniatrogenic pneumothorax, subcutaneous emphysema, and mediastinal emphysema are well-known thoracic entities, but their presence in the context of COVID-19 disease is a harbinger for worse prognosis and outcomes. The presence of pneumothorax may be associated with better prognosis and outcome compared to surgical and mediastinal emphysema.
PubMed: 33815840
DOI: 10.1155/2021/6626150 -
Respirology Case Reports Jul 2019A 21-year old female with diabetes mellitus type 1 presented to our hospital's emergency department having suffered from shortness of breath, mild chest pain, and...
A 21-year old female with diabetes mellitus type 1 presented to our hospital's emergency department having suffered from shortness of breath, mild chest pain, and vomiting following her arrival after a long-distance flight two days earlier. Symptoms had since subsided and physical examination was normal. Blood analysis revealed increased D-dimers and diabetic ketoacidosis. Computed tomography (CT) examination excluded pulmonary embolism but demonstrated significant mediastinal emphysema. After conservative treatment including nasal oxygen and adjustment of insulin therapy, follow-up low-dose CT after four days confirmed full regression of the emphysema. The patient was discharged feeling well, with a recommendation for improved diabetes treatment. Spontaneous pneumomediastinum is a rare condition occurring in younger patients without trauma or pulmonary disease. Over-inflation and/or pulmonary vasoconstriction have been proposed as major physiological contributors and were likely evoked in the present case by increased respiratory drive due to ketoacidosis and hypoxic vasoconstriction during long distance flight.
PubMed: 30997108
DOI: 10.1002/rcr2.423 -
Anesthesia Progress 2017A 76-year-old woman with right mandibular gingival cancer was scheduled for surgery. A percutaneous tracheostomy kit was used for tracheostomy under intravenous...
A 76-year-old woman with right mandibular gingival cancer was scheduled for surgery. A percutaneous tracheostomy kit was used for tracheostomy under intravenous sedation. After puncturing the cricothyroid membrane, a dilator was inserted along a guidewire. Bucking was observed at the time of insertion of the dilator, despite intratracheal lidocaine spray applied before insertion. After that, the tracheostomy tube was inserted, but no capnographic waveforms appeared when the tube was connected to the anesthesia circuit. Direct macroscopic observation revealed a perforation extending from the posterior wall of the trachea to the anterior wall of the esophagus, which prompted us to request assistance from a thoracic surgeon for treatment before reinserting the tracheostomy tube. After verifying capnographic waveforms on the monitor, anesthesia was induced. Because arterial oxygen saturation was 96% under the administration of pure oxygen, chest radiography was conducted revealing a right pneumothorax. A chest tube was inserted and the patient transported to a nearby general hospital. We suspect that pneumothorax was induced when the integrity of the mediastinal pleura was compromised by mediastinal emphysema because of the injury to the posterior tracheal wall complicated by bucking at the time of insertion of the dilator.
Topics: Aged; Female; Gingival Neoplasms; Humans; Mediastinal Emphysema; Pneumothorax; Tracheostomy
PubMed: 28604085
DOI: 10.2344/anpr-64-02-07 -
BMC Infectious Diseases Dec 2021The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases...
BACKGROUND
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities.
CASE PRESENTATION
A 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy.
CONCLUSION
The COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor.
Topics: Adult; COVID-19; Humans; Male; Mediastinal Emphysema; Pandemics; SARS-CoV-2; Subcutaneous Emphysema
PubMed: 34969371
DOI: 10.1186/s12879-021-07006-6 -
Revista Do Instituto de Medicina... 2020Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown its typical and atypical CT findings. We report one COVID-19 patient who... (Review)
Review
Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown its typical and atypical CT findings. We report one COVID-19 patient who presented with a transient pneumothorax, spontaneous pneumomediastinum (SP), as well as subcutaneous emphysema during hospitalization. Chest CT andclinical findings were discussed, and a literature review is presented. The probable cause of SP in COVID-19 was alveolar damage. Once pneumothorax and SP were present, the patient should be carefully monitored to prevent respiratory deterioration, especially when lung lesions are severe.
Topics: Betacoronavirus; COVID-19; Coronavirus; Coronavirus Infections; Humans; Mediastinal Emphysema; Pandemics; Pneumonia, Viral; Pneumothorax; SARS-CoV-2; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 33053145
DOI: 10.1590/S1678-9946202062076