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1.
BMJ Case Rep ; 14(9)2021 Sep 03.
Article in English | MEDLINE | ID: mdl-34479899

ABSTRACT

Primary pneumomediastinum is the presence of air in the interstitium of the mediastinum. The exact aetiology is unclear; nevertheless, it has been reported more frequently in patients with asthma and in individuals who use recreational drugs. It is commonly preceded by a sharp rise in intrathoracic pressure as in a Valsalva-like manoeuvre. We describe a rare case of severe pneumomediastinum with a small pneumothorax related to cannabis smoking and aggravated by vigorous sexual intercourse. The patient was successfully treated conservatively due to clinical and radiological stability and the absence of secondary cause.


Subject(s)
Cannabis , Mediastinal Emphysema , Pneumothorax , Coitus , Humans , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Smokers
2.
Cureus ; 14(12): e33144, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36721586

ABSTRACT

Hamman's syndrome is an uncommon complication of labor. Its diagnosis is based on clinical suspicion and CT imaging. It is often a benign and self-limiting condition occurring in healthy patients. The risk factors are nulliparity and a prolonged second stage of labor. Hamman's syndrome has life-threatening implications that underscore the importance of early diagnosis and management to avoid any difficulty. This paper discusses the case of a 21-year-old, healthy female without allergies who was admitted to the hospital in spontaneous labor at 40 weeks of gestation. During the second stage of labor, she developed Hamman's syndrome and presented with subcutaneous emphysema, which led to an emergency C-section. After a chest and cervical CT scan that showed extensive subcutaneous emphysema and a pneumomediastinum, the patient was admitted to the ICU.

3.
Rev. patol. respir ; 25(4): 138-149, Oct-Dic. 2022. tab, ilus
Article in Spanish | IBECS | ID: ibc-214586

ABSTRACT

La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 delsíndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la pobla-ción general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento delgradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobreunos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo locual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía porSARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes conneumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensi-vos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, elneumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que seresuelve con tratamiento conservador.(AU)


The incidence of pneumomediastinum in hospitalised patients diagnosed with SARS-CoV-2 pneumonia is by no means ne-gligible, much higher compared to the general population. The pathophysiology of pneumomediastinum in severe acute res-piratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is explained by the increase in alveolar-interstitial pressure gradient(dry coughing spells, respiratory work, barotrauma from ventilatory support) in the context of particularly “fragile” lungs due todiffuse alveolar-interstitial damage from infectious-inflammatory origin, all of which significantly increases the risk of alveolarwall rupture. The more severe the SARS-CoV-2 pneumonia, the more likely it is that pneumomediastinum will occur. The deve-lopment of pneumomediastinum in patients with SARS-CoV-2 pneumonia is associated with higher frequencies of death,intensive care unit (ICU) admission and tracheostomy and longer hospital and ICU lengths of stay. In most cases, pneumo-mediastinum in SARS-CoV-2 pneumonia is a benign and self-limiting process that resolves with conservative treatment.(AU)


Subject(s)
Humans , SARS Virus , Mediastinal Emphysema , Pneumonia , Incidence , Coronavirus Infections/epidemiology , Barotrauma , Pneumothorax , Lung Diseases , Respiratory Tract Diseases
4.
Rev. esp. patol. torac ; 34(4): 196-199, dic. 2022. tab, ilus
Article in Spanish | IBECS | ID: ibc-214617

ABSTRACT

El objetivo del presente estudio de serie de casos se centra en la descripción de las posibles causas responsables de la aparición de neumomediastino en la infección por el virus SARS-CoV-2. Para ello se han descrito las características de los pacientes ingresados en el Hospital de Jerez de la Frontera que desarrollaron esta complicación, detallando los factores de riesgo, motivo de ingreso hospitalario, factores desencadenantes de neumomediastino, así como la clínica y tipo de oxigenoterapia recibida durante su ingreso. Tras su estudio, se concluye que la etiología más probable de aparición de neumomediastino en estos cuatro sujetos fue la neumonía bilateral por el virus SARS-CoV-2, pudiendo también contribuir de manera importante en su desarrollo, la utilización de ventilación mecánica no invasiva. (AU)


The objective of this case series study focuses on the description of the possible causes responsible for the appearance of pneumomediastinum in SARS-CoV-2 virus infection. To this end, the characteristics of the patients admitted to the Jerez de la Frontera Hospital who developed this complication have been described, detailing the risk factors, reason for hospital admission, factors that trigger pneumomediastinum, as well as the clinic and type of oxygen therapy received during treatment. Your income. After their study, it is concluded that the most likely etiology of the appearance of pneumomediastinum in these four subjects was bilateral pneumonia due to the SARS-CoV-2 virus, and the use of noninvasive mechanical ventilation may also contribute significantly to its development. (AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Pandemics , Coronavirus Infections/epidemiology , Coronavirus Infections/complications , SARS Virus , Mediastinal Emphysema , Subcutaneous Emphysema
5.
Cureus ; 14(12): e32508, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36654541

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a pandemic that spread rapidly around the world, causing an enormous overload on the health systems of the different affected countries. Among the many different manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, an uncommon complication is the development of pneumomediastinum. In the clinical case presented, the patient was diagnosed with COVID-19 pneumonia and due to severe refractory hypoxemia, she was submitted to therapy with non-invasive ventilation (NIV). After initial stabilization and improvement, there was unexpected clinical deterioration and pneumomediastinum was diagnosed. The purpose of this report is to highlight the importance of considering pneumomediastinum as a complication of COVID-19 pneumonia in cases subjected to non-invasive ventilation.

6.
Heliyon ; 9(1): e12981, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36647393

ABSTRACT

Objective: The goal of this study was to look at the incidence, risk factors, clinical characteristics, and radiological aspects of COVID-19 patients who developed pneumomediastinum and compare these features between those who died and those who survived. Materials and methods: This retrospective observational study included COVID-19 patients having pneumomediastinum on CT from May 2020 to May 2021 in a COVID-19 care hospital. 1st wave patients were considered between the period of May 2020 to January 2021 and those in the second wave between February 2021 to May 2021. The clinical details were analyzed by a consultant intensivist and CT scans were read by a team of 6 resident radiologists and 5 experienced radiologists. Demographic data, co-morbidities, clinical parameters, hemodynamic markers, radiological involvement and associated complications were analyzed. Results: During the study period, 10,605 COVID-19 patients were admitted to our hospital of which 5689 underwent CT scan. 66 patients were detected to have pneumomediastinum on CT; 26 of them in the first wave and 40 in the second wave. Out of 66, 28 patients were admitted to ICU, 9 during the first wave and 18 during the second wave. The overall incidence of developing pneumomediastinum was 1.16%. Incidence in the 1st wave was 1.0% and in the 2nd wave was 1.29%. The overall mortality rate in admitted COVID-19 patients was 12.83% while it was 43.9% in COVID-19 patients who developed pneumomediastinum. Incidence of pneumomediastinum and pneumothorax was high in patients with extensive parenchymal involvement. 59/66 (89%) cases of pneumomediastinum had severe CT score on imaging. Conclusion: We conclude that pneumomediastinum is a marker of poor prognosis. Timely diagnosis of interstitial emphysema or pneumomediastinum will aid in planning early protective ventilation strategies and timely intervention of complications.

7.
J Thorac Dis ; 14(12): 4733-4740, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36647498

ABSTRACT

Background: There is an increasing number of reports on developing pneumothorax/pneumomediastinum among severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) patients. The aim of our study was whether pre-existing diffuse lung pathology increases visceral pleural vulnerability resulting in pneumomediastinum and pneumothorax among mechanically ventilated COVID-19 patients? Methods: A total of 138 consecutive COVID-19 patients admitted to the Intensive Care Unit of Petz Aladár University Teaching Hospital between 1st March 2020 and 1st February 2021 were included. Sixty/138 (43.48%) patients had one or more computer tomography scans of the chest. Analysis was focused on the image defined lung conditions during artificial ventilation. Results: Thirteen out of 60 ventilated patients developed pneumothorax or pneumomediastinum proven by computer tomography (9.42%). Three/13 patients suffered from pre-existing lung parenchyma pathology, while 10/13 had only COVID-19 infection-related image abnormality. Forty-three/60 patient had healthy lung pre-COVID. Kruskal-Wallis test, Spearman correlation and Cox regression calculations did not reveal any statistically significant result proving increased vulnerability during pressure support therapy and visceral pleural breakdown in patients with pre-existing lung pathologies. Conclusions: Pre-existing lung pathology does not increase the risk of onset of pneumothorax or pneumomediastinum in comparation with previously healthy lungs of ventilated COVID-19 patients.

8.
BMJ Case Rep ; 16(1)2023 Jan 13.
Article in English | MEDLINE | ID: mdl-36639197

ABSTRACT

Bronchogenic cysts (BCs) are congenital foregut malformations and usually asymptomatic, thin-walled, incidentally diagnosed cysts which can be easily resected by a minimal invasive approach at this time point. However, they may develop symptoms such as infection, bleeding or compression of adjacent structures. There is no consensus about the risk of developing complications during a lifetime; however, recent reports suggest a higher incidence than initially believed. Here, we report a case of severe life-threatening mediastinitis emerging from an infected BC requiring complex surgery, which could have been avoided if surgery had been performed at an early, asymptomatic stage.


Subject(s)
Bronchogenic Cyst , Mediastinitis , Humans , Bronchogenic Cyst/complications , Bronchogenic Cyst/diagnostic imaging , Bronchogenic Cyst/surgery , Mediastinitis/diagnosis , Mediastinitis/etiology , Diagnosis, Differential
10.
Cureus ; 14(12): e32380, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36632263

ABSTRACT

More complications continue to be reported with the increasing use of marijuana (MJ) in the United States, including the increasing prevalence of Cannabinoid Hyperemesis Syndrome (CHS). To our knowledge, based on a thorough review of the literature, we present the third case of CHS with associated pneumomediastinum (PM) and the first case of pneumorrhachis (PR) in a young healthy patient. The main objective of this paper is to heighten awareness of CHS and its potential complications. A brief discussion of a focused history is essential for diagnosis, proper evaluation, and treatment.

11.
J Belg Soc Radiol ; 106(1): 138, 2022.
Article in English | MEDLINE | ID: mdl-36618028

ABSTRACT

Teaching Point: The appearance of pneumatoceles in a patient with organizing pneumonia is an early sign of leak syndrome and is a significant finding as its rupture can lead to a life-threatening tension pneumothorax. Air leak syndrome (ALS), consisting of pneumothorax, subcutaneous emphysema and pneumomediastinum, is a rare complication of organizing pneumonia (OP). We report a case of a patient with bleomycin-induced OP who develops a tension pneumothorax due to a ruptured pneumatocele caused by ALS and correlate with histopathological analysis. This is the third case in the literature with these findings and the first with a tension pneumothorax.

12.
Qatar Med J ; 2023(1): 4, 2023.
Article in English | MEDLINE | ID: mdl-36606063

ABSTRACT

We have reported here two cases of coronavirus disease-2019 (COVID-19) patients aged 29 and 68 years who were diagnosed with pneumomediastinum (PM). PM is a rare complication that is being reported in association with COVID-19. Patients with COVID-19 can present with a variety of etiologies that make them vulnerable to PM. Respiratory complications due to COVID-19 are widely known, and it presents as mild to severe and critical illness. Spontaneous PM is a known complication of COVID-19. Despite seeming to be a lesser-known condition, PM can have a significant impact on disease progression and prognosis. We have presented here two contrasting cases of PM. The first patient was young and with moderate COVID-19 pneumonia and PM, while the second one was an old man with severe COVID-19 pneumonia manifestations. Both patients were diagnosed with PM, but their outcomes were completely different.

13.
Cureus ; 14(11): e31816, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36579188

ABSTRACT

Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes.

14.
Cureus ; 14(12): e32608, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36545357

ABSTRACT

Esophageal perforations due to foreign body ingestion are uncommon; however, they can be associated with extremely high mortality rate. The most dreadful complication of this entity is the infection of adjacent structures, namely, the mediastinum and the pericardium. A prompt diagnosis and a precocious start of treatment are essential to the prognosis. Thus, a high degree of suspicion is required, especially in older patients. Therapeutic options are highly variable, depend on several factors, and should be individualized to every patient and their clinical status. Surgical treatment with esophageal exclusion and diversion, in extreme circumstances, is mandatory to control the infection source site and prevent further contamination. We report a case of esophageal perforation, presenting 48 hours after onset, that led to multifactorial shock (septic and cardiogenic) due to pericarditis with pericardial and pleural effusion.

15.
BMJ Case Rep ; 15(12)2022 Dec 22.
Article in English | MEDLINE | ID: mdl-36549756

ABSTRACT

As the SARS-CoV-2 virus continues to infect millions of people worldwide, the medical profession is seeing a wide range of short-term and long-term complications of COVID-19. One lesser-known complication is that of pneumomediastinum. This is a rare, but significant, complication defined by the presence of air in the mediastinum with an incidence of 1.2 per 100 000. Described mortality rate is 30%, increasing to 60% in patients with concomitant pneumothoraces. Management of pneumomediastinum is typically conservative, but in cases of extensive subcutaneous emphysema, cardiac or airway compression, life-saving surgical decompression is necessary. We report a case of pneumomediastinum secondary to COVID-19, requiring a surgical approach not described in pneumomediastinum secondary to COVID-19. The case demonstrates the importance of prompt diagnosis and management, as well as the potential for good clinical outcome in selected patients.


Subject(s)
COVID-19 , Mediastinal Emphysema , Pneumothorax , Humans , COVID-19/complications , SARS-CoV-2 , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/surgery , Tomography, X-Ray Computed/adverse effects , Pneumothorax/complications
16.
Cas Lek Cesk ; 161(6): 224-231, 2022.
Article in English | MEDLINE | ID: mdl-36543576

ABSTRACT

Chest pain is one of the most common symptoms encountered by doctors working in acute, internal, and pulmonary clinics. In the United States in 2006, 10 percent of all visits to the emergency room were caused by diseases of the respiratory system, and chest pain was the most common symptom. The most common situations that can cause chest pain with an emphasis on their diagnosis and early treatment are chest infections, pneumothorax, pneumomediastinum and tumors affecting the pleural cavity.


Subject(s)
Mediastinal Emphysema , Pneumothorax , Humans , Chest Pain/etiology , Chest Pain/complications , Lung , Pneumothorax/diagnosis , Pneumothorax/etiology , Pneumothorax/therapy , Mediastinal Emphysema/complications , Mediastinal Emphysema/diagnosis
17.
Anesth Prog ; 69(4): 37-39, 2022 12 01.
Article in English | MEDLINE | ID: mdl-36534773

ABSTRACT

Prior to a scheduled operation for a 45-year-old male patient with tongue cancer, a tracheotomy performed under intravenous sedation to prevent asphyxia due to extensive bleeding resulted in pneumomediastinum and subcutaneous emphysema. The planned operations were postponed until reduction of the pneumomediastinum was confirmed. During operation, airway pressure was kept low to prevent tension pneumomediastinum along with a sufficient depth of anesthesia, controlled analgesia, and continuous administration of muscle relaxants. Postoperatively, sedation was used to avoid stress and complications with the vascular anastomosis site. In this case, air leakage into the soft tissues was one of the possible causes of the event associated with increased airway pressure. Although the incidence of such complications is relatively low, caution should be exercised after tracheostomy.


Subject(s)
Mediastinal Emphysema , Subcutaneous Emphysema , Tongue Neoplasms , Male , Humans , Middle Aged , Tracheostomy/adverse effects , Tongue Neoplasms/complications , Tongue Neoplasms/surgery , Subcutaneous Emphysema/complications , Subcutaneous Emphysema/surgery
18.
Cureus ; 14(11): e31413, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36523675

ABSTRACT

Spontaneous pneumomediastinum is defined as free air in the mediastinum without an explanation or known cause. Late preterm neonates are rarely affected; however, a known risk factor is aggressive resuscitative maneuvers. Moreover, spontaneous pneumomediastinum is a rare cause of neonatal respiratory distress diagnosed in the post-natal period using chest radiography. In contrast, preterm babies with respiratory distress syndrome are associated with pneumomediastinum. The condition is considered benign, and a conservative, non-interventional management approach is widely accepted, with complete gradual resolution as the usual course in affected neonates.

19.
Int J Surg Case Rep ; 102: 107832, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36512883

ABSTRACT

INTRODUCTION: Psoas abscesses are usually confined to the psoas compartment due to its fascial attachments. However, in rare situations, the infection can locally spread beyond the psoas sheath. CASE PRESENTATION: A 65-year-old patient presented with; 3 weeks of lower back and right hip pain, progressive inability to walk and one week of urinary incontinence. CT abdomen showed a right psoas abscess with pneumo-retroperitoneum extending to the right gluteus muscle, posterior compartment of the upper thigh and mediastinum. Exploration in theatre showed copious amounts of pus, visible between the fascial layers and muscles of the thigh, tracking to the level of the knee and the gluteal region. DISCUSSION: Psoas abscesses are usually confined to the psoas compartment. However, in this case, it was spread to the posterior compartment of the thigh, gluteal region and pelvis with fascial necrosis and pus. Due to the extensive nature of the disease and the patient's clinical deterioration, he underwent open drainage of the psoas abscess, exploration and debridement of the posterior compartment of thigh and gluteal region with a good outcome. CONCLUSION: Psoas abscesses can penetrate the psoas sheath to cause extra pelvic extension. A high index of suspicion and early imaging, if necessary, should be arranged if in doubt. Depending on the clinical severity, patients may need to be managed with open drainage and debridement than conventional CT-guided drainage.

20.
Rev. medica electron ; 44(1)feb. 2022.
Article in Spanish | LILACS-Express | ID: biblio-1409708

ABSTRACT

RESUMEN El neumomediastino espontáneo se caracteriza por la presencia de aire en el mediastino. Es una enfermedad generalmente benigna, que evoluciona de forma satisfactoria entre 2 y 15 días, no asociada a causa directa conocida. Es infrecuente en la tercera edad. Se presenta principalmente con dolor torácico, disnea y enfisema subcutáneo. El diagnóstico se realiza sobre la base del cuadro clínico, la radiografía de tórax y la tomografía axial computarizada de tórax, siendo esta última importante, además, para establecer el diagnóstico diferencial con el síndrome de Boerhaave de manera oportuna. Se presentó el caso de un paciente masculino de 67 años de edad, fumador con antecedente de enfermedad pulmonar obstructiva crónica, que acude al cuerpo de guardia por dolor torácico, disnea y enfisema subcutáneo después de un episodio de tos intensa. Se le realizaron radiografías de tórax posteroanterior y lateral, en las que se observan la presencia de aire en el mediastino, se descartan otras enfermedades agudas, y se corrobora el diagnóstico de neumomediastino mediante tomografía axial computarizada de tórax. Recibió tratamiento con oxígeno, broncodilatadores, esteroides y antibióticoterapia, obteniéndose una mejoría evidente. La literatura reporta que no es habitual la presencia de este cuadro en pacientes de la tercera edad, y que debe sospecharse en aquellos que presenten una exacerbación de la enfermedad pulmonar obstructiva crónica, fundamentalmente después de un episodio de tos.


ABSTRACT The spontaneous pneumomediastinum is characterized by the air presence in the mediastinum. It is a generally benign disease which evolves in a satisfactory way between 2 and 15 days, that is not associated to any directly known cause. It is infrequent in the old age. It mainly presents with chest pain, dyspnea and subcutaneous emphysema. Diagnosis realizes on the base of clinical characteristics, thorax radiography and thorax axial computed tomography, being the last one also important to establish the differential diagnosis with Boerhaave syndrome in an opportune way. The case presented is the case of a male patient aged 67 years, who smokes and has antecedents of chronic obstructive pulmonary disease. He assisted to the consultation due to thoracic pain, dyspnea and subcutaneous emphysema after an episode of intense cough. Posteroanterior and lateral thorax radiography were done, finding air presence in the mediastinum; other acute diseases were discarded and the diagnosis of pneumomediastinum was corroborated through thorax computed tomography scan. He was treated with oxygen, bronchodilators, steroids and antibiotics therapy, obtaining an evident improvement. The literature reports that the presence of these characteristics in old-aged patients is not common and that it must be suspected in those presenting an aggravation of the chronic obstructive pulmonary disease, mainly after a cough episode.

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