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Radiologia 2021To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the... (Review)
Review
OBJECTIVE
To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.
CONCLUSION
In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
Topics: Humans; Mediastinal Emphysema; Rupture; Subcutaneous Emphysema; Thorax; Trachea
PubMed: 34246426
DOI: 10.1016/j.rxeng.2021.02.005 -
CMAJ : Canadian Medical Association... Nov 2008
Topics: Adult; Humans; Male; Mediastinal Neoplasms; Neoplasms, Germ Cell and Embryonal; Pneumopericardium; Pneumothorax; Positive-Pressure Respiration; Radiography; Radiotherapy, Adjuvant; Respiratory Distress Syndrome
PubMed: 18981451
DOI: 10.1503/cmaj.080707 -
International Journal of Surgery... Aug 2018Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures. (Review)
Review
BACKGROUND
Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures.
METHODS
A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum".
RESULTS
Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases.
CONCLUSIONS
Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Mediastinal Emphysema; Middle Aged; Postoperative Complications; Radiography; Retropneumoperitoneum; Subcutaneous Emphysema; Transanal Endoscopic Surgery
PubMed: 29936199
DOI: 10.1016/j.ijsu.2018.05.743 -
Journal of Korean Medical Science Mar 2016Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but...
Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
Topics: Aged; Cardiac Tamponade; Drainage; Dyspnea; Emergency Medical Services; Heart Ventricles; Humans; Male; Medical Errors; Pericardial Effusion; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 26952636
DOI: 10.3346/jkms.2016.31.3.470 -
International Journal of Surgery Case... 2020Spontaneous pneumomediastinum (SPM) is a rare condition classified as free air in the mediastinum in the absence of any precipitating cause. This is the first time that...
INTRODUCTION
Spontaneous pneumomediastinum (SPM) is a rare condition classified as free air in the mediastinum in the absence of any precipitating cause. This is the first time that a synchronous presence of pneumopericardium is described. To date, there are no clear guidelines for diagnosis and treatment.
PRESENTATION OF A CASE
A 34-year old Caucasian male patient presented to our institution with a recently diagnosed pancreatic adenocarcinoma. He underwent an uneventful pancreaticoduodenectomy (Whipple procedure). Preoperative and intraoperative chest X-Ray after a central line placement were normal. The postoperative course was uneventful, but few hours before his discharge he presented an acute tachycardia and tachypnea with hypocapnia and a transient loss of consciousness. The full-body CT scan revealed a pneumomediastinum and pneumopericardium without any findings of anastomotic leak or other pathology from the abdomen. A meticulous review of the literature was conducted about the pathophysiology, treatment options and outcomes of pneumomediastinum after a surgical procedure.
DISCUSSION
This is the first study presenting the case of spontaneous pneumomediastinum with a synchronous pneumopericardium in the literature as a late complication of Whipple procedure. The applied diagnostic algorithm and conservative treatment are presented to extend our limited knowledge about this rare medical entity.
CONCLUSION
Awareness of these medical entities is important for the adequate management and optimal outcome of patients presenting a spontaneous pneumomediastinum. As such, all cases, treatment decisions and outcomes should be reported.
PubMed: 32428828
DOI: 10.1016/j.ijscr.2020.04.012 -
CMAJ : Canadian Medical Association... Feb 2023
Topics: Humans; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 36746478
DOI: 10.1503/cmaj.221137 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; COVID-19; Pneumothorax; Pneumopericardium; Mediastinal Emphysema; Fistula
PubMed: 37493746
DOI: 10.1590/0037-8682-0188-2023 -
Endocrinology, Diabetes & Metabolism... 2017Hamman's syndrome (spontaneous subcutaneous emphysema and pneumomediastinum) is a rare complication of diabetic ketoacidosis (DKA), with a multifactorial etiology....
UNLABELLED
Hamman's syndrome (spontaneous subcutaneous emphysema and pneumomediastinum) is a rare complication of diabetic ketoacidosis (DKA), with a multifactorial etiology. Awareness of this syndrome is important: it is likely underdiagnosed as the main symptom of shortness of breath is often attributed to Kussmaul's breathing and the findings on chest radiograph can be subtle and easily missed. It is also important to be aware of and consider Boerhaave's syndrome as a differential diagnosis, a more serious condition with a 40% mortality rate when diagnosis is delayed. We present a case of pneumomediastinum, pneumopericardium, epidural emphysema and subcutaneous emphysema complicating DKA in an eighteen-year-old patient. We hope that increasing awareness of Hamman's syndrome, and how to distinguish it from Boerhaave's syndrome, will lead to better recognition and management of these syndromes in patients with diabetic ketoacidosis.
LEARNING POINTS
Hamman's syndrome (spontaneous subcutaneous emphysema and pneumomediastinum) is a rare complication of DKA.Presentation may be with chest or neck pain and shortness of breath, and signs are subcutaneous emphysema and Hamman's sign - a precordial crunching or popping sound during systole.Boerhaave's syndrome should be considered as a differential diagnosis, especially in cases with severe vomiting.The diagnosis of pneumomediastinum is made on chest radiograph, but a CT thorax with water-soluble oral contrast looking for contrast leak may be required if there is high clinical suspicion of Boerrhave's syndrome.Hamman's syndrome has an excellent prognosis, self-resolving with the correction of the ketoacidosis in all published cases in the literature.
PubMed: 29218226
DOI: 10.1530/EDM-17-0135 -
Case Reports in Oncology 2020Pneumopericardium is a relatively rare entity mostly described in the literature as a result of causes such as penetrating/blunt trauma and iatrogenic causes during...
Pneumopericardium is a relatively rare entity mostly described in the literature as a result of causes such as penetrating/blunt trauma and iatrogenic causes during cardiothoracic procedures. We are presenting a case of pneumopericardium as a complication of progressed gastroesophageal junction tumor along with a literature review of all cancer-related pneumopericardium cases reported in the last decade. We present the case of a 65-year-old male with a past medical history significant for locally advanced gastroesophageal junction adenocarcinoma who presented to the hospital with complaints of shortness of breath and fever. A chest X-ray showed an intact esophageal stent along with radiolucency around the cardiac silhouette which suggested pneumopericardium. Computed tomography scan of the chest confirmed the presence of pneumopericardium in posterior pericardium with foci of gas above the esophageal stent likely to be communicating with the pericardium. An echocardiogram was obtained which showed no signs of tamponade. Given the advanced nature of the disease we applied a conservative management given that the pneumopericardium was deemed to be small with no tamponade. Goals of care were discussed with the patient and his family and the patient opted for comfort care measures. This case report prompted us to perform an extensive literature review of cancer-related pneumopericardium from 2008 to 2019. We found 11 cases where it was reported secondary to malignancies of different kinds. Our aim is to compile a review for clinicians to view varied presentations and better direct therapy dependent on the individual case and clinical presentation in patients with cancer-related pneumopericardium. Moreover, although pneumopericardium is rare, it should be considered in differential diagnosis in patients presenting with shortness of breath or chest pain especially with cancers involving the cardiothoracic region.
PubMed: 32110216
DOI: 10.1159/000504935 -
Cureus Nov 2021Coronavirus disease 2019 (COVID-19) and its spectrum of respiratory illnesses ranging from mild to severe and critically ill have been well established. Spontaneous...
Coronavirus disease 2019 (COVID-19) and its spectrum of respiratory illnesses ranging from mild to severe and critically ill have been well established. Spontaneous pneumomediastinum and pneumopericardium (PP) appear to be less reported entities and have been found to be reported complications in COVID-19 infection. Pneumomediastinum (PM) and PP are characterized by the presence of air in the mediastinal and pericardial cavity, respectively. Although, generally, secondary to trauma or underlying lung conditions like asthma, bronchiolitis obliterans, and blunt trauma, it can also occur spontaneously without an evident primary cause. PM and PP are increasingly reported complications in COVID-19 patients adversely affecting clinical outcomes. We present a case series of patients with spontaneous pneumomediastinum and pneumopericardium in the presence of underlying COVID-19 infection and their management at our academic medical center.
PubMed: 34926035
DOI: 10.7759/cureus.19546