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Annals of Agricultural and... Jun 2023In December 2019, an atypical form of severe pneumonia emerged in Wuhan in China's Hubei province, which in February 2020 was named COVID-19. The disease may have...
In December 2019, an atypical form of severe pneumonia emerged in Wuhan in China's Hubei province, which in February 2020 was named COVID-19. The disease may have features of interstitial pneumonia and severe respiratory failure requiring intensive oxygen therapy. Spontaneous pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea, oesophagus and bronchi. It is potentially life-threatening complication of both invasive and non-invasive mechanical ventilation. There have been reports that it may complicate the course of interstitial lung disease in the course of COVID-19. The report describes two cases of young patients who spontaneously developed this complication. Immediate diagnose is important in order to applicate adequate procedures.
Topics: Humans; COVID-19; Mediastinal Emphysema; Rare Diseases
PubMed: 37387393
DOI: 10.26444/aaem/166324 -
Arthritis and Rheumatism Jan 2009Spontaneous pneumomediastinum is a rare complication of dermatomyositis (DM) and polymyositis (PM). The aim of this study was to characterize this complication and... (Review)
Review
OBJECTIVE
Spontaneous pneumomediastinum is a rare complication of dermatomyositis (DM) and polymyositis (PM). The aim of this study was to characterize this complication and determine its prognostic factors.
METHODS
We retrospectively collected a multicenter series of PM/DM cases complicated by pneumomediastinum. We analyzed all published cases and combined those that were exploitable with ours for an investigation of the factors associated with poor survival.
RESULTS
We collected 11 PM/DM cases complicated by interstitial lung disease and pneumomediastinum. Five of the 9 DM patients had clinically amyopathic DM without muscle weakness and high serum creatine kinase levels. The outcome was favorable in 7 of these patients and 6 had no sequelae. In total, approximately 25% of our patients of the 21 analyzable cases studied died within 1 month. With a median followup of 240 days, the cumulative estimated Kaplan-Meier survival rate was 64% at 1 year and 55% at 2 years. Poor survival was associated with absence of muscle weakness (P = 0.02), initial low vital capacity (P = 0.006), and initial low carbon monoxide diffusion capacity (P = 0.04).
CONCLUSION
In this first large series of patients with connective tissue disease complicated by pneumomediastinum to be reported, most patients had DM and half amyopathic DM, as in previous reports. Pneumomediastinum may occur before DM diagnosis and may thus reveal DM with minimal or no muscle involvement. Death was associated with an absence of muscle weakness and severe pulmonary involvement before the onset of pneumomediastinum. Corticosteroids and immunosuppressive therapy can result in complete recovery, as in half our cases.
Topics: Adrenal Cortex Hormones; Adult; Aged; Dermatomyositis; Female; Health Surveys; Humans; Immunosuppressive Agents; Kaplan-Meier Estimate; Lung Diseases, Interstitial; Male; Mediastinal Emphysema; Middle Aged; Polymyositis; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 19116970
DOI: 10.1002/art.24372 -
The American Journal of the Medical... Dec 2020
Topics: Adult; Aged; COVID-19; Humans; Male; Mediastinal Emphysema; SARS-CoV-2
PubMed: 32605714
DOI: 10.1016/j.amjms.2020.06.003 -
Revista Da Sociedade Brasileira de... 2021
Topics: COVID-19; Humans; Mediastinal Emphysema; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 33656155
DOI: 10.1590/0037-8682-0871-2020 -
BMJ Case Reports Jul 2021A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable;... (Review)
Review
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
Topics: Chest Tubes; Chlorine; Humans; Male; Mediastinal Emphysema; Pneumothorax; Subcutaneous Emphysema
PubMed: 34330735
DOI: 10.1136/bcr-2020-236549 -
BMJ Case Reports Oct 2019Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be...
Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be iatrogenic or develop spontaneously, in case of emesis, coughing or forceful straining. Use of illicit drugs, such as cocaine, has been associated with multiple respiratory complications, including pneumomediastinum and subcutaneous emphysema. The pathogenesis of subcutaneous emphysema and pneumomediastinum after cocaine inhalation is not completely known, but it is thought that the physical manoeuvers used to increase its absorption and effect may lead to alveolar rupture, resulting in air escaping into the mediastinum and fascial planes of the neck and chest. Chest X-ray is usually diagnostic, but CT can be used as complementary study, allowing evaluation of adjacent structures. A case of pneumomediastinum and subcutaneous emphysema after cocaine inhalation in an otherwise healthy man is presented.
Topics: Adult; Chest Pain; Cocaine-Related Disorders; Humans; Male; Mediastinal Emphysema; Neck Pain; Oxygen Inhalation Therapy; Subcutaneous Emphysema; Tomography, X-Ray Computed; Young Adult
PubMed: 31628091
DOI: 10.1136/bcr-2019-229205 -
Monaldi Archives For Chest Disease =... Jul 2022Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19...
Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis. Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed.
Topics: Humans; COVID-19; Mediastinal Emphysema; Pandemics; Prognosis; Hospitalization
PubMed: 35904103
DOI: 10.4081/monaldi.2022.2338 -
Acta Bio-medica : Atenei Parmensis Apr 2021Spontaneous pneumomediastinum (SPM) is a rare condition characterized by chest pain of sudden- onset, difficulty breathing, dysphagia, dysphonia, and subcutaneous...
Spontaneous pneumomediastinum (SPM) is a rare condition characterized by chest pain of sudden- onset, difficulty breathing, dysphagia, dysphonia, and subcutaneous emphysema, which are some-times -accompanied by pain in the neck or back. This condition typically has a benign character that limits itself, and supportive therapy is all that is needed; however, life-threatening consequences may occur, such as upper respiratory tract obstruction, esophageal injury, and tracheal damage, requiring surgery. We report here a man aged 19 years who coughed vigorously due to acute allergic asthma, which lead to subcutaneous emphysema starting from the neck down to the chest, mediastinum and spinal epidural space. This case report stresses the importance of including SPM in the differential diagnosis of cough and chest pain in the young.
Topics: Cough; Epidural Space; Humans; Male; Mediastinal Emphysema; Subcutaneous Emphysema; Tomography, X-Ray Computed; Young Adult
PubMed: 33944825
DOI: 10.23750/abm.v92iS1.10086 -
Internal Medicine (Tokyo, Japan) Apr 2002To evaluate the difference in the clinical features of mediastinal emphysema as classified into three groups based on etiology; patients in whom it was spontaneous with... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the difference in the clinical features of mediastinal emphysema as classified into three groups based on etiology; patients in whom it was spontaneous with unknown etiology (A group), those in whom it was secondary to bronchial asthma (B group), and those in whom it was secondary with other respiratory diseases (C group).
PATIENTS
Forty-three cases (45 episodes) with mediastinal emphysema treated at Kawasaki Medical School Kawasaki Hospital between April 1985 and March 2000 (A group: 17 cases, B group: 17 cases, C group: 9 cases).
RESULTS
The average ages of the A and B groups were of little significance. Most of the patients in the A group were males with a thin body. Three patients in the A group had episodes of pneumothorax or mediastinal emphysema in their past history. Five patients in the A group had Hamman's sign on physical examination. In all of the patients in the C group, mediastinal emphysema was accompanied by subcutaneous emphysema, whereas only eight patients in the A group had subcutaneous emphysema. The prognosis was good for A and B groups because the mediastinal emphysema disappeared within 10 days, but was poor in the C group because its disappearance was very late compared with that in the other two groups and skin incision was required in three patients in the C group due to severe subcutaneous emphysema. CONCLUSIONS We suggest that the existance and kind of underlying diseases significantly affect the method of treatment and the prognosis.
Topics: Adult; Aged; Asthma; Comorbidity; Female; Humans; Male; Mediastinal Emphysema; Prognosis; Retrospective Studies; Subcutaneous Emphysema; Treatment Outcome
PubMed: 11993787
DOI: 10.2169/internalmedicine.41.277 -
The American Journal of Case Reports Jul 2020BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe...
BACKGROUND Novel Coronavirus 2019 (COVID-19) has been in the spotlight since the first cases were reported in December 2019. COVID-19 has been found to cause severe acute respiratory distress syndrome and, more uncommonly, subcutaneous emphysema and pneumomediastinum. We present a case series of 3 patients with COVID-19 infection managed in the Intensive Care Unit and found to have subcutaneous emphysema and pneumomediastinum on chest imaging. CASE REPORT We present a case series of 3 men, ages 36, 47, and 78 years, diagnosed with COVID-19 via RT-PCR, found to have severe acute respiratory distress syndrome, and managed in the Intensive Care Unit. Two patients described in this case series were mechanically ventilated on low positive end-expiratory pressures and developed subcutaneous emphysema and pneumomediastinum on chest imaging, and 1 patient developed subcutaneous emphysema prior to intubation. Each of these patients had a more eventful hospital course and worse outcomes than most COVID-19 infected patients. CONCLUSIONS Subcutaneous emphysema and pneumomediastinum in COVID-19 patients have been rarely reported and is poorly understood. In our institution, we have found the diagnosis of subcutaneous emphysema and pneumomediastinum in COVID-19 patients is associated with unfavorable outcomes and worse prognosis.
Topics: Adult; Aged; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; Prognosis; SARS-CoV-2; Subcutaneous Emphysema; Tomography, X-Ray Computed
PubMed: 32703927
DOI: 10.12659/AJCR.925557