Pneumopericardium, pneumomediastinum and surgical emphysema in spontaneous pneumothorax

Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural pneumatosis is rare. We report a 19-year-old man who presented with dyspnoea and swelling of the chest wall following a bout of cough. Bilateral subcutaneous emphysema was palpated on the anterior chest wall from the sternum to the midaxillary regions. His chest X-ray revealed subcutaneous emphysema and pneumopericardium. His computed tomography of the thorax to rule out life-threatening conditions revealed bilateral subcutaneous emphysema, pneumomediastinum, pneumo-pericardium and pneumothorax. He was transferred to the intensive care unit. An intercostal drainage tube was inserted in the left pleural cavity. The patient was followed up with repeat chest X-rays. The patient’s symptom got relieved and was discharged after day 9. Diagnosis of pneumomedia-stinum may not be as lamentable as it is seen. Close cardio-pulmonary monitoring is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management. In this case, the patient’s symptoms and severe tachypnoea prompted the insertion of an intercostal drainage tube.

Splenic tumor presenting as pyrexia of unknown origin.

Pyrexia of unknown origin has always been a challenging problem to diagnose for physicians. Here we present a case of a splenic tumor, which after histopathology and immunohistochemistry, two possibilities were considered, a diffuse large cell lymphoma--plasmablastic variant and second an anaplastic plasmacytoma. The patient was treated with chemotherapy and on followup he has no evidence of recurrence or any residual lesion.

Macrophage activation syndrome.

Macrophage Activation Syndrome is a rare and potentially fatal disease, to be considered in patients with a SIRS like clinical presentation. Falling ESR and hyperferritinemia in the appropriate clinical setting can be the greatest clues. We report a case in which a female admitted with fever and rash, initially had systemic inflammatory response syndrome (SIRS) like clinical presentation, but eventually proved to be a rare case of fatal Macrophage Activation Syndrome.