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Radiology Case Reports May 2022Spontaneous pneumomediastinum is a rare condition that mostly affects young men and generally follows a benign and self-limiting course. In contrast to secondary...
Spontaneous pneumomediastinum is a rare condition that mostly affects young men and generally follows a benign and self-limiting course. In contrast to secondary pneumomediastinum, which is caused by trauma, iatrogenic intervention or esophageal perforation, spontaneous pneumomediastinum is triggered by violent coughing, excessive vomiting, strenuous physical exercise or Valsalva maneuver. It results from an abrupt increase in intrathoracic pressure leading to alveolar rupture and air leak along the tracheobronchial tree into the mediastinal cavity. Extended spontaneous pneumomediastinum goes along with subcutaneous emphysema of the chest, neck or head. We present a case of a healthy young man who developed pneumomediastinum and profound subcutaneous emphysema with onset during masturbation. Since there is no literature on spontaneous pneumomediastinum associated with autoerotic experiences, we consider our case an unusual presentation of this entity.
PubMed: 35345564
DOI: 10.1016/j.radcr.2022.02.080 -
Clinical Medicine (London, England) Jul 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; Pneumothorax; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 36220238
DOI: 10.7861/clinmed.22-4-s51 -
Translational Pediatrics Oct 2022Subcutaneous emphysema and mediastinal emphysema and/or pneumothorax after mechanical ventilation through endotracheal intubation is not uncommon. However, cases of...
BACKGROUND
Subcutaneous emphysema and mediastinal emphysema and/or pneumothorax after mechanical ventilation through endotracheal intubation is not uncommon. However, cases of delayed mediastinal emphysema and subcutaneous emphysema after extubation and their further development into pneumothorax have rarely been reported, especially in children. Given this, we provide such a case for the reference of clinicians.
CASE DESCRIPTION
We report a case of a 2-year-old girl with no abnormalities at the preoperative examination, who developed subcutaneous emphysema and mediastinal emphysema 4 hours after recovery from general anesthesia due to ophthalmic arterial infusion chemotherapy for retinoblastoma, and bilateral pneumothorax 12 hours later. The patient recovered and was discharged following aggressive treatment of subcutaneous exhaust and thoracic closed drainage. Due to fiberoptic bronchoscopy was refused by the guardian to determine the cause, we hypothesized tracheal intubation injury occurs, air enter the trachea or bronchial mucosa, extend up to the neck, head and face along the blood vessels, larynx and deep cervical fascia spaces, causing subcutaneous emphysema, and then gradually spread to the mediastinum, resulting in mediastinal emphysema and pneumothorax. However, the etiology and preventive measures warrant further study.
CONCLUSIONS
Strengthen the etiological study of subcutaneous and/or mediastinal emphysema and pneumothorax due to endotracheal intubation, perioperative observation and postoperative follow-up are important measures for the effective prevention, early diagnosis, and timely treatment of subcutaneous and/or mediastinal emphysema and pneumothorax, and are also conducive to ensuring the safety of patients.
PubMed: 36345457
DOI: 10.21037/tp-22-453 -
Radiologia 2021To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the... (Review)
Review
OBJECTIVE
To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.
CONCLUSION
In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
Topics: Humans; Mediastinal Emphysema; Rupture; Subcutaneous Emphysema; Thorax; Trachea
PubMed: 34246426
DOI: 10.1016/j.rxeng.2021.02.005 -
The Indian Journal of Medical Research 2022
Topics: Humans; Mediastinal Emphysema; Tuberculosis
PubMed: 36926793
DOI: 10.4103/ijmr.IJMR_5_20 -
Clinical Medicine (London, England) Jul 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; Wounds, Nonpenetrating
PubMed: 36220216
DOI: 10.7861/clinmed.22-4-s56 -
Medicine Jan 2023Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical...
Current evidence suggests that intrathoracic gas effusions (pneumomediastinum and pneumothorax) may be observed among COVID-19 patients even without mechanical ventilation. Here, we report 9 patients who developed spontaneous intrathoracic gas effusions in the absence of mechanical ventilation. The incidence of spontaneous intrathoracic gas effusions is low at 0.5% in hospitalized COVID-19 patients in the absence of respiratory support. Two patients (22.2%) had spontaneous pneumomediastinum, with or without subcutaneous emphysema. Three patients (33.3%) had pneumomediastinum associated with pneumothorax, with or without subcutaneous emphysema, and 4 patients (44.4%) had spontaneous pneumothorax. The Pneumothorax was unilateral in 66.6% of cases (6/9) but without location preference. Five of our patients were smokers, of whom 80% had isolated spontaneous pneumothorax. Other comorbidities included pulmonary tuberculosis in a single patient, diabetes in 2 patients and arterial hypertension in 1 patient. None of the patients had respiratory comorbidities. All of our patients were male. The average duration of hospital stay was 10 days (±6.63). All patients required oxygen therapy. Three patients (33.3%) with spontaneous pneumothorax required chest drainage. The evolution was favorable in 6 patients (66.7%) and worse in 3 cases (33.3%). The respiratory manifestations of COVID-19 have been stereotyped. Intrathoracic effusions may also be signs of COVID-19 with varying prognoses, or even the only presentation of the disease. This should be considered in clinical practice, and doctors are encouraged to request a SARS-CoV-2 test in this situation. Further investigations with a larger sample size are needed to identify the prognostic factors in COVID-19 patients with gas effusions.
Topics: Humans; Male; Female; COVID-19; SARS-CoV-2; Pneumothorax; Mediastinal Emphysema; Subcutaneous Emphysema
PubMed: 36607883
DOI: 10.1097/MD.0000000000032605 -
Critical Care Explorations Sep 2020Management of severe coronavirus disease 2019 relies on advanced respiratory support modalities including invasive mechanical ventilation, continuous positive airway...
IMPORTANCE
Management of severe coronavirus disease 2019 relies on advanced respiratory support modalities including invasive mechanical ventilation, continuous positive airway pressure, and noninvasive ventilation, all of which are associated with the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax (herein collectively termed barotrauma).
OBJECTIVES
To assess the occurrence rate of barotrauma in severe coronavirus disease 2019 and to explore possible associated factors.
DESIGN SETTING AND PARTICIPANTS
A retrospective, single-center cohort study with nested case series, conducted at University Hospital Lewisham: a 450-bed general hospital in London, United Kingdom. All patients with confirmed coronavirus disease 2019 admitted to the critical care department from March 12, to April 12, 2020, were included.
MAIN OUTCOMES AND MEASURES
Patients were retrospectively screened for radiological evidence of barotrauma. Admission characteristics, modalities of respiratory support, and outcomes were compared between barotrauma and nonbarotrauma groups. Respiratory parameters in the period preceding barotrauma identification were recorded.
RESULTS
Of 83 admissions with coronavirus disease 2019, eight suffered barotrauma (occurrence rate 9.6%; 95% CI 4.3%-18.1%). Barotrauma cases had longer illness duration prior to critical care admission (10 vs 7 d; interquartile range, 8-14 and 6-10, respectively; = 0.073) and were more often treated with continuous positive airway pressure or noninvasive ventilation as the initial modality of advanced respiratory support (87.5% vs 36.0%; = 0.007). Patients managed with continuous positive airway pressure or noninvasive ventilation prior to the development of barotrauma had median minute ventilation of 16.2-19.9 and 21.3-22.7 L/min, respectively. Compared with the nonbarotrauma group, a higher proportion of patients with barotrauma had died (62.5% vs 43.2%), and a lower proportion of patients had been discharged (25.0% vs 53.3%) at 3-month follow-up.
CONCLUSIONS AND RELEVANCE
Barotrauma appears to be a common complication of severe coronavirus disease 2019. Determining whether high minute ventilation while using continuous positive airway pressure or noninvasive ventilation predisposes patients to barotrauma requires further investigation.
PubMed: 33063043
DOI: 10.1097/CCE.0000000000000210 -
Asian Cardiovascular & Thoracic Annals Feb 2022There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the...
INTRODUCTION
There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes.
METHODS
The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium).
RESULTS
A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006).
CONCLUSION
Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.
Topics: COVID-19; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; SARS-CoV-2; Treatment Outcome
PubMed: 34247490
DOI: 10.1177/02184923211031134 -
The Veterinary Quarterly Dec 2021Paraquat (1,1-dimethyl-4,4-bipyridinium dichloride) is a toxic herbicide. Accidental ingestion of paraquat in animals and humans causes respiratory failure and death.
BACKGROUND
Paraquat (1,1-dimethyl-4,4-bipyridinium dichloride) is a toxic herbicide. Accidental ingestion of paraquat in animals and humans causes respiratory failure and death.
AIM
To describe the radiographic features of confirmed paraquat intoxication in a group of dogs and determines whether any identified features can facilitate this diagnosis.
METHODS
Eleven dogs diagnosed with paraquat intoxication were selected from two institutions between November 2014 and August 2019 comprising five males (all intact) and six females (one intact and five spayed). The mean age was 3.9 ± 2.9 (SD) years and their mean weight was 11.6 ± 5.0 kg. The tentative diagnosis was confirmed through analysis of their urine samples using a colorimetric assay (paraquat concentation 0.39 μg/ml ranging from 0.19-0.65 μg/ml), and their clinical signs were reviewed. Thoracic radiographs were evaluated for the presence of pneumomediastinum, lung patterns (interstitial or alveolar) and their locations (caudodorsal, cranioventral, diffuse, or symmetrical), subcutaneous emphysema, pneumoretroperitoneum, and pneumothorax.
RESULTS
The most common clinical signs were dyspnea (11/11, 100%) and anorexia (9/11, 82%). Pneumomediastinum (10/11, 91%) and symmetrically increased lung opacity (7/11, 65%) were the most common radiographic features. Pneumothorax (3/11, 27%), pleural effusion (3/11, 27%), subcutaneous emphysema (2/11, 18%), and pneumoretroperitoneum (1/5, 20%) were the less common findings. None of the dogs survived.
CONCLUSION
Pneumomediastinum and diffuse or symmetrical interstitial or alveolar lung patterns are the most common radiographic features in dogs with paraquat intoxication.
CLINICAL RELEVANCE
In countries where this herbicide is not banned, paraquat intoxication should be considered if dogs with no history of trauma present with pneumomediastinum.
Topics: Animals; Dog Diseases; Dogs; Female; Lung Diseases, Interstitial; Male; Mediastinal Emphysema; Paraquat; Pneumothorax; Radiography; Retropneumoperitoneum; Subcutaneous Emphysema; Thorax
PubMed: 34223806
DOI: 10.1080/01652176.2021.1950945