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Anaesthesia Feb 1983Pneumoretroperitoneum is rare, but sometimes seen in association with pneumoperitoneum as a result of barotrauma to the lungs. However, there have only been two previous...
Pneumoretroperitoneum is rare, but sometimes seen in association with pneumoperitoneum as a result of barotrauma to the lungs. However, there have only been two previous cases of pneumoretroperitoneum without pneumoperitoneum following barotrauma. This case discusses several of the possible mechanisms by which this could occur and what associated signs, especially on chest X-ray, one should look for to confirm the aetiology of gas in the retroperitoneal space.
Topics: Adolescent; Emphysema; Female; Humans; Mediastinal Emphysema; Retroperitoneal Space
PubMed: 6829879
DOI: 10.1111/j.1365-2044.1983.tb13932.x -
Monaldi Archives For Chest Disease =... Sep 2020Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical...
Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.
Topics: Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Coronavirus Infections; Female; Humans; Incidence; Italy; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32990690
DOI: 10.4081/monaldi.2020.1399 -
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 -
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 -
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 -
Medicina 2023Hamman's syndrome, or spontaneous pneumomediastinum, is the presence of air in the mediastinum without a history of previous pulmonary pathology, chest trauma or...
Hamman's syndrome, or spontaneous pneumomediastinum, is the presence of air in the mediastinum without a history of previous pulmonary pathology, chest trauma or iatrogenesis. It has been described as a rare complication in patients with COVID-19 pneumonia. It is postulated that an increase in airway pressure associated with diffuse alveolar damage caused by the virus produces an air leak into the mediastinum. Chest pain and dyspnea associated with subcutaneous emphysema should make the treating physician suspicious. We introduce a 79-year-old patient who, during hospitalization for pneumonia secondary to COVID-19, suddenly developed dyspnea, chest pain, coughing spells and bronchospasm with the discovery of spontaneous pneumomediastinum on chest tomography. He evolved favorably with bronchodilator treatment and temporary oxygen therapy. Hamman's syndrome is a rare cause of respiratory failure progression in patients with COVID-19 pneumonia. Its recognition is crucial to implement the appropriate treatment.
Topics: Male; Humans; Aged; SARS-CoV-2; Mediastinal Emphysema; COVID-19; Dyspnea; Chest Pain; Syndrome
PubMed: 37379547
DOI: No ID Found -
European Annals of Otorhinolaryngology,... Dec 2010Etiology of head-and-neck emphysema is mainly infectious (cellulitis) or traumatic (rupture of the aerodigestive tract mucosa, usually in the larynx and trachea).
INTRODUCTION
Etiology of head-and-neck emphysema is mainly infectious (cellulitis) or traumatic (rupture of the aerodigestive tract mucosa, usually in the larynx and trachea).
CASE REPORT
We report a case of head-and-neck and mediastinal emphysema due to oral hyperpressure inducing parotid acini rupture. The aim is to highlight the importance of precise interview of patient and family so as to identify this mechanism.
DISCUSSION
Pneumoparotid is a rare cause of swelling induced by insufflation into Stensen's duct. This reflux is caused by intra-oral hyperpressure, and can cause extensive subcutaneous emphysema induced by capsule rupture. The disorder is common in players of wind instruments and glass-blowers. Positive diagnosis is based on focused interview, looking for trigger factors, and on imaging assessment. Evolution is reported to be spontaneously favorable with simple antibiotherapy. Patient education is the best means of limiting recurrence.
CONCLUSION
In case of cervical emphysema, it is important to determine the mechanism of onset and explore for pneumoparotid on CT, so as to adapt treatment and prevent possible recurrence.
Topics: Child; Female; Head; Humans; Mediastinal Emphysema; Neck; Subcutaneous Emphysema
PubMed: 21123133
DOI: 10.1016/j.anorl.2010.10.002 -
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 -
Acta Bio-medica : Atenei Parmensis Sep 2022A 62-year-old man with COVID-19 had PS for fever, coughing, and breathlessness. Two days after therapy, the patient's clinical condition worsened. X-ray and CT showed...
A 62-year-old man with COVID-19 had PS for fever, coughing, and breathlessness. Two days after therapy, the patient's clinical condition worsened. X-ray and CT showed pneumomediastinum, emphysema and pneumothorax. The patient was intubated and subjected to conservative therapy. The patient was discharged after about 20 days. Radiological imaging plays a key role in the proper diagnosis and treatment of COVID-19 patients with related complications.
Topics: COVID-19; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; Tomography, X-Ray Computed
PubMed: 36134719
DOI: 10.23750/abm.v93iS1.13061