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Journal of Radiology Case Reports Oct 2022Spontaneous pneumomediastinum is characterized by the accumulation of air in the mediastinum with no identified cause. It is a rare and self-limiting condition. We...
Spontaneous pneumomediastinum is characterized by the accumulation of air in the mediastinum with no identified cause. It is a rare and self-limiting condition. We report the case of a 32-year-old female patient with controlled bronchial asthma, who presented with spontaneous pneumomediastinum, with no precipitating event. The evolution is generally benign and the treatment is conservative. Symptomatic medication may be instituted.
Topics: Young Adult; Female; Humans; Adult; Mediastinal Emphysema; Tomography, X-Ray Computed
PubMed: 36353291
DOI: 10.3941/jrcr.v16i10.4565 -
Pulmonology 2021
Topics: Diving; Humans; Mediastinal Emphysema
PubMed: 32788058
DOI: 10.1016/j.pulmoe.2020.07.004 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2020Subcutaneous emphysema occurs when air enters the soft tissue, which usually appears in the soft tissues of the chest wall or neck. It may also arise from pneumothorax...
Subcutaneous emphysema occurs when air enters the soft tissue, which usually appears in the soft tissues of the chest wall or neck. It may also arise from pneumothorax or skin lacerations after trauma or other reasons. Mediastinal emphysema may be either associated with subcutaneous emphysema or seen alone. The air in the mastoid cells may spread from the retropharyngeal region or various neck compartments into the mediastinum. Usually, no severe neurological or clinical findings are observed except crepitation on palpation. We present a case report of a mastoid fracture as a rare cause of cervical subcutaneous and mediastinal emphysema.
Topics: Fractures, Bone; Humans; Mastoid; Mediastinal Emphysema; Neck; Subcutaneous Emphysema
PubMed: 32185755
DOI: 10.14744/tjtes.2019.02828 -
Anales Del Sistema Sanitario de Navarra 2006Spontaneous pneumomediastinum (defined by the presence of free air in the mediastinum) is an infrequent entity that is presented in the absence of diseases or...
Spontaneous pneumomediastinum (defined by the presence of free air in the mediastinum) is an infrequent entity that is presented in the absence of diseases or precipitating factors. It generally affects young and healthy males. Thoracic pain, dyspnea, or both, are the most frequent symptoms. Other signs and symptoms are subcutaneous emphysema and Hamman's sign. Simple radiography of the thorax allows for the diagnosis in a high percentage of patients. Conservative treatment is indicated in these patients and has a favourable prognosis. Relapses are infrequent.
Topics: Adolescent; Humans; Male; Mediastinal Emphysema
PubMed: 17001364
DOI: 10.4321/s1137-66272006000300011 -
Therapeutic Advances in Respiratory... Oct 2016Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually... (Review)
Review
BACKGROUND
Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually benign and self-limiting, with only supportive therapy being needed, but severe cases may require invasive measures. Asthma exacerbations have classically been described as a cause of SPM. However, detailed descriptions in asthmatic children are scarce. We aimed at improving the current understanding of the features of SPM and subcutaneous emphysema, and outcomes, by means of a case report and a systematic review.
METHODS
For the systematic review a literature search was performed in PubMed to identify reported cases of SPM in asthmatic children.
RESULTS
The case a 10-year-old asthmatic girl with SPM is reported. The patient received an inhaled corticosteroid and long-acting beta2 agonist, in addition to sublingual immunotherapy (SLIT) with eventual control of asthma symptoms.
REVIEW
A total of 114 published cases were found since 1995, most of them in teenagers; no sex differences were observed. Clinical presentation was associated with an asthma exacerbation in a number of cases. Other presenting features were chest pain, dyspnoea, cough, and particularly acute swelling of the face, neck, and upper chest. Subcutaneous emphysema was present in most patients. Overall, three cases of pneumothorax and two cases of pneumorrhachis were reported. Therapy was mainly based on supportive care, rest, oxygen therapy, analgesics, steroids, and bronchodilators. All patients recovered spontaneously, in spite of a small initial increase in SPM in a few cases.
CONCLUSIONS
Early identification of patients at risk of SPM would avoid the high number of under-diagnosed cases. Patients should be treated not only with supportive therapy but also with measures to achieve control of the underlying cause (such as poorly controlled asthma).
Topics: Anti-Asthmatic Agents; Asthma; Child; Cough; Dyspnea; Female; Humans; Mediastinal Emphysema; Subcutaneous Emphysema; Treatment Outcome
PubMed: 27585598
DOI: 10.1177/1753465816657478 -
The Lancet. Infectious Diseases Apr 2020
Topics: Adult; COVID-19; China; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Pandemics; Pneumonia, Viral
PubMed: 32164830
DOI: 10.1016/S1473-3099(20)30156-0 -
BMJ Case Reports Oct 2011A 21-year-old man presented to the emergency department with pain and swelling to the right side of his neck and chest wall with associated shortness of breath. Two days...
A 21-year-old man presented to the emergency department with pain and swelling to the right side of his neck and chest wall with associated shortness of breath. Two days earlier, while playing football, he had been involved in a minor collision with another player where he was struck on the right side of his head, but had managed to continue playing. On examination, the patient had extensive cervical surgical emphysema. There were no further positive findings on respiratory and general examination. A chest x-ray demonstrated no rib or clavicular fractures and no pneumothorax. Therefore, a CT was undertaken to ascertain the cause of the surgical emphysema. This demonstrated a pneumomediastinum, pneumopericardium and extradural air in the spinal column in addition to the subcutaneous air. The CT identified no bony trauma and no other injuries. The symptoms resolved spontaneously and follow-up radiography, 9 days later, showed no residual air.
Topics: Adult; Dyspnea; Edema; Humans; Male; Mediastinal Emphysema; Neck Pain; Pneumopericardium; Radiography; Soccer; Subcutaneous Emphysema; Thoracic Wall; Wounds, Nonpenetrating; Young Adult
PubMed: 22675022
DOI: 10.1136/bcr.09.2011.4840 -
Acta Bio-medica : Atenei Parmensis Jan 2022Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on...
Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience.
Topics: Humans; Mediastinal Emphysema; Pneumothorax; Subcutaneous Emphysema; Tracheostomy
PubMed: 35045064
DOI: 10.23750/abm.v92iS1.11551 -
Revista Espanola de Sanidad... 2020We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the...
We present the case of a 17-year-old male patient with a history of cocaine use who consulted for chest pain and dyspnoea. A pneumomediastinum is defined as the irruption of air in the mediastinal space, and is associated with different causes, including addiction to inhaled drugs. It occurs in people with predisposing factors and the presence of precipitating factors such as consumption of inhaled drugs. X-ray and computed tomography of the thorax are very useful tools in guiding the diagnosis. The low incidence of this pathology represents a difficult diagnosis for the doctor, although in some characteristic work environments a high level of suspicion is necessary.
Topics: Adolescent; Cocaine-Related Disorders; Dyspnea; Humans; Male; Mediastinal Emphysema
PubMed: 32406481
DOI: 10.18176/resp.0007 -
Journal of Intensive Care Medicine Aug 2022Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case... (Observational Study)
Observational Study
BACKGROUND
Pneumothorax (PTX) and pneumomediastinum (PM), collectively termed here "air leak", are now well described complications of severe COVID-19 pneumonia across several case series. The incidence is thought to be approximately 1% but is not definitively known.
OBJECTIVES
To report the incidence and describe the demographic features, risk factors and outcomes of patients with air leak as a complication of COVID-19.
METHODS
A retrospective observational study on all adult patients with COVID-19 admitted to Watford General Hospital, West Hertfordshire NHS Trust between March 1st 2020 and Feb 28 2021. Patients with air leak were identified after reviewing both chest radiographs (CXRs) and axial imaging (CT Thorax) with confirmatory radiology reports inclusive of the terms PTX and/or PM.
RESULTS
Air leak occurred with an incidence of 0.56%. Patients with air leak were younger and had evidence of more severe disease at presentation, including a higher median CRP and number of abnormal zones affected on chest radiograph. Asthma was a significant risk factor in the development of air leak (OR 13.4 [4.7-36.4]), both spontaneously and following positive pressure ventilation. CPAP and IMV were also associated with a greater than six fold increase in the risk of air leak (OR 6.4 [2.5-16.6] and 9.8 [3.7-27.8] respectively). PTX, with or without PM, in the context of COVID-19 pneumonia was almost universally fatal whereas those with alone PM had a lower risk of death.
CONCLUSION
Despite the global vaccination programme, patients continue to develop severe COVID-19 disease and may require respiratory support. This study demonstrates the importance of identifying that deterioration in such patients may be resultant from PTX or PM, particularly in asthmatics and those managed with positive pressure ventilation.
Topics: Adult; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Risk Factors
PubMed: 35360973
DOI: 10.1177/08850666221091441