Síndrome de Hamman em gestante: relato de caso / Hamman syndrome in pregnant women: case report

A síndrome de Hamman foi descrita pela primeira vez por Louis Hamman, em 1939, como "enfisema mediastinal espontâneo" e corresponde à presença de ar livre no mediastino, sem relação com trauma e/ou procedimentos invasivos na região torácica. A condição apresenta sintomas inespecíficos como dor torácica, dispneia, tosse, disfonia, disfagia e dor cervical. Devido aos sinais e sintomas inespecíficos, essa condição pode ser subdiagnosticada, contribuindo para a sua baixa incidência. O diagnóstico é estabelecido com exames de imagem como radiografia e tomografia computadorizada de tórax. No relato de caso descrito, temos uma paciente de 31 anos, gestante, G2P1A0, que desenvolve a síndrome concomitantemente a episódios de hiperêmese gravídica com cinco semanas e cinco dias de idade gestacional. O objetivo deste relato concentra-se em destacar essa hipótese diagnóstica para assistência adequada à paciente, uma vez que tal condição não faz parte do escopo cotidiano dentro da obstetrícia.(AU)

Hamman's syndrome was first described by Louis Hamman in 1939 as "spontaneous mediastinal emphysema" and is characterized by the presence of air in the mediastinum, unrelated to trauma, and/or invasive procedures in the thoracic region. The condition presents nonspecific symptoms such as thoracic pain, cervical pain, dyspnea, cough, and dysphonia. Due to the nonspecific signs and symptoms, this condition can be misdiagnosed, contributing to its low incidence. A diagnosis is established through imaging examinations such as chest radiography and computerized tomography. Here, we report the case of a 31-year-old female who developed Hamman's syndrome concomitantly with episodes of severe hyperemesis when she was five weeks and five days pregnant. Hamman's syndrome is a rare presentation in the field of obstetrics. This report seeks to highlight how Hamman's syndrome was diagnosed, discuss the care given to the patient, and explain the correlation between hyperemesis gravidarum and Hamman's syndrome.(AU)

Caso Clínico: Neumomediastino Anterior, Secundario a Procedimiento Dental / Case Report: Anterior Pneumomediastinum, Secondary to Dental Procedure

INTRODUCCIÓN: El neumomediastino es la presencia de aire en el mediastino, tiene incidencia variable que oscila entre 1/80 000 y 1/42 000 a nivel mundial, genera una diversidad de características clínicas, puede ser secundario a entidades torácicas o extra torácicas; dentro de las causas extratorácicas, podemos asociarlo a procedimientos dentales siendo de vital importancia considerar la posibilidad y la asociación a dichos procedimientos para su diagnóstico y tratamiento adecuado. CASO CLÍNICO: Paciente de sexo femenino de 23 años, que 24 horas previas a su ingreso, se realizó procedimiento dental tipo exodoncia del tercer molar inferior izquierdo, en el que se usó instrumental manual y neumático, que debió ser suspendido; la paciente presentó dolor intenso más dificultad respiratoria, posterior a ello dolor torácico opresivo, mandibular y en cuello de lado izquierdo, acompañado de enfisema subcutáneo en hemicara izquierda, cuello bilateralmente y subclavicular izquierdo. EVOLUCIÓN: Paciente es ingresada con diagnóstico de neumomediastino secundario a procedimiento dental para tratamiento antibiótico de amplio espectro y vigilancia, durante su hospitalización por tres días permanece estable, afebril con mejoría clínica general. CONCLUSIÓN: El neumomediastino es una complicación poco frecuente tras intervenciones odontológicas, se debe sospechar por el uso de instrumental neumático que disecan los tejidos blandos faciales, del cuello y tórax; la paciente tuvo una evolución favorable en base al diagnóstico y tratamient

BACKGROUND: Neumomediastinum is defined as the presence of air in the mediastinum, It has variable incidence that oscillates between 1/80000 and 1/420000, generates a diversity of clinical characteristics. It can be secondary to thoracic or extra thoracic entities, within extrathoracic causes; it can be associated with dental procedures, being of vital importance consider the possibility and the association to this procedure to get to an adequate diagnosis and treatment. CASE REPORT: A 23-year-old female patient who, 24 hours prior to admission, underwent a dental procedure such as a third-molar left third molar extraction, in which manual instruments and pneumatics dental lathe were used, which had to be suspended; the patient presented severe pain plus respiratory difficulty, after that she presented oppressive chest pain, mandibular and left side neck, accompanied by subcutaneous emphysema in the left side of the face, neck bilaterally and left subclavicular EVOLUTION: The patient was hospitalize with a diagnosis of neumomediastinum secondary to dental procedure to receive treatment with broad spectrum antibiotic and surveillance, during her hospitalization for three days she remains stable, afebrile with general clinical improvement. CONCLUSIONS: The neumomediastinum is a rare complication after odontological interventions. It should be suspected when pneumatic instrument lathe are used that dissect facial, neck and thorax soft tissues; the patient had a favorable evolution based on the diagnosis and early treatment proposed by the doctors according to the patients symptoms.

Neumomediastino espontáneo recidivante / Recurrent Spontaneous Pneumomediastinum

El neumomediastino espontáneo se caracteriza por la presencia de aire en el mediastino. Es una enfermedad generalmente benigna y autolimitada, no asociada a causa directa conocida. Es de infrecuente ocurrencia. Se presenta principalmente con dolor torácico, disnea y enfisema subcutáneo. El diagnóstico se realiza sobre la base del cuadro clínico y radiografía o tomografía axial computarizada de tórax. Se presenta el caso de un paciente masculino de 17 años de edad, atleta de alto rendimiento, que comienza de forma súbita con dolor torácico, disnea y enfisema subcutáneo. Se le realizó radiografía de tórax en la que se observa la presencia de aire en el mediastino, y se corrobora el diagnóstico de neumomediastino mediante tomografía axial computarizada de tórax. Recibió tratamiento conservador con mejoría evidente. Aunque la literatura reporta que no es habitual la recurrencia, en el paciente que se presenta hubo recidiva del neumomediastino a los tres meses del primer evento. Se presenta este caso por lo infrecuente de esta enfermedad y su recurrencia(AU)

Spontaneous pneumomediastinum is characterized by the presence of air in the mediastinum. It is a generally benign and self-limiting disease, not associated with known direct cause. It is of infrequent occurrence. It presents mainly with chest pain, dyspnea and subcutaneous emphysema. The diagnosis is made based on the clinical picture and chest X-ray or computed tomography. It is presented a male patient of 17 years old, a high performance athlete, who started suddenly with chest pain, dyspnea and subcutaneous emphysema. A chest x-ray was performed and the presence of air in the mediastinum was observed, confirming the diagnosis of pneumomediastinum by means of computerized tomography of the thorax. He received conservative treatment with obvious improvement. Although the literature reports that recurrence is not common, there was a recurrence of the pneumomediastinum three months after the first event. This case is presented because of the infrequence of this condition and its recurrence(AU)

Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years / Pneumomediastino espontâneo: experiência adquirida com 18 pacientes nos últimos 12 anos

ABSTRACT Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

RESUMO Objetivo: Caracterizar clinicamente todos os pacientes com pneumomediastino espontâneo (PME) admitidos em uma enfermaria de pneumologia para adultos em Lisboa, Portugal. Métodos: Estudo descritivo retrospectivo no qual foram analisados todos os pacientes adultos (≥ 18 anos de idade) com diagnóstico de PME entre janeiro de 2004 e setembro de 2015. Resultados: Pelo menos um fator predisponente foi identificado na maioria (isto é, em 88,9%) dos 18 pacientes que apresentaram PME durante o período de estudo. No tocante a fatores precipitantes, crises de tosse ocorreram em 50,0% dos pacientes. Outros fatores precipitantes foram um aumento repentino do consumo de tabaco, uso de drogas inalatórias, inalação ocupacional de vapores de vernizes, exercício intenso e vômitos. As queixas mais comuns foram dispneia (em 83,3%) e dor torácica (em 77,8%). Outras queixas foram tosse, cervicalgia, disfagia e odinofagia. Constatou-se a presença de enfisema subcutâneo na maioria dos pacientes. O diagnóstico de PME baseou-se na radiografia de tórax em 61,1% dos pacientes. Conclusões: Embora seja uma doença rara, o PME deve ser levado em conta no diagnóstico diferencial de dor torácica e dispneia. O PME pode surgir sem um evento desencadeante e sem achados conclusivos na radiografia de tórax, que é geralmente suficiente para o diagnóstico.

Dolor cervical como presentación de neumomediastino espontáneo en urgencia pediátrica. Caso clínico / Cervical pain as presentation of spontaneous pneumomediastinum in pediatric emergency. Case report

Spontaneous Pneumomediastinum is a rare clinical situation in pediatric emergency services, sometimes it presents with guiding symptoms, but in other occasions in a very nonspecific way. Definitely, needs to be highly suspected, emphasizing in the anamnesis the antecedent of intense physical exercise before the development of the triggering symptoms that determinates the consult, generally having a good evolution that gets solved in 3-4 days. There is a pediatric clinical case presented, that permits us to discuss the more relevant aspects of the clinical presentation, diagnosis methods and the updated management, in pediatric emergency services.

Pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema after endoscopic submucosal dissection of a rectal lateral spreading tumor / Pneumorretroperitônio, pneumomediastino e enfisema subcutâneo após dissecção endoscópica da submucosa de lesão retal de crescimento lateral

Introduction: Endoscopic submucosal dissection (ESD) is an already established procedure in the treatment of gastric and esophageal cancer in its early stages. Colorectal lesions, initially approached by endoscopic mucosal resection en bloc or in fragments, are the current focus for submucosal approach, especially for superficial lateral spreading tumor of 20 mm-diameter. The experience of Japanese centers, which are reference in therapeutic endoscopy, demonstrates reduction in the rate of disease recurrence with this approach and, according to specific histopathological criteria, may avoid colectomy in some cases of malignant neoplasia. Case report: The patient was 50-year-old female. She underwent endoscopic submucosal dissection of a rectal lateral spreading tumor measuring 50 mm, located 8 cm from the anal margin. The procedure was performed without major complications, with just two points for muscle layer detachment, without gross perforation and closed with metal clips. However, the patient developed air leakage to the peritoneum, retroperitoneum, mediastinum and subcutaneous tissue, being only treated with clinical procedures and without additional intervention. Conclusion: It is vital to know and be able to apply the technique of ESD, in addition to addressing its complications, since despite the numerous benefits compared to surgery, ESD can result in serious outcomes. (AU)

Introdução: A dissecção endoscópica da submucosa (ESD) já é procedimento consagrado no tratamento do câncer gástrico e esofagiano em suas fases precoces. As lesões colorre-tais, inicialmente abordadas por mucossectomia, em bloco ou em fragmentos, são o foco atual para a abordagem submucosa, principalmente para os tumores de crescimento lateral superficial a partir de 20 mm de diâmetro. A experiência de centros japoneses, referências em endoscopia terapêutica, demonstram redução no índice de recidiva da doença com esta abordagem e, segundo critérios histopatológicos específicos, podem evitar uma colectomia em alguns casos de neoplasia maligna. Relato de caso: Trata-se de paciente de 50 anos, submetida à dissecção endoscópica da submucosa de lesão de crescimento lateral, com 50 mm, localizada no reto, a 8 cm da margem anal. O procedimento foi realizado sem maiores intercorrências, com apenas dois pontos de afastamento da muscular, sem perfuração grosseira, fechados com clipe. Entretanto, a paciente evoluiu com escape aéreo para peritônio, retroperitônio, mediastino e subcútis, sendo tratada sem intervenção adicional, apenas com manejo clínico. Conclusão: É de fundamental importância conhecer e saber aplicar a técnica da ESD, além de abordar suas complicações, uma vez que, mesmo repleta de benefícios em relação à cirurgia, ela pode apresentar desfechos graves. (AU)

A Case of Pneumomediastinum and Parapneumonic Effusions Following Pharyngeal Perforation Caused by Shouting

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.

Neumomediastino espontáneo (síndrome de Hamman), una entidad poco frecuente no siempre reconocida / Spontaneous pneumomediastinum

Introduction: pneumomediastinum or Hamman syndrome usually appears in young males; any condition provoking Valsalva maneuvers can be a predisposing factor. Clinical case: we report an 18 years old male admitted to the emergency room for polydipsia, polyphagia, malaise, profuse vomiting and chest pain. A diabetic ketoacidosis was diagnosed and a chest X ray film showed a pneumomediastinum. The patient was compensated metabolically and an esophageal X ray examination discarded esophageal perforation. He was discharged in good conditions seven days after admission.

Introducción: el neumomediastino espontáneo corresponde a la presencia de aire en el mediastino sin relación con patología traumática o iatrogénica. Fue descrito por primera vez por Hamman en 1939. Se presenta con baja frecuencia y se caracteriza principalmente por dolor torácico y disnea. La manifestación más importante al examen físico es el enfisema subcutáneo. Material y Método: se presenta un caso clínico de un paciente de 18 años de edad que consulta por un cuadro de cuatro semanas de evolución caracterizado por compromiso del estado general y polidipsia, polifagia y baja de peso acompañados de vómitos profusos. Se diagnostica una cetoacidosis diabética como debut de una Diabetes Mellitus tipo I. El paciente evoluciona con dolor torácico y en el TC de tórax se evidencia la presencia de un neumomediastino. Discusión: el neu-momediastino espontáneo se produce habitualmente en pacientes jóvenes de sexo masculino sin morbilidad crónica pero se reconocen numerosas condiciones predisponentes y factores desencadenantes. Dentro de las condiciones que más se asocian a este cuadro se encuentra el asma, consumo de tabaco y drogas. Como factores desencadenantes se reconoce cualquier situación que genere una maniobra de Valsalva. El diagnóstico se hace en base al cuadro clínico y radiografía o TC de tórax. Se deben descartar otras causas más graves de neumomediastino. Conclusión: ésta es una enfermedad de baja frecuencia. El diagnóstico se realiza en base a un cuadro clínico compatible y estudios de imagen. El tratamiento es conservador y el curso clínico es habitualmente benigno. Las recurrencias son inhabituales.

Neumomediastino espontáneo: caso clínico y revisión de la literatura / Spontaneous pneumomediastinum: clinical case and literature review

El neumomediastino espontáneo (NE) es una entidad infrecuente, de curso habitualmente benigno y resolución espontánea. Se puede vincular a factores desencadenantes o presentarse en ausencia de ellos. se describe un caso de NE y se revisa la literatura puntualizando en aspectos epidemiológicos, diagnósticos y terapéuticos. se enfatiza en el alto índice de sospecha clínica requerido para su diagnóstico, principalmente en pacientes jóvenes que se presentan con dolor torácico.

Factores predisponentes y evolución del neumomediastino espontáneo en niños y adolescentes / Spontaneous pneumomediastinum in children and adolescents: predisposing factors and evolution

El neumomediastino de niños y adolescentes suele constituir una afección benigna y autolimitada. Se reconoce al asma como principal factor de predisposición. Si se dispone de una historia clínica precisa y en ausencia de complicaciones, puede considerarse apropiado el tratamiento ambulatorio.

Pneumomediastino espontâneo em adolescente após visita a parque de diversões / Spontaneous pneumomediastinum in adolescent after visit an amusement park

Objetivos: Descrever um caso de pneumomediastino espontâneo ocorrido após passeio a parque de diversões e avaliar seus possíveis desencadeantesdiretos. Descrição: Adolescente de 14 anos apresentou dor torácica e enfisema subcutâneo cervical pouco após ida a parque de diversões. Radiografia demonstrou pneumomediastino. Conclusões: O pneumomediastino espontâneo é uma entidade rara, de caráter benigno e evolução autolimitada, causado pelo gradiente de pressão gerado entre oespaço intra-alveolar e o interstício perivascular, em situações que simulem a manobra de Valsalva, liberando ar para o mediastino, subcutâneo e retroperitônio, como episódios de vômitos, tosse intensa, crise asmática, exercício físico extenuante e uso dedrogas inalatórias. Os principais achados clínicos são dor torácica, dispneia e enfisema subcutâneo. O tratamento é expectante, com analgesia e observação clínica na maioria dos casos, com evolução autolimitadaentre 3 e 15 dias.

Objectives: To report a case of spontaneous pneumomediastinum that occurred after a visit to an amusement park, and to evaluate its main precipitating factors. Description: A 14 year-old boy presented to the Emergency Department with thoracic pain and cervical subcutaneous emphysema short after having been to an amusement park. Chest and neck X-ray demonstrated the pneumomediastinum. Conclusions: Spontaneous pneumomediastinum (SPM) is a rare, benign and self limited disease, caused by an alveolar rupture due to sudden intrathoracic pressure changes, in a setting which simulates a Valsalva maneuver, with air dissecting its way to the mediastinum, subcutaneous and retroperitoneum, such as vomiting, intense cough, asthma exacerbations, extenuating exercises and inhaled drugs. Main clinical findings are chest pain, dyspnea and subcutaneous emphysema. Treatment consists mainly in analgesics and clinical observation in the majority of cases, with an evolution self-limited to 3 to 15 days.

Iatrogenic tracheal tear / Desgarro traqueal iatrogénico

Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

Grandes desgarros traqueales tras una entubación se detectan usualmente intra-operativamente debido a señales inestables, a saber, ventilación defectuosa y enfisema del mediastino. Tales desgarros requieren a menudo tratamiento quirúrgico. Los desgarros traqueales menores no se ven a menudo durante la anestesia y se reconocen sólo durante el periodo postoperatorio. Un tratamiento conservador debe ser objeto de consideración en estos últimos casos.

Neumomediastino Espontáneo: reporte de un caso y revisión de la literatura / Spontaneous pneumomediastinum: report of a case and literature review

El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.

Neumomediastino espontáneo: a propósito de un caso / Spontaneous pneumomediastinum: report of one case

Presentamos el caso de neumomediastino espontáneo en un hombre joven sin asociación a algún desencadenante o patología, que consulta por dolor cervical irradiado a región supraclavicular derecha y con examen físico compatible con enfisema cervical. La evaluación inicial incluyó estudio radiológico de cuello, columna cervical y tórax. La tomografía axial computada demostró un neumomediastino con extensión al cuello sin patología pulmonar subyacente, se complementó el estudio con esofagograma. La evolución del paciente fue satisfactoria y asintomática, como se describe en los casos reportados en la literatura internacional. Se discute la fisiopatología del neumomediastino.

We report a 22 years old male that consulted in the emergency room for a painful cervical mass that appeared spontaneously and grew rapidly. On physical examination cervical and supraclavicular subcutaneous emphysema was noted. Neck and chest CAT scan showed a pneumomediastinum in the absence of lung lesions. The condition subsided spontaneously in 24 hours and the patient remains asymptomatic.

Enfisema em decorrência de procedimentos odontológicos: revista de literatura / Surgical emphysema due dental procedures: review of the literature

Enfisema é um acidente relativamente raro que pode ocorrer em decorrência de procedimentos odontológicos. Apesar da maioria dos casos se resolverem espontaneamente, eles podem levar a complicações que exijam uma intervenção de emergência. É importante um correto diagnóstico, bem como um adequado manejo desta condição. Decidiu-se realizar uma revista de literatura para aprofundar os conhecimentos em um tema pouco abordado na prática odontológica

Síndrome de Hamman, revisión bibliográfica y presentación de un caso / Hamman syndrome, literature review and case report

Introducción: El neumomediastino se define como la presencia de aires en el espacio mediastinito. Desde su introducción en la literatura por Hamman se ha podido determinar su origen en la lesión alveolar por barotrauma. Generalmente tiene un curso benigno afectando a hombres entre los 20-30 años de edad.Objetivo: Revisión bibliográfica y presentación de caso.Lugar de aplicación: Hospital polivalente de alta complejidad.Caso Clínico: Varón de 22 años que consulta por dolor en hemotórax derecho, alteración del tono de vos y enfisema subcutáneo cervical. Al examen físico se constata signo de Hamman. Se solicita radiografía de tórax haciéndose diagnóstico de neumomediastino. Se instaura tratamiento médico con buena evolución sin requerir tratamiento quirúrgico.Discusión: El neumomediastino es una patología poco frecuente de curso generalmente benigno. Su diagnóstico obliga a descartar otras causas como la perforación esofágica o lesión del árbol traqueobronquial. Su tratamiento implica medidas de sostén y en algunos casos oxígeno a altas dosis, reservando el tratamiento quirúrgico a las complicaciones como el taponamiento cardíaco o neumotórax hipertensivo.

Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children.

The aim of this study was to analyze the clinical spectrum and seek potential curable causes of spontaneous pneumomediastinum (SPM) in children in order to minimize respiratory morbidity. Medical records from 1986 to 2003 were retrospectively reviewed at a tertiary pediatric facility in northern Taiwan. Sixteen cases of SPM were identified. There were eleven boys and five girls (M:F = 2.2:1) and ages ranged from 2 to 17 years (average, 10 years). Cough (81%), dyspnea (75%) and chest pain (56%) were the predominant symptoms and expiratory wheezing (63%) and neck crepitus (50%) were the most common physical findings. The specific sign of Hamman's crunch was noted in only one child initially. A coughing-related Valsalva maneuver (13 patients/81%) was the most common cause of pneumomediastinum in these children. The most common underlying medical causes were asthma (8 patients/50%) and idiopathic origin (5 patients/31%). Acute gastroenteritis, foreign body aspiration and mycoplasmal pneumonia were each found in one patient respectively. All patients had subcutaneous emphysema on initial chest radiographs. Two patients were complicated by pneumothorax and required intensive respiratory therapy. The average hospital stay was 4 days (range 1-9 days). Rapid resolution of symptoms without long-term sequelae was common except for one patient who had hypoxic-ischemic encephalopathy with epilepsy after foreign body removal. We conclude that in young teenagers, who suffer from cough, dyspnea, chest pain and associated discomfort of throat or neck, the diagnosis of SPM should be considered and chest radiography including posterior-anterior and lateral projections should be performed to verify the diagnosis. Because of the high prevalence of asthma related SPM, children of idiopathic SPM should undergo diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma. Targeted investigations of the underlying causes of SPM might decrease respiratory morbidity and avoid further complications.

Enfisema subcutâneo e pneumomediastino após amigdalectomia: relato de caso / Onset of subcutaneous emphysema and pneumomediastinum after tonsillectomy: a case report

Várias complicacões podem estar relacionadas a procedimentos cirúrgicos na área de cabeca e pescoco. Entre elas, o pneumomediastino, pneumotórax e enfisema subcutâneo ocorrem raramente. Relatamos o caso de uma paciente submetida a tonsilectomia palatina que evoluiu com enfisema subcutâneo da região cervical, torácica e pneumomediastino. Em cirurgias de tonsilas palatinas devem ser observados cuidados com a intubacão, uso de máscara sob pressão positiva com oxigênio na recuperacão anestésica, atos cirúrgicos intempestivos e uso de aparelhos que proporcionem lesão excessiva na loja tonsiliana a fim de se evitar as complicacões descritas.