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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 -
The American Journal of Case Reports Nov 2023BACKGROUND Influenza infection can trigger an asthma exacerbation, which can lead to spontaneous pneumomediastinum. This is a rare condition that typically occurs after...
BACKGROUND Influenza infection can trigger an asthma exacerbation, which can lead to spontaneous pneumomediastinum. This is a rare condition that typically occurs after a sudden increase in intra-alveolar pressure. Pneumomediastinum is usually a benign condition that can be treated with supportive care, and it can be accompanied by subcutaneous emphysema. However, it can progress to retropharyngeal emphysema, as reported in this case. This report is of a 27-year-old patient with past medical history of well-controlled asthma presenting for acute exacerbation of asthma secondary to influenza A infection who developed pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. To the best of our knowledge, there is only one case in literature that has reported a similar presentation secondary to influenza A infection. CASE REPORT We report a 27-year-old woman with well-controlled asthma who presented with chest pain, shortness of breath, throat pressure, dry cough, and expiratory wheezing as an acute exacerbation of asthma secondary to influenza A infection. On chest imaging, she was found to have spontaneous pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. Her symptoms were resolved with supportive measures and control of asthma symptoms. CONCLUSIONS This case highlights these atypical complications of asthma exacerbations. Although these complications are typically benign and can resolve with supportive measures, severe cases can lead to acute airway compromise, pneumothorax, tension pneumomediastinum, or tension pneumopericardium. This case also shows how important it is to consider chest radiographs in any young patient with an asthma exacerbation who has symptoms or signs suggestive of extra-alveolar air.
Topics: Female; Humans; Adult; Mediastinal Emphysema; Influenza, Human; Asthma; Subcutaneous Emphysema; Dyspnea; Pulmonary Emphysema
PubMed: 37997300
DOI: 10.12659/AJCR.941733 -
BMC Pediatrics Nov 2023Tension pneumomediastinum is a rare and dangerous complication in children that can be fatal, and timely detection and treatment are critical. The aim of this study was...
PURPOSE
Tension pneumomediastinum is a rare and dangerous complication in children that can be fatal, and timely detection and treatment are critical. The aim of this study was to evaluate the safety and feasibility of computed tomography (CT) imaging-guided parasternal approach drainage for tension pneumomediastinum in children.
METHODS
From June 2018 to February 2023, we consecutively enrolled 19 children with tension pneumomediastinum in our institution. A pigtail catheter was inserted into the anterior mediastinum by a CT imaging-guided parasternal approach. The catheter was connected to a negative-pressure water seal bottle to drain the pneumomediastinum. Clinical data and outcomes were summarized.
RESULTS
The mean age was 3.1 ± 3.4 years, the mean weight was 15 ± 9.1 kg, the mean procedure time was 11.8 ± 2.4 min, and the drainage time was 6.7 ± 3.4 days. No major complications were identified, such as haemothorax, catheter displacement, or mediastinal infection. Effective drainage was obtained in all patients as assessed by comparing images and ventilatory parameters, and no additional surgical treatment was needed. There was no recurrence during the follow-up, which was more than 2 months. In our data, two children with COVID-19 were discharged from the hospital after effective drainage and other clinical treatment.
CONCLUSION
CT-guided parasternal approach drainage is safe, minimally invasive, and effective for children with tension pneumomediastinum.
Topics: Humans; Child; Child, Preschool; Mediastinal Emphysema; Tomography, X-Ray Computed; Drainage; Catheters; Retrospective Studies
PubMed: 37993855
DOI: 10.1186/s12887-023-04417-z -
BMC Cardiovascular Disorders Nov 2023Infectious aortic disease is a rare and fatal disease, that requires the appropriate intervention. An accurate diagnosis should be promptly established. However, this is...
BACKGROUND
Infectious aortic disease is a rare and fatal disease, that requires the appropriate intervention. An accurate diagnosis should be promptly established. However, this is difficult because the clinical manifestations of this disease vary and are non-specific.
CASE PRESENTATION
(CASE 1) An 87-year-old male, presenting with generalized malaise and weight loss, was admitted for further examination. A chest computed tomography (CT) showed mediastinal emphysema. Empirical intravenous antibiotics were administered to address the non-specific infectious findings in the laboratory data. The treatment was effective, and the patient fully recovered. However, he was in shock due to aortic rupture and marked pseudo aneurysmal formation around the aortic arch day 25 of hospitalization. An emergency total aortic arch replacement was performed, and the patient was discharged. (CASE 2) An 82-year-old male who had undergone Y-graft replacement in the abdominal aorta 15 years previously was admitted due to general malaise and anorexia. Abdominal CT revealed emphysematous changes adjacent to the abdominal aorta. The patient responded favorably to empirical treatment with intravenous antibiotics and was discharged 19 days after admission. Four days after discharge, the patient went into cardiac arrest after an episode of hematemesis. Abdominal CT revealed an enlarged stomach and duodenum, filled with massive high-density contents proximal to the abdominal aorta. He died of hemorrhagic shock despite cardiopulmonary resuscitation.
CONCLUSIONS
Although emphysematous changes are rare, they are red flag signs during the early stage of infectious aortic disease. Thus, physicians should remain vigilant for this kind of critical sign.
Topics: Male; Humans; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aorta, Abdominal; Aorta, Thoracic; Vascular Surgical Procedures; Communicable Diseases; Anti-Bacterial Agents
PubMed: 37990294
DOI: 10.1186/s12872-023-03619-8 -
Surgical Case Reports Nov 2023Perforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who...
BACKGROUND
Perforation of the pyriform sinus, included in hypopharyngeal injury, is a rare condition typically caused by iatrogenic factors. We present a case of an infant who developed deep cervical and mediastinal abscesses due to a traumatic pyriform sinus perforation caused by accidentally falling with a marker pen in the mouth.
CASE PRESENTATION
An 11-month-old healthy male infant fell on a trampoline with a marker pen in his mouth. The patient developed swelling in the neck 3 h after the incident and was taken to a regional general hospital. Although a laryngoscopy showed no perforation in the oral cavity or posterior pharynx, a computed tomography (CT) scan revealed significant emphysema extending from the cervix to the mediastinum. The patient was transferred to our tertiary hospital and admitted to the intensive care unit, where he was mechanically ventilated, and antibiotic therapy was initiated. On day 3 of admission, a CT scan revealed deep abscesses in the cervical and upper posterior mediastinum with pneumomediastinum. Although his respiratory status stabilized and he was temporarily weaned, the fever recurred. Pharyngoesopagography revealed significant leakage of contrast from the left pyriform sinus to the mediastinum. Consequently, surgical drainage of the abscess was performed on day 10. Two low-pressure continuous suction drains were placed, one in the posterior mediastinum and the other close to the pyriform sinus. Pharyngoesophagography on postoperative day (POD) 7 demonstrated decreased contrast leakage into the posterior mediastinum. The patient was initiated on enteral nutrition through a nasogastric tube. The patient was discharged on POD 31 after the suction drains were replaced with open Penrose drains, and enteral nutrition via nasogastric tube was continued at home. The Penrose drains were removed on POD 54, and salivary leakage ceased on POD 111.
CONCLUSIONS
Although injuries to the oral cavity and posterior pharynx are more easily recognized, the existence of injury in the pyriform sinus can be challenging to evaluate. However, prompt and appropriate management, including intubation, antibiotic therapy, surgical drainage, and nutritional support, is critical in preventing life-threatening complications.
PubMed: 37968535
DOI: 10.1186/s40792-023-01781-x -
Cureus Oct 2023Spontaneous pneumomediastinum is a rare medical condition characterized by the presence of free air in the mediastinum, not preceded by trauma, surgery, or another...
Spontaneous pneumomediastinum is a rare medical condition characterized by the presence of free air in the mediastinum, not preceded by trauma, surgery, or another medical procedure. It predominantly affects young adult males and usually has a benign course, and in most cases, it is not possible to identify the precipitating factor. There are some conditions that predispose to its occurrence, namely those that lead to an increase in intrapleural pressure, such as coughing, vomiting, or vigorous exercise. We report a case of a 21-year-old male who presented with acute-onset shortness of breath after an episode of coughing and was found to have mediastinal and subcutaneous emphysema. Clinical, laboratory, and radiological studies did not demonstrate any predisposing factor, and the case was classified as spontaneous pneumomediastinum.
PubMed: 37965408
DOI: 10.7759/cureus.47015 -
Respiratory Investigation Jan 2024Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance... (Review)
Review
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
Topics: Humans; Positron Emission Tomography Computed Tomography; Lung; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 37948969
DOI: 10.1016/j.resinv.2023.09.004 -
Acta Medica Academica Aug 2023The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the...
OBJECTIVE
The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the necessity of identifying true SPM cases as they are currently inadequately defined.
METHODS
This is a single-center, retrospective study, conducted in a university hospital. Consecutive adult patients with pneumomediastinum (PM) between January 2009 and March 2020 were involved in the series. The data about age, gender, symptoms, signs, treatment, length of hospital stay (LOS), and in-hospital mortality were evaluated.
RESULTS
In total, 87 cases with pneumomediastinum (37 with spontaneous and 50 with secondary PM) were analyzed. Patients in both groups were of similar ages (P=0.4). Sufferers with secondary PM were more likely to have: an associated pneumothorax (19% vs 58%, P<0.05), a chest tube placed (18.9% vs 58%, P<0.05), an associated pleural effusion (0% vs 18%, P<0.05). They presented with a longer LOS (3.9 vs 5.3 days, P<0.05), and were more likely to die (0% vs 10%, P<0.05). Additionally they showed a higher prevalence of radiologic subcutaneous emphysema (49% vs 74%, P<0.05).
CONCLUSION
Spontaneous pneumomediastinum is an onset of clinical importance with a low mortality rate, short LOS and good longterm prognosis. It often presents with chest pain, dyspnea and/or subcutaneous emphysema. However, secondary causes of mediastinal air must be ruled out, due to their potential devastating outcome if not diagnosed promptly. A consensus aimed at an update of the classification guidelines is more than indispensable.
Topics: Adult; Humans; Mediastinal Emphysema; Retrospective Studies; Dyspnea; Length of Stay; Subcutaneous Emphysema
PubMed: 37933505
DOI: 10.5644/ama2006-124.408 -
Early oesophageal carcinoma with a defect of the oesophageal muscularis propria: a rare case report.The Journal of International Medical... Oct 2023We herein report a rare case of early oesophageal cancer combined with an oesophageal muscularis propria defect discovered under endoscopic submucosal dissection. The...
We herein report a rare case of early oesophageal cancer combined with an oesophageal muscularis propria defect discovered under endoscopic submucosal dissection. The surgeon did not damage the muscularis propria during endoscopic resection; however, we observed the mediastinal cavity as well as the later occurrence of subcutaneous emphysema. Consequently, the patient was considered to have a muscularis propria defect. This phenomenon has not been reported in the literature to date.
Topics: Humans; Esophageal Neoplasms; Endoscopy; Endoscopic Mucosal Resection; Stomach Neoplasms; Treatment Outcome; Retrospective Studies
PubMed: 37903318
DOI: 10.1177/03000605231204422 -
The American Journal of Case Reports Oct 2023BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include...
BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman's sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman's syndrome). CASE REPORT This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry's spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman's syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. CONCLUSIONS This report presents a rare association between protracted labor and Hamman's syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated.
Topics: Pregnancy; Female; Humans; Adult; Mediastinal Emphysema; Subcutaneous Emphysema; Thorax; Chest Pain; Dyspnea; Syndrome
PubMed: 37865817
DOI: 10.12659/AJCR.940989