ABSTRACT
This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.
Subject(s)
Cat Diseases/pathology , Lung Neoplasms/veterinary , Mediastinal Emphysema/veterinary , Pneumopericardium/veterinary , Pneumothorax/veterinary , Retropneumoperitoneum/veterinary , Animals , Cats , Female , Lung Neoplasms/complications , Lung Neoplasms/pathology , Mediastinal Emphysema/etiology , Mediastinal Emphysema/pathology , Pneumopericardium/etiology , Pneumopericardium/pathology , Pneumothorax/etiology , Pneumothorax/pathology , Retropneumoperitoneum/etiology , Retropneumoperitoneum/pathology , Tomography, X-Ray Computed/veterinaryABSTRACT
We present a case of unusual gas embolism in a 73-year-old man who was found in a state of cardiopulmonary arrest with an oxygen-supply tube connected to an intravenous catheter inserted into his median cubital vein. Postmortem computed tomography (PMCT) performed 27 h after death showed systemic gas distribution including intravascular gas, pneumothorax, pneumoperitoneum, pneumomediastinum, pneumoretroperitoneum and gastric emphysema. A second PMCT scan performed 116 h after death showed a marked decrease of air inside the body. The current case shows the importance of PMCT for visualization, quantification, and preservation of evidence for establishment of the cause of death in cases with suspected gas embolism. Our findings also indicate that performance of two PMCT examinations may be useful for differentiation of embolized gas from gas produced by putrefaction.
Subject(s)
Embolism, Air/diagnostic imaging , Multidetector Computed Tomography , Aged , Catheters, Indwelling , Embolism, Air/pathology , Emphysema/diagnostic imaging , Emphysema/pathology , Forensic Pathology , Humans , Imaging, Three-Dimensional , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/pathology , Oxygen Inhalation Therapy , Pleural Cavity/pathology , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/pathology , Pneumothorax/diagnostic imaging , Pneumothorax/pathology , Retropneumoperitoneum/diagnostic imaging , Retropneumoperitoneum/pathology , Scrotum/pathology , Stomach/diagnostic imaging , Stomach/pathology , Suicide , Whole Body ImagingSubject(s)
Embolism, Air/pathology , Embolism, Paradoxical/pathology , Image Interpretation, Computer-Assisted , Suicide/legislation & jurisprudence , Tomography, X-Ray Computed , Whole Body Imaging , Aged, 80 and over , Autopsy , Blood Vessels/pathology , Cause of Death , Humans , Male , Mediastinal Emphysema/pathology , Pneumoperitoneum/pathology , Pneumothorax/pathology , Retropneumoperitoneum/pathology , Subcutaneous Emphysema/pathologyABSTRACT
During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment.
Subject(s)
Colonoscopy/adverse effects , Intestinal Perforation/complications , Subcutaneous Emphysema/etiology , Female , Humans , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Mediastinal Emphysema/pathology , Middle Aged , Retropneumoperitoneum/pathology , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/surgeryABSTRACT
STUDY DESIGN: Case report and clinical discussion. OBJECTIVE: A rare case of air passage into multiple body compartments after thoracoscopic minimally invasive spine surgery is described. SUMMARY OF BACKGROUND DATA: In recent years, there is growing interest in thoracoscopic minimally invasive spine surgery for the treatment of thoracic and lumbar spine fractures. Severe complications due to the operative procedure are rare. METHODS: We present a case of a 73-year-old woman who developed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior stabilization of a Th12 fracture. RESULTS: The operative procedure was completed without any obvious intraoperative complications. Routine made postoperative radiograph of the chest revealed a pneumothorax on the right side, bilateral subphrenic free air, and bilateral supraclavicular air. Subsequently, a CT scan showed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and a supraclavicular subcutaneous emphysema. Bronchoscopy, esophagogastroduodenoscopy, and laryngoscopy showed no hollow organ injury or any other pathologic changes. Intraabdominal free air and pneumothoraces could not be detected on thoracic radiographs after 2 days. The patient remained cardiopulmonary stable throughout the hospital course. CONCLUSION: This report documents a rare case of air passage into multiple body compartments after thoracoscopic-assisted treatment of a spinal fracture, which has not yet been described previously. After exclusion of a tracheo-bronchial and hollow organ injury the process was self-limiting. To avoid this complication, special care should be taken to evacuate all intrathoracal air at the end of the endoscopic procedure.
Subject(s)
Pneumoperitoneum/etiology , Pneumothorax/etiology , Spinal Fractures/surgery , Spinal Fusion/adverse effects , Thoracic Vertebrae/surgery , Thoracoscopy/adverse effects , Abdominal Cavity/pathology , Abdominal Cavity/physiopathology , Aged , Bronchoscopy , Disease Progression , Female , Functional Laterality/physiology , Humans , Iatrogenic Disease/prevention & control , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/etiology , Mediastinal Emphysema/pathology , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/pathology , Pneumothorax/diagnostic imaging , Pneumothorax/pathology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/prevention & control , Retropneumoperitoneum/diagnostic imaging , Retropneumoperitoneum/etiology , Retropneumoperitoneum/pathology , Spinal Fractures/diagnostic imaging , Spinal Fractures/pathology , Spinal Fusion/instrumentation , Spinal Fusion/methods , Subcutaneous Emphysema/diagnostic imaging , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/pathology , Thoracic Cavity/pathology , Thoracic Cavity/physiopathology , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/pathology , Thoracoscopy/methods , Tomography, X-Ray ComputedABSTRACT
The medical records of 15 patients found to have pneumoretroperitoneum in a 10-year period were reviewed. The cause of retroperitoneal emphysema was infection in six patients, trauma in five and iatrogenic in four. Emphysema was confined to the retroperitoneum in 11 patients, and extended to the mediastinum in four and to the soft tissue of the neck in three. Failure to diagnose pneumoretroperitoneum resulted in delayed intervention in two patients. One patient with pneumoretroperitoneum and pneumoperitoneum secondary to a lung lesion underwent unnecessary laparotomy. Outcome was favourable in these three patients. The presence of air in the retroperitoneum is not dangerous but its early recognition and detection of the source are important as septic conditions may be involved.
