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WMJ : Official Publication of the State... Dec 2023Coronavirus disease 2019 (COVID-19) can cause multisystem complications, with pulmonary involvement associated with the highest mortality. Pneumothorax (PT) and...
INTRODUCTION
Coronavirus disease 2019 (COVID-19) can cause multisystem complications, with pulmonary involvement associated with the highest mortality. Pneumothorax (PT) and pneumomediastinum (PM) are uncommon complications of COVID-19 that have been reported to occur in the absence of trauma or mechanical ventilation. This study seeks to determine the incidence of these complications in patients with COVID-19 and evaluate clinical characteristics and outcomes.
METHODS
We identified 3375 patients admitted to our health system during March 2020 through November 2020 who tested positive for SARS-CoV-2 with a polymerase chain reaction test. Patients were screened for PT or PM and were matched to COVID-19-positive patients without PT and/or PM. Data compared demographics, clinical characteristics, and laboratory values.
RESULTS
Out of a total of 3375 COVID-19 admissions, 33 patients with PT/PM (1%) were compared to 32 matched controls without PT and/or PM. The patients with PT and/or PM demonstrated a significantly higher incidence of concomitant cancer diagnosis than those without PT and/or PM (18% vs 3%, respectively; = 0.05). Those with PT and/or PM required significantly more invasive mechanical ventilation than those without PT and/or PM (79% vs 47%; < 0.01). Mortality was significantly higher among those patients with PT and/or PM than those without PT/PM (55% vs 25%; < 0.05).
DISCUSSION
A significant number of COVID-19 patients with PT and/or PM had a concomitant cancer diagnosis, required supplemental oxygen on admission, and invasive mechanical ventilation during hospitalization. Additionally, the COVID patients with PT and/or PM had significantly higher mortality compared to those without PT and/or PM. However, with all retrospective studies, there are limitations.
Topics: Humans; COVID-19; Incidence; Mediastinal Emphysema; Pneumothorax; Retrospective Studies; SARS-CoV-2; Pneumonia; Prognosis; Neoplasms
PubMed: 38180920
DOI: No ID Found -
Journal of Medical Case Reports Jan 2024Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk...
BACKGROUND
Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk factors and etiology remain unknown. Herein, we investigated the clinical characteristics of mechanically ventilated patients with COVID-19 with PTX or PM.
METHODS
We examined patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit of a tertiary-level emergency medical center in Tokyo, Japan between April 1, 2020. and October 31, 2021. We collected and analyzed the clinical characteristics of the patients who presented with either PTX or PM during mechanical ventilation.
RESULTS
During the study period, a total of 165 patients required mechanical ventilation, and 15 patients with PTX/PM during mechanical ventilation were selected. Three patients with obvious causes were excluded, and the remaining 12 patients were analyzed (7.3%). The mortality rate in these patients was as high as 50%, demonstrating the difficulty of treatment in the presence of PTX/PM. PTX/PM occurred 14.5 days after intubation. A peak pressure of > 30 cmHO was only apparent in one patient, suggesting that high positive pressure ventilation may be less involved than mentioned in the literature. In addition, the inspiratory effort was not strong in our group of patients. (P0.1 was 2.1 cm H2O [1.0-3.8]).
CONCLUSION
Various factors are associated with the development of PTX/PM in patients on mechanical ventilation for COVID-19. We did not find a strong correlation between PTM/PM and barotrauma or strong inspiratory efforts, which have been identified as potential causes in previous studies.
Topics: Humans; COVID-19; Pneumothorax; Respiration, Artificial; Mediastinal Emphysema; Positive-Pressure Respiration
PubMed: 38166996
DOI: 10.1186/s13256-023-04281-6 -
BMC Anesthesiology Jan 2024To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent...
BACKGROUND
To perform step-by-step analysis of the different factors (material, anesthesia technique, human, and location) that led to major pneumothorax during an infrequent pediatric cardiac MRI and to prevent its occurrence in the future. Anesthesia equipment used in a remote location is often different than those in operating rooms. For magnetic resonance imaging (MRI), ventilation devices and monitors must be compatible with the magnetic fields. During cardiac MRI numerous apneas are required and, visual contact with the patient is limited for clinical evaluation. Anesthesia-related barotrauma and pneumothorax are rare in children and the first symptoms can be masked.
CASE PRESENTATION
A 3-year-old boy with atrial septal defect (ASD) and suspicious partial anomalous pulmonary venous return was anesthetized and intubated to perform a follow up with MRI. Sevoflurane maintenance and ventilation were performed using a circular CO absorber device, co-axial circuit, and 500 mL pediatric silicone balloon. Apneas were facilitated by Alfentanyl boluses and hyperventilation. A few moderated desaturations occurred during the imaging sequences without hemodynamic changes. At the end of the MRI, facial subcutaneous emphysema was observed by swollen eyelids and crackling snow neck palpation. A complete left pneumothorax was diagnosed by auscultation, sonography examination, and chest radiograph. Pneumo-mediastinum, -pericardium and -peritoneum were present. A chest drain was placed, and the child was extubated and transferred to the pediatric intensive care unit (PICU). Despite the anesthesiologist's belief that PEEP was minimal, critical analysis revealed that PEEP was maintained at a high level throughout anesthesia. After the initial barotrauma, repeated exposure to high pressure led to the diffusion of air from the pleura to subcutaneous tissues and mediastinal and peritoneal cavities. Equipment check revealed a functional circular circuit; however, the plastic adjustable pressure-limiting valve (APL) closed within the last 30° rotation. The balloon was found to be more rigid and demonstrated significantly reduced compliance.
CONCLUSIONS
Anesthetists require proficiency is using equipment in non-OR locations and this equipment must be properly maintained and checked for malfunctions. Controlling the human factor risks by implementing checklists, formations, and alarms allows us to reduce errors. The number of pediatric anesthesia performed routinely appeared to be essential for limiting risks and reporting our mistakes will be a benefit for all who care about patients.
Topics: Child, Preschool; Humans; Male; Anesthesia, General; Apnea; Barotrauma; Magnetic Resonance Imaging; Pneumothorax
PubMed: 38166574
DOI: 10.1186/s12871-023-02375-8 -
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 -
Tomography (Ann Arbor, Mich.) Dec 2023Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to...
Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak.
Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.
Topics: Humans; Respiration, Artificial; Pneumothorax; Retrospective Studies; Mediastinal Emphysema; Pandemics; X-Rays; COVID-19; Barotrauma; Subcutaneous Emphysema; Hospitalization; Italy
PubMed: 38133075
DOI: 10.3390/tomography9060171 -
Journal of Thoracic Disease Nov 2023Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of...
BACKGROUND
Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of our study was to describe the cases of SA-PAF in our institution and to report the correlating clinical and radiological findings.
METHODS
We reviewed 231 chest computed tomography (CT) scans performed in our institution due to hemoptysis from January 2020 to February 2023. In patients diagnosed with SA-PAF had their electronic medical records and CT images analyzed.
RESULTS
In 231 patients, 19 (8.2%) of them had SA-PAF findings which was characterized by a peripheral nodular soft tissue opacity in the subpleural lung and traceable vascular structure in continuity with one or more peripheral pulmonary artery branches in CT. Etiology of each patient was categorized as either congenital (7, 36.8%), and acquired (12, 63.2%). The origins of SA-PAFs were 16 intercostal, two anterior mediastinal, and one costocervical artery. Eight of 19 patients did not show any associated intralobar imaging abnormalities, while bronchiectasis, cellular bronchiolitis, centrilobular emphysema, and pleura effusion were observed in 11 patients.
CONCLUSIONS
SA-PAF is a benign vascular anomaly which is frequently overlooked when evaluating hemoptysis by either clinician or radiologists but is an important factor in the differential diagnosis of patients with hemoptysis.
PubMed: 38090324
DOI: 10.21037/jtd-23-861 -
Upsala Journal of Medical Sciences 2023Nitrous oxide, commonly known as 'laughing gas', has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily...
Nitrous oxide, commonly known as 'laughing gas', has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium. This case study highlights the potential dangers of recreational abuse of nitrous oxide.
Topics: Humans; Nitrous Oxide; Pneumothorax; Mediastinal Emphysema; Pneumopericardium; Seizures
PubMed: 38084205
DOI: 10.48101/ujms.v128.10281 -
Cureus Nov 2023We present a rare case of pneumomediastinum in the setting of hyperemesis gravidarum. Pneumomediastinum is a condition characterized by the presence of air leaking into...
We present a rare case of pneumomediastinum in the setting of hyperemesis gravidarum. Pneumomediastinum is a condition characterized by the presence of air leaking into the mediastinum. Often secondary to trauma, there remains the potential for it to develop spontaneously. This is a time-sensitive diagnosis that requires vigilance for effective treatment. A 21-year-old gravida 1 para 0 female at 15 weeks of gestation with no significant past medical history presented to the emergency department complaining of four weeks of daily nausea and vomiting and two weeks of chest pain, cough, and difficulty breathing. Computed tomography angiography of the chest revealed the presence of subcutaneous air in the mediastinum, and esophageal rupture was ruled out by a gastrografin esophagram. Due to extensive pneumomediastinum and severe metabolic derangements, the patient was admitted to the intensive care unit. A gastrografin esophagram was obtained, which showed no esophageal tear.No surgical intervention was performed, and she was managed with conservative treatment. This case illustrates some of the severe complications of pregnancy. Although pneumomediastinum secondary to hyperemesis gravidarum seen in this patient is rare (the incidence of pregnancy-related pneumomediastinum has been noted to be 1:100,000), it is an important adverse complication that the clinician should keep in mind in pregnant patients with hyperemesis gravidarum. Providing education to patients during the prenatal process can help identify the signs and symptoms of this condition to prevent potentially fatal consequences.
PubMed: 38074045
DOI: 10.7759/cureus.48574 -
Journal of Medical Case Reports Dec 2023Superior vena cava syndrome is rarely attributed to chronic obstructive pulmonary disease.
BACKGROUND
Superior vena cava syndrome is rarely attributed to chronic obstructive pulmonary disease.
CASE PRESENTATION
We present the case of an 82-year-old Japanese man who experienced gradually progressive dyspnea on exertion. His physical examination revealed small vascular dilatations on his chest and upper abdominal skin characterized by blood flow from head to leg, indicating superior vena cava syndrome. Radiographic findings included lung hyperinflation with a drop-like heart on chest X-ray, and emphysematous changes on computed tomography. The superior vena cava appeared extremely narrow and slit-like, with no adjacent mass or giant bulla. Pulmonary function testing indicated a forced expiratory volume in 1 second of 0.82L (44.4% of predicted value) and a forced expiratory volume in 1 second/forced vital capacity of 31.29%. A diagnosis of chronic obstructive pulmonary disease was made. We discuss how longitudinal forces can narrow the superior vena cava, particularly when it protrudes toward the lung field due to its anatomical location in the upper mediastinum. The absence of mediastinal adipose tissue may render the superior vena cava susceptible to compression, resulting in a loss of its typical columnar structure. The protrusion of the superior vena cava toward the lung field may be a contributing factor to superior vena cava narrowing in chronic obstructive pulmonary disease.
CONCLUSION
This case represents the first reported instance of superior vena cava syndrome associated with chronic obstructive pulmonary disease, characterized by lung hyperinflation, in the absence of a giant bulla.
Topics: Male; Humans; Aged, 80 and over; Superior Vena Cava Syndrome; Vena Cava, Superior; Blister; Pulmonary Disease, Chronic Obstructive; Lung
PubMed: 38037127
DOI: 10.1186/s13256-023-04256-7 -
Cureus Oct 2023Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly...
Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population. Symptoms include sudden onset chest pain, dyspnea, neck pain, vomiting, and odynophagia. Physical examination usually reveals subcutaneous emphysema, hoarse voice, tachycardia, tachypnea, and occasionally a Hamman's sign, which is a mediastinal "crunch" sound heard on cardiac auscultation. We present a case of an 18-year-old male baritone player who presented to the ED with chest pain and odynophagia shortly after waking up one morning. The patient's chest radiograph (CXR) revealed free air in the mediastinum with subcutaneous air tracking into the soft tissues of the neck and supraclavicular region. CT of the chest with contrast esophagram confirmed the diagnosis of primary SPM. The cause of his condition was likely due to barotrauma secondary to playing the baritone in his marching band. He had no evidence of esophageal injury or infectious process which further supports the diagnosis of primary SPM. After an extensive workup, the patient was discharged from the ED with instructions on rest, analgesia, and antitussives as needed. Evaluation of chest pain patients in the ED should include a CXR, in addition to other indicated tests, to rule out this potentially debilitating condition. Fortunately, though SPM is potentially life-threatening, most cases resolve spontaneously without surgical intervention.
PubMed: 38021896
DOI: 10.7759/cureus.47289