-
Therapeutic Advances in Respiratory... Dec 2009Spontaneous pneumomediastinum (SPM) is a rare disorder most often affecting young males which is generally self-limiting. Despite the benign prognosis with few... (Review)
Review
Spontaneous pneumomediastinum (SPM) is a rare disorder most often affecting young males which is generally self-limiting. Despite the benign prognosis with few complications and little morbidity, it frequently confuses clinicians in primary settings, who may have difficulty differentiating SPM from other serious organ ruptures, especially oesophageal rupture (the so-called Boerhaave syndrome), which may lead to mediastinitis and may be fatal, even with appropriate interventions. An overview of adult SPM is provided, reviewing 17 studies (414 patients), including our clinical experience, and finally an algorithm for diagnosis and management of SPM is proposed, based on the characteristics of SPM.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Child; Diagnosis, Differential; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Prognosis; Young Adult
PubMed: 19934282
DOI: 10.1177/1753465809350888 -
Journal of Sports Science & Medicine Mar 2021Spontaneous pneumomediastinum (SPM) is an uncommon and usually benign self-limiting clinical disorder found in young people, often without apparent precipitating factors...
Spontaneous pneumomediastinum (SPM) is an uncommon and usually benign self-limiting clinical disorder found in young people, often without apparent precipitating factors or diseases. A pressure gradient exists between the peripheral pulmonary alveoli and the hilum, and increased intra-alveolar pressure causes rupture of the terminal alveoli. We present the case of a 15-year-old male soccer player who presented with a complaint of anterior chest pain and dysphagia after stopping the strong ball with his chest. His symptom gradually progressed over hours. We can make the diagnosis of SPM using by chest X-ray and computed tomography (CT) scanning. His symptoms were gradually resolved over the course of approximately one week with no exercise and careful observation. We believe that our case provides very useful information to alert clinicians and coaches regarding this rare disease that may occur in anyone including adolescent soccer players.
Topics: Adolescent; Athletes; Chest Pain; Deglutition Disorders; Humans; Male; Mediastinal Emphysema; Pressure; Soccer; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 33707986
DOI: 10.52082/jssm.2021.52 -
Critical Care Medicine Jan 2023Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to... (Observational Study)
Observational Study
OBJECTIVES
Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia.
DESIGN
Retrospective observational study.
SETTING
Population-based, single-setting, tertiary-care level COVID treatment center.
PATIENTS
Individuals hospitalized with a diagnosis of COVID-19 pneumonia and severe to critical illness were included. Those hospitalized without respiratory failure, observed for less than 24 hours, or admitted from an ICU were excluded.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
All patients underwent a complete clinical assessment and chest CT scan, and were followed up from hospitalization to discharge or death. The outcome was the number of cases of PNM, defined as the presence of free air in the mediastinal tissues diagnosed by chest CT scan, in non-ICU hospitalized patients and the subsequent risk of intubation and mortality. PNM occurred in 48 out of 331 participants. The incidence was 14.5% (95% CI, 10.9-18.8%). A CT-Scan Severity score greater than 15 was positively associated with PNM (odds ratio [OR], 4.09; p = 0.002) and was observed in 35.2% of the participants (95% CI, 26.2-44.9%). Noninvasive ventilation was also positively associated with PNM (OR, 4.46; p = 0.005), but there was no positive association with airway pressures. Fifty patients (15%) were intubated, and 88 (27%) died. Both the risk for intubation and mortality were higher in patients with PNM, with a hazard ratio of 3.72 ( p < 0.001) and 3.27 ( p < 0.001), respectively.
CONCLUSIONS
Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.
Topics: Humans; COVID-19; Mediastinal Emphysema; Incidence; Respiratory Distress Syndrome; Respiration, Artificial
PubMed: 36200776
DOI: 10.1097/CCM.0000000000005680 -
Jornal Brasileiro de Pneumologia :... Dec 2021
Topics: Dermatomyositis; Humans; Mediastinal Emphysema; Pneumorrhachis; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 34932727
DOI: 10.36416/1806-3756/e20210352 -
BMJ Case Reports Sep 2021
Topics: Dentistry; Humans; Mediastinal Emphysema; Neck; Subcutaneous Emphysema
PubMed: 34479883
DOI: 10.1136/bcr-2021-243256 -
Thorax Jul 1966
Topics: Adolescent; Adult; Diagnosis, Differential; Female; Gastrostomy; Humans; Male; Mediastinal Emphysema; Middle Aged; Pregnancy; Pregnancy Complications; Radiography
PubMed: 5968120
DOI: 10.1136/thx.21.4.325 -
Asian Journal of Surgery Jul 2023
Topics: Female; Animals; Mediastinal Emphysema; Chickens; Emphysema; Neck
PubMed: 36641276
DOI: 10.1016/j.asjsur.2023.01.017 -
BMJ Case Reports May 2018We present the case of a 22-year-old primigravida with symptoms of neck swelling and difficulty breathing 3 hours after uneventful vaginal delivery. On examination,...
We present the case of a 22-year-old primigravida with symptoms of neck swelling and difficulty breathing 3 hours after uneventful vaginal delivery. On examination, there was surgical emphysema. A CT scan confirmed air in the subcutaneous tissues and also revealed pneumomediastinum. There was no evidence of pneumothorax and gastro-oesophageal endoscopy showed no signs of oesophageal rupture. The patient remained clinically stable throughout her admission and was discharged home after 48 hours of observation. Pneumomediastinum is one of the rare causes of shortness of breath and chest pain during the postpartum period, and it should be considered in the differential diagnosis. Despite the significant abnormalities seen on plain radiography and CT scan, this condition spontaneously resolves. Although postpartum pneumomediastinum has been related to prolonged labour, this was not the case in our patient.
Topics: Chest Pain; Diagnosis, Differential; Dyspnea; Female; Humans; Mediastinal Emphysema; Pregnancy; Puerperal Disorders; Subcutaneous Emphysema; Young Adult
PubMed: 29776942
DOI: 10.1136/bcr-2018-224800 -
European Journal of Medical Research Sep 2021Pneumomediastinum is a rare complication of COVID-19 pneumonia, which may or may not be associated with invasive ventilatory support. Therefore, the report and findings...
BACKGROUND
Pneumomediastinum is a rare complication of COVID-19 pneumonia, which may or may not be associated with invasive ventilatory support. Therefore, the report and findings associated with its evolution can be of great contribution in the management of this unknown disease.
CASE PRESENTATION
Here, we present a series of four patients with severe pneumomediastinum requiring intensive care unit. These patients developed pneumomediastinum before or during orotracheal intubation (OTI) or without OTI. The four patients were three men and one woman with a mean age of 60.5 years (48-74 years). No patients had a known history of lung disease or traumatic events, except for one patient who had a history of smoking, but who was without parenchymal disease. All intubations were performed without complications. No cases of pneumomediastinum occurred after tracheostomy, and none of the patients had tomographic or bronchoscopic evidence of tracheal injury. Although the pneumomediastinum observed in our cases was apparently not related to a violation of the aerodigestive track, this complication was associated with a worse prognosis.
CONCLUSION
Pneumomediastinum is a rare complication of COVID-19 pneumonia, and the most likely etiopathogenesis is severe pulmonary involvement, which may or may not be associated with invasive ventilatory support. Future studies with a greater number of cases should elucidate the relationship of pneumomediastinum to a probable prognostic factor.
Topics: Aged; Anti-Bacterial Agents; COVID-19; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Respiration, Artificial; Tomography, X-Ray Computed
PubMed: 34565471
DOI: 10.1186/s40001-021-00585-9 -
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