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International Journal of Surgery Case... Jul 2024Tonsillectomy is known as one of the safest otorhinolaryngology surgery procedure. Rarely, it can lead to serious complications. Cervico-facial emphysema is an...
INTRODUCTION
Tonsillectomy is known as one of the safest otorhinolaryngology surgery procedure. Rarely, it can lead to serious complications. Cervico-facial emphysema is an exceptional complication of tonsillectomy. Here we reported a case of post-tonsillectomy emphysema. Our objective was to emphasize the different characteristics of this entity and draw attention to the risk of potentially fatal respiratory complications.
PRESENTATION OF CASE
A 46-year-old healthy woman had a tonsillectomy because of recurrent tonsillitis. Four hours after extubation, she presented a subcutaneous emphysema under the left mandibular angle, slightly extended to the left cheek and left laterocervical region. An immediate cervicofacial CT scan showed a dissecting cervical emphysema of the left hemiface of moderate abundance that extended to the pre-vascular space of the superior mediastinum. The decision was to keep the patient hospitalized, to avoid forced glottic closure and to put her on prophylactic antibiotics. The further course was uneventful with respiratory state stability and emphysema's disappearance.
CLINICAL DISCUSSION
Cervicofacial emphysema is a very rare but life-threatening tonsillectomy complication that may cause acute respiratory failure. Emphysema's main clinical characteristics are a non-tender cervicofacial swelling and crepitus. Post-tonsillectomy emphysema treatment is usually conservative. In cases of respiratory failure, it is necessary to secure the airway by intubation or tracheostomy. An important mediastinal expansion of the emphysema requires a thoracotomy.
CONCLUSION
Cervicofacial emphysema is an unpredictable complication of tonsillectomy. Its prevention requires per-operative vigilance from both ENT surgeons and anesthetists. Moreover, early diagnosis and management are essential to avoid its potentially fatal consequences.
PubMed: 38889514
DOI: 10.1016/j.ijscr.2024.109866 -
Veterinary Journal (London, England :... Jun 2024Pneumomediastinum denotes the presence of gas within the mediastinum and generally occurs by leakage of air from an aerated viscus that traverses or abuts the...
Spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no clinical signs: 12 cases.
Pneumomediastinum denotes the presence of gas within the mediastinum and generally occurs by leakage of air from an aerated viscus that traverses or abuts the mediastinal plane. The Macklin effect has been described in several veterinary studies and describes gas tracking along the perivascular interstitium following alveolar rupture causing interstitial emphysema, pneumomediastinum and subsequently cervical subcutaneous emphysema. This retrospective case series describes incidental spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no related clinical signs. Twelve dogs were identified from the author's institution, of which 75 % were Sighthounds (Greyhounds, Whippets or Lurchers). Pulmonary interstitial emphysema had a predominantly paravascular distribution, although in some cases a parabronchial distribution was also identified. We conclude that incidental pulmonary interstitial emphysema, pneumomediastinum and secondary cervical subcutaneous emphysema can be incidental, presumed secondary to the Macklin effect and that Sighthound breeds may be overrepresented.
PubMed: 38849024
DOI: 10.1016/j.tvjl.2024.106158 -
World Journal of Clinical Cases May 2024In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery...
In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery related. The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging. The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic. Oesophageal perforation (Boerhaave syndrome) is associated with Mackler's triad in upto 50% of patients (severe retrosternal chest pain, pneumomediastinum, mediastinitis). Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.
PubMed: 38817226
DOI: 10.12998/wjcc.v12.i15.2479 -
Journal of Medical Case Reports May 2024Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity...
BACKGROUND
Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations.
CASE PRESENTATION
We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia.
CONCLUSION
Anesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.
Topics: Humans; Male; Mediastinal Emphysema; Aged; Analgesia, Epidural; Pneumorrhachis; Arthroplasty, Replacement, Hip; Hemodynamics; Tomography, X-Ray Computed; Anesthesia, Spinal
PubMed: 38807243
DOI: 10.1186/s13256-024-04588-y -
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 -
PloS One 2024With recent advances in magnetic resonance imaging (MRI) technology, the practical role of lung MRI is expanding despite the inherent challenges of the thorax. The...
BACKGROUND
With recent advances in magnetic resonance imaging (MRI) technology, the practical role of lung MRI is expanding despite the inherent challenges of the thorax. The purpose of our study was to evaluate the current status of the concurrent dephasing and excitation (CODE) ultrashort echo-time sequence and the T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence in the evaluation of thoracic disease by comparing it with the gold standard computed tomography (CT).
METHODS
Twenty-four patients with lung cancer and mediastinal masses underwent both CT and MRI including T1-weighted VIBE and CODE. For CODE images, data were acquired in free breathing and end-expiratory images were reconstructed using retrospective respiratory gating. All images were evaluated through qualitative and quantitative approaches regarding various anatomical structures and lesions (nodule, mediastinal mass, emphysema, reticulation, honeycombing, bronchiectasis, pleural plaque and lymphadenopathy) inside the thorax in terms of diagnostic performance in making specific decisions.
RESULTS
Depiction of the lung parenchyma, mediastinal and pleural lesion was not significant different among the three modalities (p > 0.05). Intra-tumoral and peritumoral features of lung nodules were not significant different in the CT, VIBE or CODE images (p > 0.05). However, VIBE and CODE had significantly lower image quality and poorer depiction of airway, great vessels, and emphysema compared to CT (p < 0.05). Image quality of central airways and depiction of bronchi were significantly better in CODE than in VIBE (p < 0.001 and p = 0.005). In contrast, the depiction of the vasculature was better for VIBE than CODE images (p = 0.003). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significant greater in VIBE than CODE except for SNRlung and SNRnodule (p < 0.05).
CONCLUSIONS
Our study showed the potential of CODE and VIBE sequences in the evaluation of localized thoracic abnormalities including solid pulmonary nodules.
Topics: Humans; Female; Male; Middle Aged; Lung Neoplasms; Aged; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Imaging, Three-Dimensional; Adult; Lung; Retrospective Studies; Breath Holding
PubMed: 38722966
DOI: 10.1371/journal.pone.0296696 -
Annals of Cardiac Anaesthesia Jan 2024Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old....
Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients' vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.
Topics: Humans; Female; Middle Aged; Intubation, Intratracheal; Trachea; Conservative Treatment; Lacerations; Tomography, X-Ray Computed; Mediastinal Emphysema; Subcutaneous Emphysema; Postoperative Complications; Anti-Bacterial Agents
PubMed: 38722131
DOI: 10.4103/aca.aca_106_23 -
AJP Reports Apr 2024Giant pulmonary cyst in extremely low birth weight (ELBW) infants has been described as one of severe pulmonary diseases. Any definitive therapy for refractory cases,...
Giant pulmonary cyst in extremely low birth weight (ELBW) infants has been described as one of severe pulmonary diseases. Any definitive therapy for refractory cases, where conservative methods of treatments are not effective, has not been established as a standard. Herein, we report an ELBW infant with a giant pulmonary cyst cured by percutaneous drainage without any adverse events. A female infant was born with a birth weight of 327 g. Surfactant was administered on days 1 and 2 of life to treat respiratory distress syndrome. Tracheal intubation was performed and synchronized intermittent mandatory ventilation was promptly initiated following birth. On the course, right giant pulmonary cyst developed on day 9 after birth. Although we started conservative therapy, including right lateral decubitus positioning, high-frequency oscillatory ventilation, and systemic corticosteroid administration, the diameter of the cyst had reached 34 mm, and mediastinal displacement was observed on day 28 after birth when she weighed 393 g. She recovered by percutaneous drainage followed by suction with a pressure of -10 cm H O under mild sedation for 3 days. We believe that percutaneous drainage can be one of the available options for unilateral pulmonary interstitial emphysema.
PubMed: 38707264
DOI: 10.1055/s-0044-1786713 -
IDCases 2024Air leak syndrome, including pneumomediastinum (PM), pneumopericardium, pneumothorax, or subcutaneous emphysema, is primarily caused by chest trauma, cardiothoracic...
Air leak syndrome, including pneumomediastinum (PM), pneumopericardium, pneumothorax, or subcutaneous emphysema, is primarily caused by chest trauma, cardiothoracic surgery, esophageal perforation, and mechanical ventilation. Secondary pneumomediastinum (SP) is a rare complication, with a much lower incidence reported in patients with coronavirus disease 2019 (COVID-19). Our patient was a 44-year-old nonsmoker male with a previous history of obesity (Body Mass Index [BMI] 35 kg/m), hyperthyroidism, hypokinetic cardiopathy and atrial fibrillation in treatment with flecainide, who presented to the emergency department with 6 days of fever, cough, dyspnea, and respiratory distress. The COVID-19 diagnosis was confirmed based on a polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After initiation of mechanical ventilation, a chest computed tomography (CT) on the first day revealed bilateral multifocal ground-glass opacities, consolidation and an extensive SP and pneumoperitoneum. Our therapeutic strategy was initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as a bridge to recovery after positioning 2 drains (mediastinal and pleural), for both oxygenation and carbon dioxide clearance, to allow protective and ultra-protective ventilation to limit ventilator-induced lung injury (VILI) and the intensity of mechanical power for lung recovery. After another chest CT scan which showed a clear reduction of the PM, 2 pronation and neuromuscular relaxation cycles were also required, with improvement of gas exchange and respiratory mechanics. On the 15th day, lung function recovered and the patient was then weaned from VV-ECMO, and ultimately made a good recovery and was discharged. In conclusion, SP may be a reflection of extensive alveolar damage and should be considered as a potential predictive factor for adverse outcome in critically ill SARS-CoV2 patients.
PubMed: 38681081
DOI: 10.1016/j.idcr.2024.e01956 -
Journal of Medical Case Reports Apr 2024Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and...
BACKGROUND
Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.
CASE PRESENTATION
A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.
CONCLUSIONS
This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.
Topics: Humans; Female; Aged; Retropneumoperitoneum; Mediastinal Emphysema; Pneumoperitoneum; Diabetes Mellitus, Type 2; Peritonitis; Diverticulitis; Intestinal Perforation
PubMed: 38627832
DOI: 10.1186/s13256-024-04488-1