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Veterinary Medicine and Science Nov 2022Oesophageal pneumatosis (OP) is defined as the presence of gas within the oesophageal wall. The description of this condition in veterinary medicine is currently...
BACKGROUND
Oesophageal pneumatosis (OP) is defined as the presence of gas within the oesophageal wall. The description of this condition in veterinary medicine is currently lacking. The pathogenesis of alimentary tract pneumatosis remains unclear. Current literature describes that access of gas into the oesophageal wall may occur by one or a combination of the following mechanisms: mucosal disruption, increased intra or extra-luminal pressure or dissection of gas from an extra-oesophageal source.
OBJECTIVES
The aim of this multi-centric case series was to describe the computed tomography (CT) findings of OP in dogs.
METHODS
Three adult dogs were included. One dog presented with gastrointestinal signs and general malaise while the other two presented with spontaneous facial and cervical subcutaneous emphysema.
RESULTS
CT revealed different degrees of intramural gas along the oesophageal wall in all cases. The first dog was diagnosed with emphysematous gastritis based on the presence of gastric pneumatosis paired with compatible clinicopathological and endoscopic findings. This dog was successfully treated with antibiotics. The remaining two dogs were diagnosed with spontaneous pneumomediastinum and required no surgical or medical treatment.
CONCLUSIONS
In all cases with OP, there was concurrent gastric pneumatosis. Gas extensively and circumferentially distributed with a banded shape along the oesophageal wall was present in patients with presumed mural gas dissection because of pneumomediastinum. Conversely, a focal and mild amount of mural gas with a tubular shape was identified in the distal segment of the oesophagus in the patient with emphysematous gastritis.
Topics: Dogs; Animals; Pneumatosis Cystoides Intestinalis; Mediastinal Emphysema; Tomography, X-Ray Computed; Gastritis; Esophagus; Dog Diseases
PubMed: 36177968
DOI: 10.1002/vms3.957 -
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 -
Acta Bio-medica : Atenei Parmensis Jan 2022Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on...
Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience.
Topics: Humans; Mediastinal Emphysema; Pneumothorax; Subcutaneous Emphysema; Tracheostomy
PubMed: 35045064
DOI: 10.23750/abm.v92iS1.11551 -
Revista Espanola de Sanidad... 2020We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the...
We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the irruption of air in the mediastinal space, and is associated with different causes, including addiction to inhaled drugs. It occurs in people with predisposing factors and the presence of precipitating factors such as consumption of inhaled drugs. X-ray and computed tomography of the thorax are very useful tools in guiding the diagnosis. The low incidence of this pathology represents a difficult diagnosis for the doctor, although in some characteristic work environments a high level of suspicion is necessary.
Topics: Adolescent; Cocaine-Related Disorders; Dyspnea; Humans; Male; Mediastinal Emphysema
PubMed: 32406481
DOI: 10.18176/resp.0007 -
Journal of Intensive Care Medicine Aug 2022Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case... (Observational Study)
Observational Study
BACKGROUND
Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case series. The incidence is thought to be approximately 1% but is not definitively known.
OBJECTIVES
To report the incidence and describe the demographic features, risk factors and outcomes of patients with air leak as a complication of COVID-19.
METHODS
A retrospective observational study on all adult patients with COVID-19 admitted to Watford General Hospital, West Hertfordshire NHS Trust between March 1st 2020 and Feb 28 2021. Patients with air leak were identified after reviewing both chest radiographs (CXRs) and axial imaging (CT Thorax) with confirmatory radiology reports inclusive of the terms PTX and/or PM.
RESULTS
Air leak occurred with an incidence of 0.56%. Patients with air leak were younger and had evidence of more severe disease at presentation, including a higher median CRP and number of abnormal zones affected on chest radiograph. Asthma was a significant risk factor in the development of air leak (OR 13.4 [4.7-36.4]), both spontaneously and following positive pressure ventilation. CPAP and IMV were also associated with a greater than six fold increase in the risk of air leak (OR 6.4 [2.5-16.6] and 9.8 [3.7-27.8] respectively). PTX, with or without PM, in the context of COVID-19 pneumonia was almost universally fatal whereas those with alone PM had a lower risk of death.
CONCLUSION
Despite the global vaccination programme, patients continue to develop severe COVID-19 disease and may require respiratory support. This study demonstrates the importance of identifying that deterioration in such patients may be resultant from PTX or PM, particularly in asthmatics and those managed with positive pressure ventilation.
Topics: Adult; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Risk Factors
PubMed: 35360973
DOI: 10.1177/08850666221091441 -
The American Journal of Case Reports Sep 2022BACKGROUND Tracheostomy is a surgical procedure that is done by creating an ostomy in the anterior wall of the trachea to facilitate airway access and ventilation. It is...
BACKGROUND Tracheostomy is a surgical procedure that is done by creating an ostomy in the anterior wall of the trachea to facilitate airway access and ventilation. It is indicated for acute respiratory failure after prolonged intubation, upper airway obstruction, difficult airway, and extensive secretions. Early perioperative complications include bleeding, pneumothorax/pneumomediastinum from a false tract, subcutaneous emphysema, esophageal perforation, and tracheal ring fractures. CASE REPORT We present the case of a 64-year-old woman with a past medical history of hypertension, asthma, alcohol and cocaine abuse, bipolar, and, right breast cancer that was treated by chemotherapy and total mastectomy. She was diagnosed with adductor spasmodic dysphonia of unknown etiology 6 months ago and has been treated with Botulinum toxin injection, with an incomplete resolution. She was admitted to the Respiratory Intensive Care Unit with acute hypoxic respiratory failure associated with stridor secondary to laryngospasm, which was unresponsive to steroids and racemic epinephrine. She underwent an emergent open tracheostomy with a regular nonfenestrated tracheostomy tube. A few hours after surgery, she was weaned from mechanical ventilation to a tracheostomy mask oxygen and had an episode of strong cough followed by extensive neck and facial subcutaneous emphysema. CONCLUSIONS Subcutaneous emphysema is a rare complication but it can be catastrophic, especially if it is associated with pneumothorax and/or pneumomediastinum. Avoiding tight a tracheostomy tube strap and fenestrated tracheostomy tube is one of the measures that can be used to avoid this complication.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Mediastinal Emphysema; Middle Aged; Pneumothorax; Respiratory Distress Syndrome; Subcutaneous Emphysema; Tracheostomy
PubMed: 36065149
DOI: 10.12659/AJCR.937102 -
Journal of Sports Science & Medicine Mar 2021Spontaneous pneumomediastinum (SPM) is an uncommon and usually benign self-limiting clinical disorder found in young people, often without apparent precipitating factors...
Spontaneous pneumomediastinum (SPM) is an uncommon and usually benign self-limiting clinical disorder found in young people, often without apparent precipitating factors or diseases. A pressure gradient exists between the peripheral pulmonary alveoli and the hilum, and increased intra-alveolar pressure causes rupture of the terminal alveoli. We present the case of a 15-year-old male soccer player who presented with a complaint of anterior chest pain and dysphagia after stopping the strong ball with his chest. His symptom gradually progressed over hours. We can make the diagnosis of SPM using by chest X-ray and computed tomography (CT) scanning. His symptoms were gradually resolved over the course of approximately one week with no exercise and careful observation. We believe that our case provides very useful information to alert clinicians and coaches regarding this rare disease that may occur in anyone including adolescent soccer players.
Topics: Adolescent; Athletes; Chest Pain; Deglutition Disorders; Humans; Male; Mediastinal Emphysema; Pressure; Soccer; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 33707986
DOI: 10.52082/jssm.2021.52 -
Critical Care Medicine Jan 2023Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to... (Observational Study)
Observational Study
OBJECTIVES
Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia.
DESIGN
Retrospective observational study.
SETTING
Population-based, single-setting, tertiary-care level COVID treatment center.
PATIENTS
Individuals hospitalized with a diagnosis of COVID-19 pneumonia and severe to critical illness were included. Those hospitalized without respiratory failure, observed for less than 24 hours, or admitted from an ICU were excluded.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
All patients underwent a complete clinical assessment and chest CT scan, and were followed up from hospitalization to discharge or death. The outcome was the number of cases of PNM, defined as the presence of free air in the mediastinal tissues diagnosed by chest CT scan, in non-ICU hospitalized patients and the subsequent risk of intubation and mortality. PNM occurred in 48 out of 331 participants. The incidence was 14.5% (95% CI, 10.9-18.8%). A CT-Scan Severity score greater than 15 was positively associated with PNM (odds ratio [OR], 4.09; p = 0.002) and was observed in 35.2% of the participants (95% CI, 26.2-44.9%). Noninvasive ventilation was also positively associated with PNM (OR, 4.46; p = 0.005), but there was no positive association with airway pressures. Fifty patients (15%) were intubated, and 88 (27%) died. Both the risk for intubation and mortality were higher in patients with PNM, with a hazard ratio of 3.72 ( p < 0.001) and 3.27 ( p < 0.001), respectively.
CONCLUSIONS
Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.
Topics: Humans; COVID-19; Mediastinal Emphysema; Incidence; Respiratory Distress Syndrome; Respiration, Artificial
PubMed: 36200776
DOI: 10.1097/CCM.0000000000005680 -
Jornal Brasileiro de Pneumologia :... Dec 2021
Topics: Dermatomyositis; Humans; Mediastinal Emphysema; Pneumorrhachis; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 34932727
DOI: 10.36416/1806-3756/e20210352 -
BMJ Case Reports Sep 2021
Topics: Dentistry; Humans; Mediastinal Emphysema; Neck; Subcutaneous Emphysema
PubMed: 34479883
DOI: 10.1136/bcr-2021-243256