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Pediatric Pulmonology Nov 2023Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after...
BACKGROUND AND AIMS
Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome.
METHODS
We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome.
RESULTS
In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak.
CONCLUSIONS
Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.
Topics: Adolescent; Young Adult; Humans; Retrospective Studies; Pneumothorax; Graft vs Host Disease; Pleurodesis; Respiratory Insufficiency
PubMed: 37641438
DOI: 10.1002/ppul.26645 -
The Journal of Emergency Medicine Feb 2024
Topics: Humans; Pneumopericardium; Tomography, X-Ray Computed; Peptic Ulcer
PubMed: 38242752
DOI: 10.1016/j.jemermed.2023.08.015 -
Cureus Aug 2023Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal,...
Spontaneous Subcutaneous Emphysema in a Teenage Male Extending As Pneumomediastinum, Pneumothorax, Pneumopericardium, and Epidural Pneumatosis: A Rare Combination of Anatomical Locations.
Subcutaneous emphysema (SE) and pneumomediastinum can be spontaneous or traumatic in origin. Spontaneous SE involving cervical, parapharyngeal, mediastinal, pericardial, and pleural space together is rare, while epidural pneumatosis is an even rarer entity. We report a previously healthy teenage male with sudden onset chest pain whose plain radiographs and high-resolution computed tomography (HRCT) showed extensive spread of air in the mediastinum, pericardial space, pleural space, and epidural space. He was hemodynamically stable and had a spontaneous recovery after one week. Follow-up radiological imaging showed complete radiological resolution of gas lucencies. It is quite important for clinicians to be aware of this condition, common and rare routes of extension, and possible complications. Clinical suspicion is vital to plan appropriate investigations especially radiological modalities such as chest X-ray and HRCT. This will help in evaluating the severity of the condition, exclude possible etiologies, and look for potential complications so that proper management and follow-up can be planned.
PubMed: 37711916
DOI: 10.7759/cureus.43462 -
Medicine Aug 2023Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use...
Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory exchange technique during tracheostomy: A case report.
RATIONALE
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management.
PATIENT CONCERNS
A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%.
DIAGNOSIS
Endotracheal tube was directed toward the tracheal wall, causing airway obstruction.
INTERVENTIONS
THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation.
OUTCOMES
The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9.
LESSONS
THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.
Topics: Female; Humans; Middle Aged; Tracheostomy; Tracheal Stenosis; Insufflation; Administration, Intranasal; Apnea; Airway Obstruction
PubMed: 37543766
DOI: 10.1097/MD.0000000000034567 -
ACG Case Reports Journal Mar 2024A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric...
A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric fullness after eating a bony fish. A diagnosis of gastroesophageal reflux disease was made. After a week of progressive worsening of her symptoms, she was referred to the specialist hospital. There, computed tomography imaging strongly suggested that a likely fishbone had penetrated the esophagus into the mediastinal structures; it seemed to have produced a pneumopericardium. Other tests suggested diffuse changes in ventricular repolarization, pericardial thickening, and diastolic restriction. Exploratory thoracotomy confirmed esophageal-pericardial perforation by the fishbone and purulent pericarditis. Despite appropriate surgical repair, the patient died on fifth postoperative day from an asystolic cardiac arrest that was refractory to repeated attempts to resuscitate her.
PubMed: 38445259
DOI: 10.14309/crj.0000000000001291 -
Diving and Hyperbaric Medicine Dec 2023We report the case of a 23-year-old male novice diver who sustained cerebral arterial gas embolism (CAGE) during his open water certification training whilst practising...
We report the case of a 23-year-old male novice diver who sustained cerebral arterial gas embolism (CAGE) during his open water certification training whilst practising a free ascent as part of the course. He developed immediate but transient neurological symptoms that had resolved on arrival to hospital. Radiological imaging of his chest showed small bilateral pneumothoraces, pneumopericardium and pneumomediastinum. In view of this he was treated with high flow normobaric oxygen rather than recompression, because of the risk of development of tension pneumothorax upon chamber decompression. There was no relapse of his neurological symptoms with this regimen. The utility and safety of free ascent training for recreational divers is discussed, as is whether a pneumothorax should be vented prior to recompression, as well as return to diving following pulmonary barotrauma.
Topics: Male; Humans; Young Adult; Adult; Embolism, Air; Swimming; Barotrauma; Diving; Oxygen; Pneumothorax; Decompression Sickness
PubMed: 38091595
DOI: 10.28920/dhm53.4.345-350 -
Cureus Dec 2023Intubation and mechanical ventilation are common therapeutic interventions in intensive care unit settings. Barotrauma is a known complication of using positive...
Intubation and mechanical ventilation are common therapeutic interventions in intensive care unit settings. Barotrauma is a known complication of using positive pressures in a tissue defined by extra alveolar air in locations where it is not generally found in patients receiving mechanical ventilation. Several clinical manifestations of barotrauma include pneumothorax, subcutaneous emphysema, pneumoperitoneum, pneumomediastinum or pneumopericardium, air embolization, and hyperinflated left lower lobe. However, papilledema is an unreported and uncommon complication we observed in one of our patients, making it a unique presentation. We present the case of a young male patient intubated for asthma exacerbation requiring mechanical ventilation with subsequent development of papilledema. Our case report highlights the importance of knowing this rare complication of barotrauma as early commencement of lung-protective strategies will help prevent it.
PubMed: 38186471
DOI: 10.7759/cureus.50044 -
European Heart Journal. Cardiovascular... Jun 2024
PubMed: 38905149
DOI: 10.1093/ehjci/jeae150 -
The American Journal of Case Reports Nov 2023BACKGROUND Influenza infection can trigger an asthma exacerbation, which can lead to spontaneous pneumomediastinum. This is a rare condition that typically occurs after...
BACKGROUND Influenza infection can trigger an asthma exacerbation, which can lead to spontaneous pneumomediastinum. This is a rare condition that typically occurs after a sudden increase in intra-alveolar pressure. Pneumomediastinum is usually a benign condition that can be treated with supportive care, and it can be accompanied by subcutaneous emphysema. However, it can progress to retropharyngeal emphysema, as reported in this case. This report is of a 27-year-old patient with past medical history of well-controlled asthma presenting for acute exacerbation of asthma secondary to influenza A infection who developed pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. To the best of our knowledge, there is only one case in literature that has reported a similar presentation secondary to influenza A infection. CASE REPORT We report a 27-year-old woman with well-controlled asthma who presented with chest pain, shortness of breath, throat pressure, dry cough, and expiratory wheezing as an acute exacerbation of asthma secondary to influenza A infection. On chest imaging, she was found to have spontaneous pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. Her symptoms were resolved with supportive measures and control of asthma symptoms. CONCLUSIONS This case highlights these atypical complications of asthma exacerbations. Although these complications are typically benign and can resolve with supportive measures, severe cases can lead to acute airway compromise, pneumothorax, tension pneumomediastinum, or tension pneumopericardium. This case also shows how important it is to consider chest radiographs in any young patient with an asthma exacerbation who has symptoms or signs suggestive of extra-alveolar air.
Topics: Female; Humans; Adult; Mediastinal Emphysema; Influenza, Human; Asthma; Subcutaneous Emphysema; Dyspnea; Pulmonary Emphysema
PubMed: 37997300
DOI: 10.12659/AJCR.941733 -
JPMA. the Journal of the Pakistan... Mar 2024A 5 year old boy with acute ly mphoblastic leukaemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general...
A 5 year old boy with acute ly mphoblastic leukaemia on chemotherapy presented with chest pain and vomiting for two days after an elective procedure under general anaesthesia. H is ches t x-ray was remarkabl e for a promin ent halo sign, an air gap surrounding the he art indicat ing a large pneumope ricardium. Alth ough the pneu mo pericardium could not be appre ciated on an echocardiogram, the child developed clinical sig ns of cardiac t amponade. Attem pts to evacu ate the pneumopericardium were unsuccessful leading to death.
Topics: Male; Child; Humans; Child, Preschool; Pneumopericardium; X-Rays; Radiography; Pericardium; Chest Pain
PubMed: 38591303
DOI: 10.47391/JPMA.9393