Abstract
Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.
Highlights
Subcutaneous cervical and mediastinal emphysema usually can occur as a result of surgery or trauma
Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract
We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum
Summary
Subcutaneous cervical and mediastinal emphysema usually can occur as a result of surgery or trauma. Their spontaneous onset in absence of previous disorders or provocating factors is very rare. Pneumomediastinum and subcutaneous emphysema are very rare; reported signs of colonic perforation most often are associated with diverticulitis, toxic megacolon, and colonoscopy [2]. Most commonly the diagnosis of subcutaneous emphysema and pneumomediastinum is made by chest X-ray, except in case of small gas collections that can be identified only by chest CT scan. We describe a rare case of spontaneous subcutaneous emphysema, extending from the soft tissues of the abdominal wall to the neck, pneumomediastinum, and pneumoretroperitoneum resulting from an unknown sigmoid diverticulum perforation
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