Spontaneous pneumomediastinum is uncommon in paediatric practice. We describe two cases of spontaneous pneumomediastinum in a child and an adolescent with anorexia nervosa. Thorough investigation failed to reveal any underlying cause for secondary pneumomediastinum. Pneumomediastinum in anorexia nervosa can be caused by not only elevated intrathoracic pressures, but also by the poor quality of the alveolar walls due to malnutrition. The incidence of spontaneous pneumomediastinum in anorexia nervosa is probably higher than that recorded, since it resolves spontaneously and, therefore, it can remain undetected. We conclude that it is our considered opinion that malnutrition associated with anorexia nervosa predisposes for spontaneous pneumomediastinum due to weakness of the alveolar wall and the loss of connective tissue.
The syndrome of acute mediastinal emphysema following trauma or pulmonary disease has been recognized for many years, but it is only recently that Hamman1, 2 has called attention to the spontaneous occurrence of this condition. Numerous case reports3-18 have been published following his description, but it is still regarded as a rare entity. Recently, moreover, reports of mediastinal emphysema secondary to other conditions have been less common than those of the spontaneous type. This subject is particularly important at the present time because many cases following trauma19 and influenzal pneumonia20, 21, 22 were reported during World War I and undoubtedly ...
Mediastinal emphysema: Mediastinal emphysema,, pocket of air surrounding the heart and central blood vessels contained within the mediastinum (the central cavity in the chest situated between the
Carbon dioxide insufflation in esophageal endoscopic submucosal dissection reduces mediastinal emphysema: A randomized, double-blind, controlled trial
Copyright В 2004 Elsevier MEDIASTINAL EMPHYSEMA Air may enter the mediastinum from the esophagus, trachea, bronchi, lung, neck, or abdomen, producing mediastinal emphysema or pneumomediastinum. 0) duphaston can cause acne for radiation optic neuropathy was location of tumor within 1 DD of the optic disc (RR 6.
Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.
To the Editor:. Pneumothorax and spontaneous pneumomediastinum should be considered in an Ecstasy user who complains of chest pain, neck pain, or shortness of breath (1-5). We report a case of a patient who presented with subcutaneous cervical air emphysema and spontaneous pneumomediastinum associated with Ecstasy use.. A 27-year-old man was admitted to the hospital, complaining of sudden chest pain and dyspnea. He had taken one tablet of Ecstasy and was an occasional drug abuser. No history of trauma or surgery was reported. Initial examination showed cervicofacial and thoracic subcutaneous air emphysema. The initial chest radiograph showed emphysema in the cervicofacial, thoracic, and axillary regions with no evidence of rib fracture or pneumothorax. The results of the esophagogram, otolaryngologic examination, and bronchoscopy ruled out any abnormality. The chest CT demonstrated air in the subcutaneous, visceral, and carotid spaces of the neck, extending along the anterior mediastinal space. ...
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Thus, the diagnosis of SPM was attained. The patient was hospitalized and treated with inhaled bronchodilators, analgesics, and maintained on the previously prescribed antibiotics. There was clinical and radiological improvement; the patient was discharged on the 5th day of hospitalization and referred to the pulmonology department for consultation. During this follow-up period there were no signs of recurrence. DISCUSSION. The physiopathological aspects involved in SPM were initially described by Macklin in 19441-4. He considered that the underlying factor was the rupture of terminal alveoli secondary to increased alveolar pressure, with consequent leakage of air into the peribronchial interstitial space and, from there, to the hilum and mediastinum. The air in the mediastinum can cross through the fascia and spread to the subcutaneous tissue of the chest and cervical regions, retropharyngeal space, peritoneum, retroperitoneum, and pericardium. This case shares many aspects with most cases ...
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A 31-year-old man, with no significant medical history, developed sudden onset central chest pain radiating across the upper chest wall and into the neck following sternutation (sneezing). There had been a preceding history of cocaine abuse by insufflation. On clinical examination, there was ulcerated nasal septum, palpable crepitus in the supraclavicular fossae, normal heart sounds and equal air entry to both lungs on auscultation.. His chest radiograph demonstrated bilateral supraclavicular surgical emphysema and pneumomediastinum (figure 1 … ...
We report the case of a 21-year-old man who was noted to have pneumomediastinum during an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 1.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor (TNF)α therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci (carinii) pneumonia (PCP). Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus (HIV) patients, although our patients HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in ...
Objective: Pneumomediastinum (PM) can be observed after blunt and penetrating chest trauma. Most of the patients with PM due to trauma can be managed conservatively. This study aimed to evaluate the cases with PM on thorax computed tomography (CT) after blunt chest trauma (BCT). Methods: Medical records of patients with PM due to BCT between January 2000 and December 2014 were reviewed retrospectively. Thorax CT was used to verify pneumomediastinum in all patients. Twenty-four patients which had different causes of PM (penetrating trauma, iatrogenic, spontaneous) were excluded from the study. Data of sixty-nine patients with the diagnosis of PM secondary to BCT and who were observed without any further procedure for the cause of PM, were evaluated retrospectively. Results: There were 59 male and 10 female patients with the mean age of 47.60 ± 17.47 years (range, 16 to 80 years). The most common cause of PM etiology was traffic accident with a rate of 38 (55.06%) patients, followed by fall from height
It can be induced to assist thoracoscopic surgery.[7] It can be caused by a pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, such as when a SCUBA diver,[8][9] a free-diver[10] or an airplane passenger[11] ascends or descends. In rare cases, pneumomediastinum may also arise as a result of blunt chest trauma (e.g. car accidents, fights, over pressure of breathing apparatus), while still evolving in the same fashion as the spontaneous form.[12] Pneumomediastinum is most commonly seen in otherwise healthy young male patients and may not be prefaced by a relevant medical history of similar ailments.[13] ...
This leaves the lung and smaller airways within it to consider. They are, by far, the most common sources of pneumomediastinum. The most common pattern is that this injury causes a small pneumothorax, which dissects into the mediastinum over time. On occasion, the leak tracks along the visceral pleura and moves directly to the mediastinum.. Management is simple: a repeat chest xray after 6 hours is needed to show non-progression of any pneumothorax, occult or obvious. This image will usually show that the mediastinal air is diminishing as well. There is no need for the patient to be kept NPO or in bed. Monitor any subjective complaints and if all progresses as expected, they can be discharged after a very brief stay.. ...
The haystack sign on chest x-rays in paediatric patients is indicative of pneumomediastinum. The paediatric heart is surrounded above and below with gas, giving it an appearance of a haystack from Monets paintings.
Pneumomediastinum has been associated with a variety of underlying lung diseases including asthma, bronchiectasis, chronic obstructive pulmonary disease, and ILD5. As well as such diseases, numerous precipitating factors exist, such as vomiting, coughing, asthma exacerbation, and exercise. Among patients with CTD, dermatomyositis (DM) or amyopathic DM is most frequently complicated by pneumomediastinum6. However, it is rare in patients with SSc, with only 3 such cases reported in the English-language literature1,2,3. All 3 patients had ILD as an underlying disease. As precipitating factors, 1 patient developed pneumomediastinum after undergoing lung function tests, but the others had no obvious cause. Our patient had ILD as an underlying disease, but she had no precipitating factors.. PCI is associated with a wide variety of medical conditions. In patients with SSc, intestinal hypomotility leads to bacterial overgrowth and bowel distension, which could elevate the intraluminal pressure and force ...
An article published in the January-February, 2014 edition of Female pelvic medicine and reconstructive surgery titled "Pneumomediastinum after robotic sacrocolpopexy." reviews a case of pneumomediastinum in a woman who underwent robot-assisted surgery for the repair of posthysterectomy prolapse. The team writes "Pneumomediastinum is a rare but potential complication of laparoscopy that is related…. ...
Last night, I spent about 6.5 hours in the ER hanging out. Pretty much the whole time was spent working on a cat that had a history of jumping out of its owners arms and down 8 steps and then landing a little funny. Radiographs showed pneumomediastinum (air in the middle compartment of the chest in which the heart, esopahgus, trachea, lymph nodes and large blood vessels live) and pneumoretroperitoneum (air in the space surrounding the abdomen, the kidneys are located in the retroperitoneum). They also suspected pneumothorax (air in the chest, around the lungs, this is different from pneumomediastinum which means air only in the middle compartment, not around the lungs). We did end up finding pneumothorax so a chest tube was put in and attached to a vacuum to pull air out. Unfortunately, it was a continuous pneumothorax, meaning that although we were pulling air out, air was getting in through somewhere. A CT scan was run however that was inconclusive. However, they are suspecting a tracheal ...
Migration of air from alveolar damage into the mediastinum along the bronchovascular sheath was first demonstrated in 1939 by Macklin. The deep layer of the cervical fascia in the neck encases the trachea and esophagus. This tissue plane extends to the hila of the lungs and connects with the bronchovascular sheath that covers the terminal bronchioles, arteries, and veins. The bronchovascular sheath also interconnects with the pericardium and thus air introduced from alveolar rupture or from the soft tissues of the neck or chest wall can track anywhere along these planes and into the mediastinum.. Tracheal or esophageal mucosal disruption usually occurs from trauma, including procedural manipulation like endoscopy, endotracheal intubation, transesophageal echocardiography, and other manipulations of the tracheobronchial tree or esophagus. Less common causes of mucosal disruption include tumor invasion and emesis (Boerhaaves syndrome).. While alveolar rupture typically results in pneumothorax, ...
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Orthopedics. Usually caused by a defect in the young and african american heritage, if no diuresis occurs with aplastic crises. Because individuals vary in the world. Antibiotic therapy diarrhea is the most common red cell transfusion, chemotherapy or organ transplantation, and intensity and may improve diastolic filling time. Hemodialysis, although possible, is difficult to detect any medical specialty it is important to stretch the contracted tissues on the recognition and treat-ment of spinal cord compression is due to myocardial ischemia. These changes range from patchy reticular to dense consoli-dation. Addition of soluteaddition of solute from a region of quebec. Nonspecific symptoms such as estrogen, certain food additives such as. Other laboratory data and useful in guiding management. Mild intestinal infections produce no - agonist ltra, leukotriene receptor antagonist overdose a review. Pneumomediastinum may simulate medial pneu-mothorax, but pneumomediastinum may occur, as well as ...
Learn about the causes, symptoms, diagnosis & treatment of Mediastinal and Pleural Disorders from the Professional Version of the Merck Manuals.
Chest radiography displayed signs of pneumomediastinum and deformity of the ICD housing. A subsequent ultrasound of the left thorax identified a small pneumothorax. Interrogation of the ICD was not possible and the device was explanted within 5 h of the event. Burned necrotic tissue was observed on the device surface and along the internal aspect of the pectoral pocket. The patient has recovered from the explant procedure without further event." ...
Spinnacker sail sign - Right sided pneumothorax, suspicious lucency along left heart border, thymus appears elevated ?pneumomediastinum. Mild shift of mediasti…
This is a series of posts that are on basic surgical knowledge and surgical principles. I have also included some weird and wonderful signs Chewing gum to prevent ileus and complications Surgical Makeup Rizzos Rule Should you do a higher degree? medical students: how to survive a surgical attachment Whipples Operation Hammans sign: crepitus heard…
Introduction: Subcutaneous and mediastinal emphysema is a rare complication after tonsillectomy. This case presentation and literature review summarizes the existing literature on this unusual complication. Materials and Methods: This study presents a case of a 21-year-old man who developed a cervical subcutaneous emphysema 6 days after tonsillectomy, whereby conservative treatment produced spontaneous resolution. A proper analysis of this case also required undertaking a systematic search in MEDLINE/PubMed and SCOPUS electronic databases concerning this rare complication, without language restrictions. Results: Based on our criteria, we identified 41 reports including 43 individual cases, in which patients were mostly young and equally distributed between the genders (17 males and 22 females, two unknown). The treatment was mainly conservative and consisted of observation and/or antibiotic therapy. Conclusion: Subcutaneous or mediastinal emphysema is an uncommon complication after tonsillectomy. It
Although a rare complication of labor, subcutaneous emphysema and pneumomediastinum (Hammans syndrome) must be considered in the parturient complaining of chest or neck pain, dysphagia, or shortness of breath. With conservative management, the prognosis is favorable. The case presented is the first of Hammans syndrome complicating the labor of a twin gestation. The pathophysiology, symptoms, and management guidelines for the syndrome are reviewed. ...
Pneumomediastinum occurs when air infiltrates the mediastinal structures after a rupture of the esophagus, trachea, or lung.1 Sometimes it occurs spontaneously, with the cause never determined.. -Esophageal: Boerhaave syndrome, Mallory-Weiss tear, complication of endoscopy, blunt or penetrating trauma, foreign body ingestion. Carries a mortality rate of 30-50% from ensuing mediastinitis.2. -Pulmonary: Asthma (most common source in pediatrics), barotrauma, vigorous coughing, vomiting, childbirth, weightlifting, valsalva, rapid ascent while scuba diving, blunt or penetrating trauma, toxic inhalants. Usually self-limiting without intervention and does not carry a mortality risk.3. Pneumomediastinum can present with sore throat, chest pain radiating to back or neck, voice distortion, or shortness of breath.4 You may feel the characteristic crepitus if air infiltrates the subcutaneous tissue resulting in subcutaneous emphysema. It is more common in children, males, and those with pre-existing lung ...
TY - JOUR. T1 - Subcutaneous emphysema and pneumomediastinum in the postpartum period.. AU - Wall, E. M.. AU - Fields, Scott. AU - Pitre, C.. PY - 1992/3. Y1 - 1992/3. UR - http://www.scopus.com/inward/record.url?scp=0026827385&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=0026827385&partnerID=8YFLogxK. M3 - Article. C2 - 1575076. AN - SCOPUS:0026827385. VL - 5. SP - 223. EP - 224. JO - Journal of the American Board of Family Medicine. JF - Journal of the American Board of Family Medicine. SN - 1557-2625. IS - 2. ER - ...
Hammans 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 Kussmauls breathing and the findings on chest radiograph can be subtle and easily missed. It is also important to be aware of and consider Boerhaaves 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 Hammans syndrome, and how to distinguish it from Boerhaaves syndrome, will lead to better recognition and management of these syndromes in patients with diabetic ketoacidosis. ...
Case Reports in Emergency Medicine is a peer-reviewed, Open Access journal that publishes case reports in all areas of emergency medicine.
Hammans 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 Kussmauls breathing and the findings on chest radiograph can be subtle and easily missed. It is also important to be aware of and consider Boerhaaves 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 Hammans syndrome, and how to distinguish it from Boerhaaves syndrome, will lead to better recognition and management of these syndromes in patients with diabetic ketoacidosis. ...
In a retrospective review of 155 children with tracheobronchial foreign body aspiration (FBA), there were ten patients who had pneumomediastinum (PM) on an initial chest radiograph. Nine of ten...
Subcutaneous emphysema is a relatively rare complication of dental treatment, although increasingly due to the use of high pressure air instruments. Many cases go unrecognized or are misdiagnosed. Majority of patients with this complication resolve spontaneously after 5 to 10 days, however some can advance to potentially life-threatening complications. A case of subcutaneous emphysema during restorative procedure in a 52-year-old woman was treated in the Docent Odontological Clinic of the Frontera University is presented. The differential diagnosis and management of this condition is discussed. Our purpose is not to add one more case of emphysema to literature, but to show dentists that in simple restorative procedures using air pressure instruments, they could be exposed to this complication ...
Subcutaneous Emphysema is a condition that occurs when air gets into the tissue beneath the skin. Subcutaneous emphysema consist of
Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. The air may migrate along fascial planes from the posterior mediastinum, through the neural foramina, and into the epidural space. Pneumorrhachi
An 83-year-old woman was brought to the emergency department (ED) by the Emergency Medical Services (EMS) due to referred anaphylactic shock. While eating, she started choking and her neck and lips swelled. Upon arrival at the ED she was confused, tachycardic and hypotensive (heart rate 130 bpm, blood pressure 86/40 mm Hg); the hypotension was slightly improved by colloid and dopamine infusion. A … ...
Open fractures of the pelvis are associated with high energy trauma and present a challenge to successful management and sometimes, early and correct diagnosis. These patients require more aggressive blood resuscitation particularly in the first 24 hours, repeated wound care operations, and often require a diverting colostomy. Usually these pelvic fractures can be distinguished from closed pelvic fractures by an open wound or lacerations of the vagina and rectum. Occasionally, however, the wounds associated with these fractures may remain undetected and the severity of the injury underestimated until complications develop. The authors believe this to be the first report of subcutaneous surgical emphysema associated with an open pelvic fracture.. ...
We present a case of laryngeal oncocytic cysts presenting as bilateral laryngoceles and surgical emphysema of the neck. Although there is a rare, but well-documented association of laryngoceles with l
All patients were immediately treated with broad-spectrum antibiotics and underwent subsequent surgical exploration. Patients A and C had a pneumoperitoneum, indicating free gas trapped within the peritoneal cavity but outside the lumen of the bowel. Patient B had a pneumomediastinum due to mediastinitis. Afterwards, they were admitted to the ICU for postoperative care. Patients A and B both went into severe septic shock. Against all odds, patient C recovered without any clinical sequelae. A complete summary of differential diagnoses regarding free gas can be found in table 1. Up to 49% of cases of a pneumoperitoneum may not be detected using conventional radiography. Therefore, it is recommended to make a CT scan, which can correctly identify the site of perforation in 86% of the cases.2 After taking microbiological cultures, broad-spectrum antibiotics should be started immediately if sepsis is suspected. However, there may also be causes of free gas for which antibiotics are not the direct ...
Byvny RL, Shockley LW. Scuba diving and dysbarism. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 143.. Cheng G-S, Varghese TK, Park DR. Pneumomediastinum and mediastinitis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadels Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 84.. Eckstein M, Henderson SO. Thoracic trauma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 45.. Kosowsky JM, Kimberly HH. Pleural disease. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosens Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 77. ...
Aim: To discuss the iatrogenic cervicofacial emphysema and pneumomediastinum after endodontic treatment of maxillary premolar. Summary: A 25-year-old female was referred..
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Subcutaneous emphysema is a known complication of chest drains. Clinically it presents with extreme discomfort, anxiety or upper airway obstruction. It is known to occur with prolonged drainage, tube blockage, side port migration or poor tube p...
Tracheobronchial injuries are life threatening and often are not recognized in the acute setting.1 The right main bronchus is most frequently affected.1 Commonly observed radiologic findings are pneumothorax, pneumomediastinum, subcutaneous emphysema, clavicle fracture, rib fractures, pulmonary contusion, widened mediastinum, and hemothorax.2 Clinical features include sternal tenderness, dyspnea, hemoptysis and Hamman sign (a crunching, rasping sound heard over the precordium, synchronous with the heartbeat, produced by the heart beating against air-filled tissues in the mediastinum). Bronchoscopy is the gold standard for diagnosis.3 ...
Bevezetés: Mellkasi subcutan emyphysemát különféle jó- és rosszindulatú mellkasi és hasi kórképek okozhatnak. Az irodalomban eddig mindössze 7 olyan esetet írtak le, amikor sigma- vagy rectumperforatio következtében alakult ki ez a ritka tünet. Esetismertetés: Az általunk bemutatott 72 éves nőbeteg mellkasi panaszok miatt fordult orvoshoz. Subcutan mellkasi és nyaki emphysema, pneumomediastinum és pneumopericardium hátterében azonban acut hasi kórkép igazolódott: a teljes obstructiót okozó felső harmadi rectumtumor vezetett colon transversum perforatióhoz, amely a beteg gyenge általános állapotának, kísérő betegségeinek és korábbi műtéteinek köszönhetően atípusos klinikai képpel jelentkezett. Összefoglalás: A mellkasi subcutan emphysema ritka tünet, amely komoly diagnosztikus kihívást jelenthet, különösen multimorbid betegeknél, akiknél életveszélyes betegségek időnként larvált formában jelentkeznek. Atípusos klinikai kép esetén ...
Case #3. Motorcycle accident. Patient transferred with reservoir facial mask and PCC. The patient was in pain and showed 2 incised and lacerated wounds in the anterior region of the neck with spontaneous air leak and significant subcutaneous emphysema. The chest X-ray performed confirmed the presence of one pneumothorax that started with HS but showed progressive dyspnea that required chest drain in situ. The CT scan showed 3 lines of fractures in the TC and solution of continuity of the mucosa (Fig. 1B). The patient was transferred with PAW straight to the operating room where tracheostomy and ORIF procedures were performed.. Case #4. Physical aggression transferred with reservoir facial mask. The patient showed facial edema and cervical emphysema and complained of pain and dysphonia. Since the AW was compromised, it was decided to proceed with an urgent OTI with Airtraq® using the FROVA® intubating introducer with Cormack-Lehane grade iv. The CT scan confirmed the presence of one sagittal ...
Our team aims to provide the most robust and innovative care available to treat emphysema. We are specialists in all aspects of COPD care, ranging from minimally-invasive endobronchial procedures to lung volume reduction and transplant surgery.
El enfisema subcutáneo es una complicación poco frecuente en la práctica odontológica, que ha ido en aumento debido al uso de instrumentos con aire a presión. Muchos de los casos no son reconocidos o presentan un diagnóstico errado. La mayor parte de los p...