Neumorraquis y neumomediastino espontáneo asociado a crisis asmática en el adulto

Introducción: la forma más frecuente del síndrome de fuga de aire en la crisis asmática es el neumomediastino, siendo habitualmente de curso benigno. La neumorraquis es una complicación poco descrita en la literatura. Presentamos el caso clínico de un paciente de 35 años, portador de asma intermitente, y que ingresa a terapia intensiva por crisis bronco obstructiva severa, enfisema subcutáneo cervical y cara anterior de tórax. La tomografía de tórax demostró neumomediastino extenso y neumorraquis. No se documentó neumotórax ni compromiso hemodinámico por la crisis. Presentó evolución satisfactoria con ventilación mecánica invasiva, broncodilatadores y corticoides sistémicos.

A case report: Pneumomediastinum is the most common form of air leak syndrome in asthmatic crisis and is usually benign in nature. Pneumorrhachis is a complication that is rarely described in the literature. We present the clinical case of a 35-year-old patient with intermittent asthma who was admitted to the Intensive Care Unit due to a severe bronchoobstructive crisis, cervical subcutaneous emphysema, and anterior chest wall emphysema. Chest computed tomography revealed extensive pneumomediastinum and pneumorrhachis Pneumothorax or hemodynamic compromise due to the crisis was not documented. The patient showed a satisfactory outcome with invasive mechanical ventilation, bronchodilators, and systemic corticosteroids.

Relato de caso: O pneumomediastino é a forma mais comum de síndrome de presença de ar no mediastino em crises de asma, geralmente com curso benigno. A pneumorráquis é uma complicação raramente descrita na literatura. Apresentamos o caso clínico de um paciente de 35 anos, com asma intermitente, admitido na Unidade de Cuidados Intensivos por crise bronco-obstrutiva grave, enfisema subcutâneo cervical e de parede torácica anterior. A tomografia de tórax mostrou extenso pneumomediastino e pneumorraque. Não se observou pneumotórax ou comprometimento hemodinâmico devido à crise. Apresentou evolução satisfatória com ventilação mecânica invasiva, broncodilatadores e corticoides sistêmicos.

Clearing the air around spontaneous pneumorrhachis

We present a case of spontaneous pneumorrhachis associated with minimal pneumomediastinum from a tertiary care cancer hospital in Mumbai. A 16-year-old boy who was a case of Hodgkin lymphoma undergoing chemotherapy presented to the physician with complaints of cough associated with white-colored sputum and chest pain. Computed tomography of the chest done to rule out infection revealed pneumorrhachis, that is, air lurking in the spinal canal. Radiological and laboratory investigations were done to rule out crucial and life-threatening differentials. The patient was kept on observation, and finally, we figuratively cleared the air around the finding of “air in the spinal cord.” This is the first reported case in the literature of pneumorrachis in a patient with Hodgkin’s lymphoma

Comparison of the value of different scoring scales in predicting risk of stroke-associated pneumonia / 中国医师进修杂志

Objective:To explore the value of the age, atrial fibrillation, dysphagia, sex, stroke severity (A2DS2) score, the prestroke independence, sex, age, National Institutes of Health stroke scale (ISAN) score, acute ischemic stroke-associated pneumonia score (AIS-APS), and intracerebral hemorrhage associated pneumonia score without hematoma volume included (ICH-APS-A) in predicting risk of stroke-associated pneumonia (SAP).Methods:From January to June 2019, 304 patients with acute stroke who were hospitalized in the Lianyungang Hospital Affiliated to Xuzhou Medical University were analyzed retrospectively. There were 164 patients with acute ischemic stroke (AIS), including 82 patients with SAP. And there were 140 patients with intracerebral hemorrhage (ICH), including 70 patients with SAP. They were divided into SAP group (152 cases) and non-SAP group (152 cases) depending on whether they had SAP. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scores.Results:When predicting risk of SAP in patients with the stroke, the A2DS2 score had the largest AUC compared to the ISAN score, AIS-APS score, and ICH-APS-A score. When predicting risk of SAP in patients with AIS, the AUC (0.875, 95% CI 0.815 to 0.922) of the A2DS2 score was greater than the AIS-APS score and the ISAN score. When predicting risk of SAP in patients with ICH, the AUC (0.950, 95% CI 0.900 to 0.980) of the A2DS2 score was greater than the ICH-APS-A score and the ISAN score. When predicting risk of SAP in patients with AIS and ICH: 0.911 (95% CI 0.873 to 0.94) vs. 0.882 (95% CI 0.840 to 0.916), Z = 2.319, P = 0.020, the A2DS2 score was significantly better than the ISAN score ( P<0.05). When predicting risk of SAP in patients with AIS, the A2DS2 score, ISAN score, and AIS-APS score all have good predictive value ( P>0.05). When predicting SAP in patients with ICH, the A2DS2 score, ISAN score, and ICH-APS-A score all have good predictive value ( P>0.05). Conclusions:When predicting risk of SAP in patients, the A2DS2 score is a reliable prediction tool, with good predictive value.

A Case of Pneumorrhachis Associated with Spontaneous Pneumomediastinum and Subcutaneous Emphysema / 대한이비인후과학회지

Pneumorrhachis or epidural emphysema is an uncommon finding observed in the spinal epidural space. Pneumorrhachis could be occasionally associated with pneumomediastinum or pneumothorax or subcutaneous emphysema. Probably this results from air that leaks from the mediastinum, which traverses through the fascial planes and intervertebral neural foramina. In particular, without any causes, these conditions rarely appear simultaneously with trauma, surgery, malignancy, anesthesiological interventions, or Valsalva maneuvers. We report a case of pneumorrhachis accompanied by spontaneous pneumomediastinum and subcutaneous emphysema that was resolved after conservative treatment.

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion.

Pneumorraquis, espondilitis y meningitis secundarios a cistitis enfisematosa / Pneumorrhachis, spondylitis and meningitis secondary to emphysematous cystitis. Report of one case

We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses.

Spontaneous Pneumomediastinum with Concurrent Pneumorrhachis

Spontaneous pneumomediastinum is a very uncommon entity that is defined as the presence of free air in the mediastinum without an obvious etiology. The presence of air in the spinal canal, known as concurrent pneumorrhachis, is an extremely rare epiphenomenon of spontaneous pneumomediastinum. We report a rare case of spontaneous pneumomediastinum with pneumorrhachis associated with influenza. The patient was diagnosed without invasive procedures, was managed with supportive treatment, and recovered without any complications.

Atypical Traumatic Pneumorrhachis Accompanied by Paraparesis

Pneumorrhachis, caused by intraspinal air, is an exceptional but important radiographic finding that is accompanied by different etiologies. Pneumorrhachis, by itself, is usually asymptomatic and gets reabsorbed spontaneously. Therefore, the patients with pneumorrhachis are mostly managed conservatively. We encountered a unique case of atypical traumatic pneumorrhachis accompanied by paraparesis.

Patient with Pneumomediastinum and Air in the Spine.

Air in the epidural space of the spine in most cases is found in association with air in other body locations including pneumothorax, pneumomediastinum, pneumopercardium and subcutaneous emphysema. Most spontaneous cases resolve on their own. Here we present a 3 year old boy with pneumomediastinum and pneumorrhachis that resolved with supportive care.

A Case of Pneumorrhachis and Pneumoscrotum Following Colon Endoscopic Submucosal Dissection

Endoscopic submucosal dissection has been a useful treatment of selected colorectal neoplasia cases. The incidence of perforation related to colorectal endoscopic submucosal dissection is 5-20%. However, while there have been numerous reports regarding retroperitoneal, mediastinal, pleural and subcutaneous emphysema after therapeutic colonoscopy, pneumoscrotum is a relatively rare manifestation of perforation associated with colorectal endoscopic submucosal dissection. In particular, pneumorrhachis, or air within the spinal cord, following therapeutic colonoscopy, is extremely rare. Herein, we report a conservatively treated perforation case as having pneumorrhachis, penumoscrotum, and pneumoperitoneum after colorectal endoscopic submucosal dissection.

Symptomatic Epidural Pneumorrhachis : A Rare Entity

Pneumorrhachis, which involves the entrapment of air or gas within the spinal canal, is a rare clinical entity, and the pathogenesis and etiologies of this uncommon entity are various and can present a diagnostic challenge. Usually, pneumorrhachis represents an asymptomatic epiphenomenon but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of symptomatic epidural pneumorrhachis accompanying pneumothorax. Possible pathogenic mechanisms are discussed and a review of the literature is included.

A Case of Broncho-Paraspinal Fistula Induced by Metallic Devices: Delayed Complication of Thoracic Spinal Surgery

We present a case report of a 45-year-old woman with spontaneous pneumocephalus accompanied by pneumorrhachis of the thoracic spine, which is a very rare condition generally associated with trauma and thoracic or spinal surgery. The patient had undergone an operation about 10 years earlier to treat a giant cell tumor of the thoracic spine. During the operation, a metallic device was installed, which destroyed the bronchus and caused the formation of a broncho-paraspinal fistula. This is the suspected cause of her pneumocephalus and pneumorrhachis. To our knowledge, this is a very rare case of pneumocephalus accompanied by pneumorrhachis induced by metallic device, and when considering the length of time after surgery these complications presented are also exceptional.