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The Israel Medical Association Journal... May 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 35598061
DOI: No ID Found -
Clinical Imaging Oct 2022To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To...
OBJECTIVES
To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To describe the chest radiography patterns of barotrauma and understand the development in relation to mechanical ventilation and patient mortality.
METHODS
We performed a retrospective study of 363 patients with COVID-19 from March 1 to April 8, 2020. Primary outcomes were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. The secondary outcomes were length of intubation and death. In patients with pneumomediastinum and/or subcutaneous emphysema, we conducted an imaging review to determine the timeline of barotrauma development.
RESULTS
Forty three out of 363 (12%) patients developed barotrauma radiographically. The median time to development of either pneumomediastinum or subcutaneous emphysema was 2 days (IQR 1.0-4.5) after intubation and the median time to pneumothorax was 7 days (IQR 2.0-10.0). The overall incidence of pneumothorax was 28/363 (8%) with an incidence of 17/43 (40%) in the barotrauma cohort and 11/320 (3%) in those without barotrauma (p ≤ 0.001). In total, 257/363 (71%) patients died with an increase in mortality in those with barotrauma 33/43 (77%) vs. 224/320 (70%). When adjusting for covariates, barotrauma was associated with increased odds of death (OR 2.99, 95% CI 1.25-7.17).
CONCLUSION
Barotrauma is a frequent complication of mechanically ventilated COVID-19 patients. In comparison to intubated COVID-19 patients without barotrauma, there is a higher rate of pneumothorax and an increased risk of death.
Topics: Barotrauma; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Prognosis; Retrospective Studies; Subcutaneous Emphysema
PubMed: 35926316
DOI: 10.1016/j.clinimag.2022.06.014 -
Saudi Medical Journal Feb 2021To evaluate resected congenital lung and mediastinal lesions among children and their characteristics in a single tertiary hospital.
OBJECTIVES
To evaluate resected congenital lung and mediastinal lesions among children and their characteristics in a single tertiary hospital.
METHODS
A retrospective chart review analysis of all patients under 14 years of age who underwent congenital lung and mediastinal lesion resection in a single tertiary center from June 1997 to June 2018 was performed.
RESULTS
In total, 108 cases of resected lung and mediastinal lesions were performed from June 1997 to June 2018. Congenital lung and mediastinal lesions were found in 52 (48%) cases. Overall, 23 cases were males (44%) and 29 (56%) were females. The most common histopathology was congenital lobar emphysema.
CONCLUSION
This study provides a 21-year review of the clinical and histopathological features of resected congenital lung and mediastinal lesions in a single center. Congenital lung and mediastinal lesions represented 48% of all resected lesions.
Topics: Bronchopulmonary Sequestration; Child; Female; Humans; Lung; Lung Diseases; Male; Mediastinal Diseases; Pulmonary Emphysema; Retrospective Studies
PubMed: 33563741
DOI: 10.15537/smj.2021.2.25705 -
Journal of Medical Case Reports Mar 2021Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The therapeutic options also differ by the cause. This systematic review was done to provide, as far as we know, the first attempt to broadly assess the clinical feature, predisposing factors, possible management, and outcome of spontaneous primary pneumomediastinum.
METHODS
In addition to the two patients treated at our hospital, a Pub Med Search for literature on case reports of spontaneous pneumomediastinum published in English up to November 2018 was done. We extracted data on patients' demographic characteristics, symptoms, timing, diagnosis, management, and outcome of the treatment were analyzed based on the preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) RESULT: A total of 339 cases were reviewed. 71.7% of them were male. The Mean age affected was 22.4 ± 11.3 years. Chest pain, 196 (57.8%), is the most common presenting symptom, followed by dyspnea, 156 (46%), cough 95 (28%), neck swelling 92 (27.13%), cervical pain 88 (25.9%), dysphagia 39 (11.5%), odynophagia 37 (10.9%), and Dysphonia 14 (4.1%). Fifty-seven patients (16.8%) had a prior history of Asthma, 19 (5.6%) had Connective Tissue Disorders, and 12 (3.5%) had associated malignancy as an identified risk factor. In 35 (10.3%) patients, spontaneous pneumomediastinum was found incidentally. The mean number of days before the clinical resolution of spontaneous pneumomediastinum was 6.65 ± 11.8 days and the average hospital stay was 4.15 ± 1.93 days. Nineteen (5.6%) patients have died as a result of the underlying disease not related to SPM.
CONCLUSION
Spontaneous pneumomediastinum is uncommon, usually benign, a self-limited disorder that commonly occurs in a young adult without any apparent precipitating factor or disease. Spontaneous pneumomediastinum usually responds very well to conservative treatment without recurrence. However, secondary causes should be ruled out to minimize the unfavorable outcome.
Topics: Adolescent; Adult; Chest Pain; Child; Cough; Dyspnea; Female; Humans; Male; Mediastinal Emphysema; Neoplasm Recurrence, Local; Young Adult
PubMed: 33761988
DOI: 10.1186/s13256-021-02701-z -
Turkish Journal of Medical Sciences Apr 2022Sjögren's syndrome is a systemic, autoimmune disease and can affect many organs and systems. In this study, we aimed to evaluate the respiratory manifestations, and the...
BACKGROUND
Sjögren's syndrome is a systemic, autoimmune disease and can affect many organs and systems. In this study, we aimed to evaluate the respiratory manifestations, and the association between interstitial lung disease (ILD) and disease activity in primary SS (pSS) patients.
METHODS
The study design was retrospective cross-sectional, and 151 patients followed up with a diagnosis of pSS between 2004 and 2019 were included in the study. Demographic and clinical data, laboratory results, chest radiographs and thorax computed tomography (CT) results were obtained from patient files and hospital imaging system. Thorax CT was requested from all patients with respiratory complaints and abnormalities in physical examination and pulmonary function test. Disease activity was calculated with EULAR pSS disease activity index (ESSDAI) and clinical European League Against Rheumatism SS Disease Activity Index (clin-ESSDAI).
RESULTS
In our study, 97% of pSS patients were female, and the mean age was 55.9 ± 12 years, disease onset age was 45.5 ± 12.1 years, disease duration was 10.7 (1-38) years. According to CT findings of 120 patients, 35% had nodules, and 13.3% had ILD (62.5% nonspecific interstitial pneumonia, 25% lymphocytic interstitial pneumonia, 12.5% usual interstitial pneumonia). Bronchiectasis, emphysema, sequelae fibrotic changes, and pleural thickening was found in 3.3%, 5.8%, 15.8%, and 1.7% of patients, respectively. It was observed that there was a significant relationship between the presence of ILD and persistent cough, mediastinal LAP, low DLCO, high ESSDAI and clin-ESSDAI scores reflecting disease activity.
DISCUSSION
The most common pulmonary manifestation in our patients was ILD. ILD was observed more frequently in patients with moderate and severe disease activity. Some of the ILD patients were diagnosed while they were asymptomatic. Even if they are asymptomatic, it is important to follow up the patients with physical examination, spirometry, DLCO and thorax CT.
Topics: Humans; Female; Adult; Middle Aged; Aged; Male; Sjogren's Syndrome; Retrospective Studies; Cross-Sectional Studies; Lung Diseases, Interstitial; Lung
PubMed: 36422505
DOI: 10.55730/1300-0144.5513 -
The American Journal of Case Reports Jun 2023BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication...
BACKGROUND The nasogastric tube (NGT) is a common medical device, and serious complications associated with NGT insertions are rare. The most common serious complication is tracheal insertion; cervical emphysema and pneumomediastinum are rare. There are several methods for confirming the location of the NGT, but a single method of confirmation is often inadequate. Confirmation by air insufflation into the NGT is currently not recommended and is highly invasive. Here, we report a case of cervical emphysema and pneumomediastinum caused by an NGT. CASE REPORT A 94-year-old woman experienced a stroke and was hospitalized for neurosurgery. The nurse inserted an NGT and performed insufflation, but air sounds were not detected. Chest radiography did not reveal the tip of the NGT. Computed tomography (CT) revealed cervical emphysema, pneumomediastinum, an NGT bent in the esophagus, and the distal end of the NGT in the nasopharynx. Nasopharyngeal endoscopy revealed damaged nasopharyngeal mucosa and the distal end of the NGT. The patient was diagnosed with insufflated air passing through the damaged nasopharynx, which had spread to the cervical area and mediastinum. The NGT was removed, and the patient was treated with antibiotics. CT showed cervical emphysema, and the pneumomediastinum resolved after 20 days. CONCLUSIONS It is important to recognize that there are numerous serious and unexpected complications associated with NGT. Different methods should be considered and used to confirm the location of an NGT. Further studies on the confirmation methods and dissemination of such knowledge are required to reduce NGT complications.
Topics: Female; Humans; Aged, 80 and over; Mediastinal Emphysema; Emphysema; Intubation, Gastrointestinal; Radiography; Tomography, X-Ray Computed; Pulmonary Emphysema
PubMed: 37269087
DOI: 10.12659/AJCR.939836 -
Journal of Otolaryngology - Head & Neck... Aug 2020Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections. (Review)
Review
BACKGROUND
Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.
CASE PRESENTATION
We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.
CONCLUSION
As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
Topics: Aged; Dental Care; Dental Instruments; Dental Restoration, Permanent; Diagnosis, Differential; Fasciitis, Necrotizing; Humans; Male; Mediastinal Emphysema; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 32811562
DOI: 10.1186/s40463-020-00455-0 -
Cureus Oct 2023A case of a 19-year-old male with mediastinal and subcutaneous emphysema consistent with pulmonary barotrauma after diving is reported. He presented with facial...
A case of a 19-year-old male with mediastinal and subcutaneous emphysema consistent with pulmonary barotrauma after diving is reported. He presented with facial swelling, voice change, chest pain, and shortness of breath after multiple dives between 8 and 12 feet deep without underwater breathing equipment in a river. Relevant radiology, including radiographs and computed tomography (CT imaging), and a discussion of pulmonary barotrauma are presented.
PubMed: 38021658
DOI: 10.7759/cureus.47382 -
Tidsskrift For Den Norske Laegeforening... Oct 2021
Topics: Humans; Mediastinal Emphysema; Punctures
PubMed: 34641662
DOI: 10.4045/tidsskr.21.0330 -
Diagnostic and Interventional Imaging Apr 2022
Topics: Catheter Ablation; Cryosurgery; Emphysema; Humans; Kidney; Mediastinal Emphysema; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 34991992
DOI: 10.1016/j.diii.2021.11.003