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Clinical and Experimental Rheumatology Feb 2024To investigate the clinical characteristics of subcutaneous emphysema (SE) and mediastinal emphysema (ME) occurring in patients with anti-melanoma...
The clinical characteristics of subcutaneous and mediastinal emphysema in anti-melanoma differentiation-associated 5 positive dermatomyositis associated with interstitial lung disease.
OBJECTIVES
To investigate the clinical characteristics of subcutaneous emphysema (SE) and mediastinal emphysema (ME) occurring in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated with interstitial lung disease (anti-MDA5-positive DM-ILD).
METHODS
In this retrospective study, a total of 117 anti-MDA5-positive DM-ILD patients were admitted to our hospital. All patients underwent an assessment of autoantibodies, serum ferritin levels, and lung high-resolution CT scans.
RESULTS
In patients with anti-MDA5-positive DM-ILD, the incidence of SE/ME was found to be 11.1%, which was significantly higher compared to patients with anti-synthetase syndrome (p<0.01). The mortality rate among anti-MDA5-positive DM-ILD patients with SE/ME was significantly higher than those without SE/ME (p=0.0022). There was no statistically significant difference in the occurrence of SE/ME between patients with positive anti-Ro-52 antibodies and those with negative anti-Ro-52 antibodies (p=0.18). Patients with higher serum ferritin levels (1000 ng/ml ≤serum ferritin ≤1500 ng/ml) had a higher likelihood of developing SE/ME compared to patients with lower serum ferritin levels (serum ferritin <500 ng/ml) (p<0.01). Among 13 anti-MDA5-positive DM-ILD patients with SE/ME, six (46.2%) developed SE/ME within 1 month of being diagnosed and 53.8% of patients underwent positive pressure ventilation prior to the onset of SE/ME.
CONCLUSIONS
We found that SE/ME is not uncommon in anti-MDA5-positive DM-ILD and is an important factor associated with poor patient prognosis. The occurrence of SE/ME is correlated with high levels of serum ferritin and is not related to anti-Ro-52 antibodies. Rheumatologists should pay close attention to SE/ME caused by positive pressure ventilation in anti-MDA5-positive DM-ILD patients.
Topics: Humans; Prognosis; Dermatomyositis; Retrospective Studies; Mediastinal Emphysema; Interferon-Induced Helicase, IFIH1; Lung Diseases, Interstitial; Autoantibodies; Ferritins
PubMed: 38147317
DOI: 10.55563/clinexprheumatol/84kd56 -
The American Journal of Case Reports Oct 2023BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include...
BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman's sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman's syndrome). CASE REPORT This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry's spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman's syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. CONCLUSIONS This report presents a rare association between protracted labor and Hamman's syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated.
Topics: Pregnancy; Female; Humans; Adult; Mediastinal Emphysema; Subcutaneous Emphysema; Thorax; Chest Pain; Dyspnea; Syndrome
PubMed: 37865817
DOI: 10.12659/AJCR.940989 -
Journal of Intensive Care Medicine Nov 2023The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)... (Observational Study)
Observational Study
INTRODUCTION
The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated.
METHODS
This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied.
RESULTS
A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; < .001), while it was 10.5% (131/1250) among patients without PM and PTX.
CONCLUSIONS
In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
Topics: Humans; SARS-CoV-2; COVID-19; Respiratory Care Units; Mediastinal Emphysema; Pneumothorax; Pneumonia; Oxygen Inhalation Therapy; Respiratory Insufficiency; Noninvasive Ventilation
PubMed: 37306158
DOI: 10.1177/08850666231180165 -
Heliyon Jul 2023The terms "free air or gas located within the mediastinum and subcutaneous tissue that are not associated with any obvious causes, such as chest trauma," are used to...
The terms "free air or gas located within the mediastinum and subcutaneous tissue that are not associated with any obvious causes, such as chest trauma," are used to characterise spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE). SPM has been linked to a variety of illnesses and causes, including bronchial asthma, diabetic ketoacidosis, strenuous exercise, strenuous coughing, medication intake, and other actions involving the Valsalva maneuver. We describe a case of spontaneous cervical, retropharyngeal, and mediastinal emphysema in a young female who was previously healthy. She was brought into the ward for observation, vital sign monitoring, analgesics, and prophylactic antibiotics. She started taking analgesics, preventative antibiotics, and 100% oxygen throughout that period to help with absorption. The neck pain gradually subsided, and there were no bouts of oxygen desaturation or abnormal vital signs. After subsequently getting better, the patient went home. The patient was examined in an outpatient clinic two weeks after being discharged and shown no signs of illness. To sum up, subcutaneous emphysema and pneumomediastinum are uncommon presentations seen in the emergency room, but they are typically self-limiting.
PubMed: 37519660
DOI: 10.1016/j.heliyon.2023.e18326 -
BMC Pediatrics Aug 2023Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better... (Review)
Review
Mycobacterium abscessus pulmonary disease presenting with spontaneous pneumomediastinum and subcutaneous emphysema in childhood acute lymphoblastic leukemia: a case report and literature review.
INTRODUCTION
Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better understanding of this pathogen in children is essential.
CASE PRESENTATION
We report the case of a 49-month-old female child without previous underlying pulmonary diseases but with acute lymphoblastic leukemia (ALL). The patient was complicated with pneumonia during chemotherapy, which was primarily characterized by spontaneous pneumomediastinum and subcutaneous emphysema on chest computed tomography (CT). M. abscessus sequences were detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. With mechanical ventilation, closed thoracic drainage, and anti-infective therapy for 6 months, the patient's infection was controlled. The patient completed 2.5 years of treatment for ALL, and the drugs were discontinued. The patient currently remains in complete hematologic remission.
DISCUSSION
We reviewed the literature on 33 children with M. abscessus pulmonary disease. These children mostly had underlying immunodeficiency. Chest CT most often showed nodular shadows, consolidation, and bronchiectasis. Spontaneous pneumomediastinum and subcutaneous emphysema were not reported as major manifestations.
CONCLUSION
Spontaneous pneumomediastinum and subcutaneous emphysema were our patient's main characteristics on chest CT, and this study enriches the knowledge regarding possible imaging changes in M. abscessus pulmonary disease in children. This case report reflects good clinical experience in maintaining the balance between chemotherapy and anti-infective therapy in childhood ALL.
Topics: Adult; Child; Female; Humans; Child, Preschool; Mycobacterium abscessus; Mediastinal Emphysema; Subcutaneous Emphysema; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lung Diseases
PubMed: 37641081
DOI: 10.1186/s12887-023-04199-4 -
The American Surgeon Nov 2023Synthetic cannabinoids are a recreational drug that can cause toxicity with significant side effects.
BACKGROUND
Synthetic cannabinoids are a recreational drug that can cause toxicity with significant side effects.
CASE
We report a 21-year-old incarcerated male with a delayed presentation of pneumothorax, pneumomediastinum, and pneumoperitoneum following synthetic cannabinoid use with altered mental status.
DISCUSSION
This case not only highlights the need to consider pneumothorax when evaluating synthetic cannabinoid toxicity but it also emphasizes a vulnerable population (incarcerated individuals at risk for trauma, substance use disorders, and mental illness) who are at risk for delayed medical care and poor follow-up.
Topics: Humans; Male; Young Adult; Cannabinoids; Mediastinal Emphysema; Pneumoperitoneum; Pneumothorax; Prisoners; Subcutaneous Emphysema
PubMed: 36426894
DOI: 10.1177/00031348221142589 -
Pediatric Pulmonology May 2024Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. We present the case of a...
Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. We present the case of a newborn who initiated respiratory distress from the first minutes of life, presenting with hypoventilation and rightward displacement of the cardiac impulse, requiring oxygen therapy and intubation. The first radiograph shows a left pulmonary emphysema. The computerized axial tomography revealed a large mediastinal mass causing an obstructive syndrome of the left bronchus. The mass was successfully excised, resulting in a favorable clinical evolution. Although the presentation of our case is exceptional, it is worth noting that while most bronchogenic cysts are asymptomatic, they can occur in childhood, even from birth, as in our case.
PubMed: 38742252
DOI: 10.1002/ppul.27048 -
BMJ Case Reports Oct 2023A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and...
A boy in his late adolescence, with no history of airway disease or medication use, presented with acute history of non-exertional chest pain increased on coughing and deep inspiration accompanied by dysphonia and odynophagia in the last 1 day. He had a notable history of viral fever with non-productive cough 2 weeks prior, which resolved spontaneously. Examination revealed stable haemodynamic parameters. Palpable non-tender crepitus was felt in left anterior chest wall, axilla and both sides of the neck. Auscultation revealed Hamman's sign. ECG showed high voltage complexes and 2-dimensional echocardiogram (2D ECHO) showed normal biventricular function. CXR was evident of subcutaneous emphysema, pneumopericardium and Naclerio's sign clinching the diagnosis of pneumomediastinum. CT findings were consistent with a diagnosis of Hamman's syndrome. Patient was admitted for observation and treated with high-flow oxygen. He improved symptomatically and was discharged on the fourth day of admission.
Topics: Male; Adolescent; Humans; Auscultation; Mediastinal Emphysema; Dyspnea; Pneumopericardium; Diagnosis, Differential; Syndrome; Subcutaneous Emphysema
PubMed: 37798040
DOI: 10.1136/bcr-2022-253248 -
Journal of Thoracic Disease Dec 2023Transbronchial lung cryobiopsy (TBLC) is a novel technology in which a cryoprobe is used to obtain large tissue samples from the lungs of patients with interstitial lung...
BACKGROUND
Transbronchial lung cryobiopsy (TBLC) is a novel technology in which a cryoprobe is used to obtain large tissue samples from the lungs of patients with interstitial lung diseases (ILDs) and peripheral pulmonary lesions (PPLs). We aimed to determine the efficacy and safety of TBLC in the diagnosis of peripheral lung diseases in the Endoscopy Center of Shanghai Pulmonary Hospital. Further, the application value of radial endobronchial ultrasound (R-EBUS) used to determine the optimal area for cryobiopsy was evaluated in this study.
METHODS
In this retrospective study, the data of patients with unclarified ILDs or PPLs who underwent TBLC guided by R-EBUS between April 2020 and December 2021 at Shanghai Pulmonary Hospital in China were analyzed.
RESULTS
A total of 137 patients [72 men, 65 women; median age, 52 years (range, 24-76 years)] were enrolled in the study. Out of the 137 patients included in the study, 123 (89.8%) were diagnosed after multidisciplinary discussions (MDDs), including 105 (85.4%) with ILD, 10 (8.1%) with tuberculosis, and 8 (6.5%) with a malignant tumor. Sixty-five (47.4%) patients had a definitive pathologic diagnosis through TBLC, including 54 (83.1%) with ILD, 5 (7.7%) with tuberculosis and 6 (9.2%) with malignant tumors. The overall pathological diagnosis rate was 47.4%. In addition to clarifying the blood supply situation of the candidate target, R-EBUS detected lesions in 44 (32.1%) patients. Mild and moderate bleeding occurred in 75.2% and 24.8% of patients, respectively. No cases of severe bleeding were observed. Pneumothorax occurred in 6 (4.4%) patients, of which 2 recovered without additional treatment, and 4 (66.7%) needed closed thoracic drainage. Hydropneumothorax and mediastinal emphysema occurred in one patient each. No patients died due to TBLC.
CONCLUSIONS
R-EBUS-guided TBLC is safe and effective for the diagnosis of lung diseases, including ILDs and other PPLs. R-EBUS can guide cryobiopsy and avoid the potential risk of severe bleeding as well as radiation exposure. The pathological diagnosis rate of ILDs is relatively low, and MDD plays an important role in the diagnosis of ILDs.
PubMed: 38249930
DOI: 10.21037/jtd-23-1005 -
Journal of Comparative Pathology May 2024Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial...
Air leak syndrome (ALS) is described in human medicine as a constellation of clinical disorders including pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The pathogenesis of ALS depends on the anatomy of the mediastinum and its associations with thoracic, abdominal and cervical connective tissues, as well as a physical phenomenon referred to as the Macklin effect. Various animal species develop diverse combinations of these lesions, although ALS has not been recognized in animals. However, this term aids pathologists in addressing this disease compilation. The aim of this retrospective study is to illustrate examples of ALS in animals by arbitrarily selecting 13 cases in dogs, cats, pinnipeds, sea otters and harbour porpoises. ALS can be classified into three groups based on aetiology: iatrogenic, secondary or spontaneous. Iatrogenic ALS was diagnosed in two cats with tracheal laceration following endotracheal intubation. Secondary ALS was identified in two dogs, one with acute respiratory distress syndrome and the other due to grass awn migration. Secondary ALS in pinnipeds was diagnosed following severe pulmonary parasitism, uraemic pneumonia and oesophageal perforation. The other marine mammals developed ALS following trauma. Spontaneous ALS was also diagnosed in one cat and one dog without any apparent predisposing causes.
Topics: Animals; Cats; Pneumothorax; Dogs; Mediastinal Emphysema; Retrospective Studies; Cat Diseases; Dog Diseases; Female; Male; Subcutaneous Emphysema; Pneumoperitoneum
PubMed: 38776614
DOI: 10.1016/j.jcpa.2024.04.005