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La Tunisie Medicale Feb 2023Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019...
INTRODUCTION
Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood.
OBSERVATIONS
we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases.
CONCLUSIONS
Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.
Topics: Humans; Female; Adult; Middle Aged; Aged; Mediastinal Emphysema; COVID-19; Pneumonia; Oxygen; Hospitalization
PubMed: 37682278
DOI: No ID Found -
The Kobe Journal of Medical Sciences Jul 2023We conducted the treatment of a highly obese patient with severe Covid-19 pneumonia who had a history of asthma. When she arrived at the hospital, she was already...
We conducted the treatment of a highly obese patient with severe Covid-19 pneumonia who had a history of asthma. When she arrived at the hospital, she was already intubated and had mediastinal emphysema and severe hypoxemia. Because the patient's condition did not improve with mechanical ventilation, we introduced extracorporeal membrane oxygenation (ECMO) immediately after admission. The patient improved with early induction of ECMO and prone positioning. In the management of patients with severe Covid-19 pneumonia, early introduction of ECMO should be considered if oxygenation does not improve with mechanical ventilation, and prone positioning can also be effective.
Topics: Female; Humans; Mediastinal Emphysema; Extracorporeal Membrane Oxygenation; COVID-19; Obesity; Hypoxia
PubMed: 37661702
DOI: No ID Found -
BMC Pediatrics Aug 2023Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better... (Review)
Review
Mycobacterium abscessus pulmonary disease presenting with spontaneous pneumomediastinum and subcutaneous emphysema in childhood acute lymphoblastic leukemia: a case report and literature review.
INTRODUCTION
Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better understanding of this pathogen in children is essential.
CASE PRESENTATION
We report the case of a 49-month-old female child without previous underlying pulmonary diseases but with acute lymphoblastic leukemia (ALL). The patient was complicated with pneumonia during chemotherapy, which was primarily characterized by spontaneous pneumomediastinum and subcutaneous emphysema on chest computed tomography (CT). M. abscessus sequences were detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. With mechanical ventilation, closed thoracic drainage, and anti-infective therapy for 6 months, the patient's infection was controlled. The patient completed 2.5 years of treatment for ALL, and the drugs were discontinued. The patient currently remains in complete hematologic remission.
DISCUSSION
We reviewed the literature on 33 children with M. abscessus pulmonary disease. These children mostly had underlying immunodeficiency. Chest CT most often showed nodular shadows, consolidation, and bronchiectasis. Spontaneous pneumomediastinum and subcutaneous emphysema were not reported as major manifestations.
CONCLUSION
Spontaneous pneumomediastinum and subcutaneous emphysema were our patient's main characteristics on chest CT, and this study enriches the knowledge regarding possible imaging changes in M. abscessus pulmonary disease in children. This case report reflects good clinical experience in maintaining the balance between chemotherapy and anti-infective therapy in childhood ALL.
Topics: Adult; Child; Female; Humans; Child, Preschool; Mycobacterium abscessus; Mediastinal Emphysema; Subcutaneous Emphysema; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lung Diseases
PubMed: 37641081
DOI: 10.1186/s12887-023-04199-4 -
BMJ Case Reports Aug 2023An adolescent boy presented to the clinic with upper chest pain, anterior neck pain and difficulty swallowing 3 weeks following a COVID-19 infection. The pain started...
An adolescent boy presented to the clinic with upper chest pain, anterior neck pain and difficulty swallowing 3 weeks following a COVID-19 infection. The pain started a few days before while participating in football practice. He reported no significant trauma or specific incidence when the pain began. His vital signs were stable and within normal limits. There was tenderness to palpation in the upper sternal area and low anterior neck. A chest X-ray was performed and was originally read by the primary care physician as unremarkable. This was followed by the official radiology read, which identified a spontaneous pneumomediastinum. A follow-up CT was confirmatory. The physician recommended rest and minimal activity, and the symptoms gradually resolved in 1 week. A follow-up 1 week after the initial visit revealed complete resolution by radiograph. One week later, a final set of radiographs confirmed sustained resolution of free air in the mediastinum. He was able to gradually return to normal activity.
Topics: Adolescent; Male; Humans; Child; Mediastinal Emphysema; COVID-19; Mediastinum; Chest Pain; Deglutition
PubMed: 37620104
DOI: 10.1136/bcr-2022-253263 -
Clinical Case Reports Aug 2023This report describes a case of a pediatric patient with a fever after an oral cavity injury caused by a toothbrush. On physical examination, no bleeds or injuries in...
This report describes a case of a pediatric patient with a fever after an oral cavity injury caused by a toothbrush. On physical examination, no bleeds or injuries in his mouth were evident, but diagnostic imaging revealed wide mediastinal emphysema including the left carotid arteries. It shows the importance of carefully examining patients not to miss life-threating conditions.
PubMed: 37554571
DOI: 10.1002/ccr3.7782 -
Cureus Jun 2023Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of air beneath the skin layers and in the mediastinal space, respectively, following routine...
Subcutaneous emphysema (SE) and pneumomediastinum are rare complications of air beneath the skin layers and in the mediastinal space, respectively, following routine dental procedures. A few cases exist in the literature. A 53-year-old female presented to the emergency department shortly after a cavity filling, with marked swelling of her right orbit, face, and neck. Physical examination and computed tomography (CT) revealed subcutaneous emphysema and pneumomediastinum. The patient was treated with prophylactic antibiotics for one week and Peridex rinse twice daily. Subcutaneous emphysema and pneumomediastinum cases have been associated with potentially life-threatening sequelae and infections. Although these conditions are almost exclusively benign and self-limiting, physicians should consider the associated fatal complications and manage accordingly. Dental providers should be able to recognize this complication and provide patients with appropriate guidance.
PubMed: 37525788
DOI: 10.7759/cureus.41177 -
Heliyon Jul 2023The terms "free air or gas located within the mediastinum and subcutaneous tissue that are not associated with any obvious causes, such as chest trauma," are used to...
The terms "free air or gas located within the mediastinum and subcutaneous tissue that are not associated with any obvious causes, such as chest trauma," are used to characterise spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE). SPM has been linked to a variety of illnesses and causes, including bronchial asthma, diabetic ketoacidosis, strenuous exercise, strenuous coughing, medication intake, and other actions involving the Valsalva maneuver. We describe a case of spontaneous cervical, retropharyngeal, and mediastinal emphysema in a young female who was previously healthy. She was brought into the ward for observation, vital sign monitoring, analgesics, and prophylactic antibiotics. She started taking analgesics, preventative antibiotics, and 100% oxygen throughout that period to help with absorption. The neck pain gradually subsided, and there were no bouts of oxygen desaturation or abnormal vital signs. After subsequently getting better, the patient went home. The patient was examined in an outpatient clinic two weeks after being discharged and shown no signs of illness. To sum up, subcutaneous emphysema and pneumomediastinum are uncommon presentations seen in the emergency room, but they are typically self-limiting.
PubMed: 37519660
DOI: 10.1016/j.heliyon.2023.e18326 -
The Clinical Respiratory Journal Aug 2023Para-tracheal or para-carinal air cysts (PACs) are often asymptomatic and usually detected incidentally by methods such as computed tomography. Their clinical...
BACKGROUND
Para-tracheal or para-carinal air cysts (PACs) are often asymptomatic and usually detected incidentally by methods such as computed tomography. Their clinical significance is unclear in patients with pleuroparenchymal fibroelastosis (PPFE).
METHODS
We evaluated the clinical significance of PACs in PPFE and their relationship with pneumomediastinum or pneumothorax.
RESULTS
In total, 50 patients had PPFE and 34 (68%) had PACs. Most PACs were para-carinal (n = 30). A para-tracheal air cyst was detected in only nine patients, which included five patients having both para-carinal and para-tracheal air cysts. Overall median survival was 24.7 months. Survival was not significantly different between the patients with [PACs(+)] and without PACs (P = 0.268). A high frequency (64%) of the complication of pneumomediastinum or pneumothorax occurred in the overall population during follow-up. Pneumomediastinum/pneumothorax occurred significantly more frequently in patients with PACs(+) than in those without (76.5% vs. 37.5%; P = 0.012). PACs(+) was the only significant risk factor for pneumomediastinum/pneumothorax.
CONCLUSIONS
Our data showed that PACs commonly occur in patients with PPFE, and most PACs were para-carinal air cysts. Additionally, PACs(+) was a significant risk factor for pneumomediastinum/pneumothorax; therefore, clinicians should be more aware of these complications during follow-up examination, particular in PACs(+) patients with PPFE.
Topics: Humans; Pneumothorax; Mediastinal Emphysema; Clinical Relevance; Tomography, X-Ray Computed; Cysts
PubMed: 37515360
DOI: 10.1111/crj.13671 -
PloS One 2023To evaluate the precipitating factors and symptoms of primary spontaneous pneumomediastinum (PSPM) and to assess the factors related with recurrent spontaneous...
OBJECTIVE
To evaluate the precipitating factors and symptoms of primary spontaneous pneumomediastinum (PSPM) and to assess the factors related with recurrent spontaneous pneumomediastinum (RSPM).
METHODS
From 2010 to 2021, 237 PSPM patients were included in this retrospective study. Clinical information including in-hospital periods, morbidity, mortality, presenting symptoms, precipitating events, smoking, and asthma history was obtained. The patients with smoking history were subdivided into "ex-smoker" or "current smoker". The severity of asthma was categorized into "mild intermittent", "mild persistent", "moderate persistent", or "severe persistent". During follow-up, patients with RSPM were classified into "recurrence" group and the others were into "no recurrence" group. Multivariate regression analysis was used to elucidate the associated factors with RSPM.
RESULTS
The mean age of study patients (men: women = 222: 15) was 23.4 years and mean period of hospital stay was 7.5 days. There was no mortality and morbidity. Most frequent symptom and precipitating factor were acute chest pain (n = 211, 89.0%) and cough (n = 72, 30.4%), respectively. RSPM occurred in 11 patients (4.6%). The proportion of patients with smoking (72.8% vs. 37.1%, p = 0.010) or asthma (81.8% vs. 39.8%, p<0.001) was significantly higher in "recurrence" group than "no recurrence" group. On multivariate analysis, asthma was the only factor associated with RSPM (mild intermittent/persistent, OR = 7.092, p = 0.047; moderate persistent, OR = 8.000, p = 0.011).
CONCLUSION
PSPM is a benign disease with no morbidity and mortality. Asthma may be the associated factor with RSPM; thus, despite the low rate of recurrence, patients with asthma should be informed about the chance of RSPM.
Topics: Male; Humans; Female; Young Adult; Adult; Retrospective Studies; Mediastinal Emphysema; Asthma; Chest Pain; Cough
PubMed: 37494372
DOI: 10.1371/journal.pone.0289225 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023