Neumomediastino espontáneo en la dermatomiositis / Spontaneous pneumomediastinum in dermatomyositis

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Spontaneous pneumothorax and subcutaneous emphysema in COVID-19 patient: Case report.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). As known, COVID-19 has become a global pandemic and serious health problem. Disease mainly affects lungs and common findings are fever cough and shortness of breath. Computerized tomography (CT) has an important role in initial evaluation and follow up of COVID-19. Main (CT) finding of the disease is bilateral extensive ground-glass opacification (GGO) with a peripheral or posterior distribution, mainly involving the lower lobes. In this case report, we present a pneumothorax and subcutaneous emphysema case in a patient with COVID-19. To the best of authors' knowledge, it is the first illustrated case of pneumothorax accompanying COVID-19 pneumonia.

Epidural pneumorrhachis, a rare complication of asthma exacerbation.

Introduction: An association between pneumorrhachis and asthma exacerbation is uncommon. However, we present a clinical case involving a patient with exacerbated asthma, subcutaneous emphysema, spontaneous pneumomediastinum (SPM), and pneumorrhachis. Case study: The patient was an 18-year-old male with asthma since childhood who only relied on salbutamol to control his asthma symptoms. Results: The patient suddenly experienced dyspnea, chest tightness, and paroxysmal coughing, which prompted him to visit the emergency department. Upon arrival, subcutaneous emphysema was detected on the face, neck, thorax, and left forearm. Chest X-ray showed air in the mediastinum, neck, left supraclavicular region, and chest, all of which were verified by a computed tomography scan that also revealed air in the epidural region. At the hospital, his treatment focused on preventing asthma exacerbation and managing associated symptoms. Conclusion: When a patient has asthma exacerbation that is accompanied by SPM and extensive emphysema, the presence of epidural pneumorrhachis should not be overlooked.

Subcutaneous emphysema to the head and neck: an unlikely traumatic origin.

Subcutaneous emphysema to the neck represents a rare entity mainly derived from iatrogenic and traumatic origin. We report a case of a subcutaneous emphysema resulted from an intraoral injury aiming to emphasise the significance of precise medical history to identify an unlikely mechanism. A 40-year-old female patient was presented with subcutaneous emphysema extending from the region underneath the left eye up to the submandibular area of the neck. The patient complained of painful, swollen neck. The patient mentioned that the symptoms began after an intraoral injury accidentally caused by the use of a high-pressure water jet device meant for car wash. The patient was managed conservatively and was discharged after 2 days. This case highlights the urgency for clinical suspicion for unlikely mechanisms. Moreover, the manufacturer companies should alert and give official warning for the contingency of injury due to incorrect or careless usage.

Cervicofacial and mediastinal emphysema complicating tooth extraction in an elderly patient: a preventable complication.

Subcutaneous emphysema is widely documented in the literature and well known by doctors and dentists. However, subcutaneous emphysema following tooth extraction is not very common.We report the case of a 72-year-old female who presented to the emergency department of the Bunbury Hospital in Bunbury in the state of Western Australia in Australia, with subcutaneous emphysema of the face and neck with extension into the mediastinum, following a complicated tooth extraction in 2016. It was a dramatic and scary occurrence for both the patient and dentist, but totally preventable. The investigations and treatment could have been very invasive. However, with limited and essential management, the process was kept simple and safe for the patient.

[Cervicofacial emphysema and pneumomediastinum after dental treatment]. / Cervikofacialt emfysem og pneumomediastinum efter tandbehandling.

Pneumomediastinum with subcutaneous emphysema is a rarely observed complication of dental treatment. It is a potentially dangerous condition, but the majority of cases are self-limiting and benign. We present a case of pneumomediastinum and cervicofacial emphysema that occurred after dental treatment. The rapid onset of swelling and dyspnoea are often misinterpreted as an allergic reaction to the anaesthesia used during the procedure. Physicians and dentists should be aware that cervicofacial emphysema can cause swelling after dental procedures and may mimic an allergic reaction.

Hamman and Boerhaave syndromes - diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report.

INTRODUCTION: Hyperemesis gravidarum describes persistent vomiting leading to fluid and electrolyte imbalance. It is the commonest reason for admission in the first half of pregnancy. We describe a case of Hamman syndrome secondary to hyperemesis gravidarum. We also discuss Boerhaave syndrome: a particularly rare condition with only a handful of cases being described in the literature. CASE PRESENTATION: A 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph. She was treated conservatively for potential ruptured oesophagus but then self-discharged against medical advice. CONCLUSION: Subcutaneous emphysema is an alarming finding in any pregnancy and should be treated in a timely and cautious manner. This case report adds weight to the previous literature advocating a conservative versus surgical approach to the management of a woman with Hamman syndrome secondary to hyperemesis gravidarum.

[Subcutaneous emphysema after adenotonsillectomy]. / Subkutant emfysem efter tonsillektomi.

Adenotonsillectomy is a commonly performed procedure in otorhinolaryngology departments. A rare complication is cervicofacial subcutaneous emphysema, that often resolves spontaneously, but may progress to obstruct upper airways or spread to the thorax causing pneumomediastinum or pneumothorax and impair cardiorespiratory function. A case of cervicofacial emphysema in a young woman undergoing routine adenotonsillectomy is presented, and possible mechanisms and treatment options are discussed.

Pneumorrhachis and pneumomediastinum in connective tissue disease-related interstitial lung disease: case series from a tertiary care teaching hospital in South India.

Pneumomediastinum has been described as a rare complication of connective tissue diseases. Here, we report four cases of pneumomediastinum: three of which are associated with dermatomyositis and one with mixed connective tissue disease. All our patients had interstitial lung disease. The first case of dermatomyositis described below was complicated by epidural emphysema (pneumorrhachis) in addition to pneumomediastinum. Pneumorrhachis is reported in many isolated case reports and series in the setting of asthma, pneumothorax, blunt chest trauma, etc. Less than 10% of pneumomediastinum cases develop this complication and vast majority of cases resolve spontaneously. The mechanism behind this has been postulated to be the passage of air through the intervertebral foramen. Others suggest entrapment of air which dissects between paraspinal soft tissues and along the vascular and nerve sheaths into the epidural space. This is the first ever reported case of epidural emphysema in connective tissue disease to the best of our knowledge.

[Visit at the dentist with consequences]. / Zahnarztbesuch mit Folgen.

A 52-year-old patient presented to the emergency department of the polyclinic with a cervicofacial swelling. The indolent swelling appeared after professional tooth cleaning. Computed tomography scanning of the cervical region and thorax revealed entrapped air extending from the frontotemporal to the mediastinal regions. The patient was diagnosed with cervicofacio mediastinal emphysema and subsequently treated with antibiotics. The symptoms subsided and the patient left hospital free of symptoms.

Subcutaneous emphysema during third molar surgery: a case report.

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.

A extração de terceiros molares é o procedimento cirúrgico mais comum na prática diária em cirurgia oral, e complicações podem ocorrer a despeito da habilidade e experiência do cirurgião. Complicações observadas durante ou após extração de terceiros molares podem incluir dor, edema, sangramento, infecção, perfuração de seio e dano nervoso. Felizmente, a incidência de tais eventos é baixa quando se emprega conduta adequada e boa técnica cirúrgica. O enfisema subcutâneo associado à extração dentária ocorre quando o ar da turbina de alta rotação é forçado para dentro dos tecidos moles através de um retalho rebatido e invade os tecidos adjacentes, causando edema, crepitação à palpação, e eventualmente espalhando-se pelos espaços teciduais dos planos fasciais. Embora seja raro, o enfisema subcutâneo iatrogênico pode ter conseqüências sérias e com risco de morte. É necessário ter cuidado com o uso de turbinas de alta rotação durante a realização de procedimentos cirúrgicos orais. A penetração de ar nos tecidos faciais não está limitada às extrações dentárias, e pode ocorrer também por outras vias de acesso, tais como dentes tratados endodonticamente, periodonto e lacerações de tecidos moles intraorais. Quando ocorre, o enfisema subcutâneo deve ser diagnosticado rapidamente e tratado adequadamente para diminuir o risco de outras complicações. Este relato apresenta um caso de enfisema subcutâneo ocorrido durante a extração de um terceiro molar inferior com emprego de turbina de alta rotação. O manejo do caso é descrito e os aspectos relacionados ao diagnóstico e à prevenção desta complicação cirúrgica são discutidos.

[Subcutaneous emphysema of upper limb]. / Subkutant emfysem på overekstremitet.

Subcutaneous emphysema involving the upper limb can result from infection with gas-producing microorganisms or from a variety of non-infective causes. This case illustrates the reflections that should be made in such cases to avoid over- or undertreating the patient.

Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: The Macklin effect.

OBJECTIVE: We describe the clinical features of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe atelectasis. Her PM resulted from the "Macklin effect," which involves a three-step process: overly distended alveolar rupture, air dissection along the bronchovascular sheaths, and air spreading into the mediastinum. METHODS: Treatment consisted of oxygen therapy, parenteral corticosteroids, and nebulized bronchodilators. RESULTS: She made a good recovery, and was discharged from the intensive care unit after 2 days. CONCLUSION: This case illustrates that conservative management strategies in this severe and unusual complication of asthma exacerbation can result in rapid and complete recovery. Nonetheless, every asthma exacerbation should be considered potentially life-threatening, and must be treated promptly and adequately.