Case Of Pneumomediastinum Research Articles

Factors Associated With Presence Of Pneumomediastinum And Pneumothorax In Patients With Covid 19 In Public Hospital In Puebla

Introduction: acute respiratory distress syndrome secondary to covid 19 can lead to the presence of pneumothorax and pneumomediastinum; rare but potentially fatal and is related to mechanical ventilation or the severity of the disease. Recently, cases of pneumomediastinum have been documented despite the use of different protective ventilation measures, without being clear about its origin or prognosis. Material and methods: descriptive, retrospective and single-center study in patients with covid 19 admitted to a second level hospital in the city of puebla during march 1, 2020 to march 1, 2021. Results: during the period from january 2020 to january 2021, 966 patients were admitted to hospital with a diagnosis of covid 19. 29 (3%) patients presented some pleural complication. 23 (84%) had pneumomediastinum and 5 (18%) had pneumothorax. The most prevalent comorbidities were diabetes, arterial hypertension and obesity. 80% of the patients had dyspnea and chest pain as the initial symptom. In laboratory tests, 80% of the patients had high ldh and c-reactive protein associated with leukocytosis. Conclusion: the prevalence of pneumothorax and pneumomediastinum in patients with covid 19 was 3% with a mortality rate of 25%

Neumomediastino como complicación de enfermedad pulmonar intersticial en dermatomiositis

Introduction: dermatomyositis is an idiopathic, heterogenous, inflammatory myopathy, which is difficult to diagnose. It is associated with cutaneous manifestations and is considered a variable disease in terms of clinical presentation, course, and prognosis. It may involve different organs and systems, in addition to the skin and muscles. Case report: 56-year-old patient with a history of dermatomyositis who was admitted to the emergency room with dysphagia to solids and liquids, asthenia and adynamia. A thoracic CT scan evidenced pneumomediastinum and multilobar consolidations. Symptoms improved after antibiotic management and methotrexate initiation. Discussion: not many cases of pneumomediastinum in the context of interstitial disease associated with dermatomyositis have been described, thus studying this condition is relevant. The patient did not refer respiratory symptoms. The endoscopy study and esophageal CT scan did not reveal esophageal perforation, thus pneumologists attributed this clinical presentation to the Macklin effect. Conclusion: spontaneous pneumomediastinum is a rare complication carrying a high mortality rate, however it can occur in patients with interstitial lung disease.

A case of pneumomediastinum after dental root canal treatment

We presented a rare case in which a 27-year-old female patient developed cervicofacial emphysema and pneumomediastinum following dental root canal treatment on her lower right second molar. She presented to the emergency department with facial and neck pain, difficulty in swallowing, and a feeling of tightness and pressure in the chest. Computed tomography revealed free air foci extending from the right mandibular region to the mediastinum. Pneumomediastinum related to dental root canal treatment was considered and the patient was admitted to the thoracic surgery department and oxygen therapy and prophylactic antibiotics were initiated. After 3 days of observation, the emphysema resolved, the symptoms disappeared, and the inflammatory markers remained within normal limits. The patient was discharged in stable condition.

Negative Pressure Pneumomediastinum: A Novel Concept of Spontaneous Pneumomediastinum Without Mediastinal Widening Following Weight Loss.

Spontaneous pneumomediastinum, supposedly attributed to air leakage from the respiratory tract, is a common complication of interstitial lung disease often resulting in mediastinal widening. However, several cases of pneumomediastinum without mediastinal widening have been observed. This study aimed to investigate the cause of pneumomediastinum in patients without mediastinal widening. This study included 41 patients diagnosed with pneumomediastinum using computed tomography (CT) between July 2011 and September 2021 at Yokohama Minamikyosai Hospital; patients had undergone previous CT showing no gas density. Based on a comparison with previous CT images, the patients were classified into two groups: without mediastinal widening and with mediastinal widening. Of the 41 patients, 13 and 28 had pneumomediastinum without and with mediastinal widening, respectively. There were no significant differences in the sex, age, body mass index, or pneumomediastinum distribution between the groups. However, the rate of weight loss per month was significantly greater in the group without mediastinal widening than in that with mediastinal widening. No significant differences were observed in the respiratory function test results between the two groups; that said, 10 of the 13 patients without mediastinal widening had restrictive disorders. Pulmonary disease in this group included idiopathic pulmonary fibrosis (n = 6), interstitial lung disease with collagen disease (n = 4), and other disease (n = 1). Pneumomediastinum occurred during periods of weight loss in all patients without widening, excluding two patients without data. Pneumomediastinum without mediastinal widening occurs during rapid weight loss and is often associated with restrictive lung disorders. The negative pressure attributed to the decreased plasticity of the lungs, which complements the space where the mediastinal fat has disappeared, is presumably the cause of pneumomediastinum. This pathophysiology is different from that of conventional pneumomediastinum attributed to increased intrapleural space pressure; thus, we propose to name the abovementioned pathophysiology "negative pressure pneumomediastinum".

A Rare Case of Pneumomediastinum Due to Prolonged Use of N95 Facemasks During the Covıd-19 Pandemic

This case and literature study aim to highlight a rare cause of pneumomediastinum in a health professional due to the long-term use of an N95 facemask during the pandemic. In our case, a twenty-eight-year-old female patient with mild intermittent asthma was presented to the emergency room with stinging pain in the anterior chest wall and parasternal areas. Laboratory tests and chest x-ray showed no significance, but pneumomediastinum was present on chest computed tomography. Pneumomediastinum is a rare complication in asthmatic patients. However, events that may cause alveolar and intrabronchial pressure increases can lead to pneumomediastinum. In conclusion, increased airway pressure due to prolonged use of N95 facemasks can lead to pneumomediastinum.

Pneumomediastinum in Diabetic Ketoacidosis: A case report

Pneumomediastinum (PM) is the presence of air within the mediastinum. It is a rare illness that affects 1 in 33,000 people in the general population, according to reports. It is a rare complication of diabetic ketoacidosis (DKA). We report a case of pneumomediastinum complicating an inaugural diabetic ketoacidosis.

Chest Tightness with Cycling Turned Out To Be Pneumomediastinum.

BACKGROUND Pneumomediastinum, or mediastinal emphysema, means air present inside the mediastinum. It usually presents with symptoms of chest pain and shortness of breath. Examination can be significant for crepitus along the neck area. There are many risk factors associated with pneumomediastinum, including asthma and COVID-19. Most cases of pneumomediastinum improve with conservative management, and surgery (mediastinotomy) is reserved for complicated cases with tension pneumomediastinum. CASE REPORT This is the case of a 23-year-old man who presented with chest tightness after 3.5 h of cycling. The patient did have a prior history of clinically stable asthma, with no recent exacerbation, and denied any other associative factors. Imaging was significant for pneumomediastinum. The patient was admitted for observation in the hospital and treated with supportive care, without any surgical intervention. The patient had appropriate improvement in his symptoms in 24 h. Repeat imaging showed improvement in the pneumomediastinum, and the patient was discharged to outpatient follow-up. CONCLUSIONS Our case presents a unique link between cycling and pneumomediastinum. Prolonged cycling may emerge as a risk factor for this complication. People with a previous history of pneumomediastinum should be careful to review other risk factors prior to planning long-distance bicycling. Physicians need to keep this differential diagnosis in mind when encountering a patient with similar symptoms so that a timely diagnosis is made.

Retrospective analysis of COVID-19 patients developing otherwise rare complications

BackgroundOver the last 2 years, it has been felt that there was a disproportionate incidence of complications including pneumothorax, pneumomediastinum, and renal disease necessitating dialysis in patients with COVID-19 as compared to patients without COVID-19.MethodsIn a retrospective cohort, all patients were admitted to St. Joseph Mercy Oakland Hospital in Pontiac, Michigan, between March 2020 and November 2021. The data collected included age, sex, BMI, length of stay, COVID-19 PCR result, diagnosis of pneumothorax, diagnosis of pneumomediastinum, diagnosis of renal failure, orders for dialysis, and orders for mechanical ventilation.ResultsNine thousand five hundred twenty-two patients are included in this study, with 35.6% (3,392 patients) COVID-19 suspected or confirmed positive and 64.4% (6130 patients) confirmed COVID-19 negative. There were 29 cases of pneumomediastinum and 24 cases of pneumothorax, none of which occurred in intubated patients. The incidence of pneumomediastinum (p = 0.001), CODE BLUE (p = 0.01), and mechanical ventilation (p = 0.001) was significantly higher in the COVID-19 positive/suspected group. There was no significant difference in incidence of pneumothorax (p = 0.294). The incidence of dialysis was significantly higher (p < 0.0001) in the COVID-19 negative group.ConclusionsIn review of prior literature and proposed mechanisms, we believe that it was possibly the damage that SARS-CoV-2 inflicts upon lung parenchyma that led to the increased incidence of pneumomediastinum. Given our mixed findings of incidences of pneumomediastinum, pneumothorax, and dialysis, our hope is to remain vigilant to uncover further disease associations and/or complications as more COVID-19 case data becomes available.

Pneumomediastinum following immunization of BioNTech COVID-19 vaccine: A coincidence?

Background: To build immunity against the pandemic severe acute respiratory syndrome coronavirus-2 infection in adolescents, wide-ranging immunization with BioNTech (BNT) vaccine was initiated in September 2021 in Taiwan. Some adverse events are, therefore, reported after vaccination. Herein, we stated a case series with uncommon pneumomediastinum after BNT vaccination. Materials and Methods: This study retrospectively enrolled adolescents, who being diagnosed to have pneumomediastinum, during the 3-month period (between September 22, 2021, and December 22, 2021). Clinical information, such as clinical symptoms, radiographic characteristics, and clinical outcomes, were further analyzed. Results: A total of eight adolescents developed pneumomediastinum during the 3-month period after BNT vaccination. The time interval between pneumomediastinum and vaccination showed bimodal peak (around 10 and 60 days after BNT vaccination). Significant Macklin effect can be sketched in radiographic images of six patients. Conclusion: Several cases of pneumomediastinum were found in adolescents after BNT vaccination. The precise association is needed for further investigation.

“Pneumomediastinum: A marker of severity in Covid-19 disease”

ObjectiveThe 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 methodsThis 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. ResultsDuring 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. ConclusionWe 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.

Two cases of pneumomediastinum in full-term newborns after uncomplicated vaginal deliveries: Various etiologies and radiographic appearances

Pnemomediastinum is defined as the presence of aberrant air in the mediastinum, also known as mediastinal emphysema. Significant pneumomediastinum is rare, particularly in term neonates. It is usually related to the different predisposing factors such as birth injury, meconium aspiration, assisted ventilation or infectious diseases although it may occur idiopathically. Pneumomediastinum is one of the important causes of respiratory distress syndrome that should not be overlook in term neonates. The elevation of thymic lobes off the heart on plain view and the presence of retrosternal air collection on lateral view are crucial signs on chest x-rays that need to be assessed cautiously by radiologists and neonatologists. We report two cases of pneumomediastinum in term infants who presented with respiratory distress. One case was diagnosed as pneumomediastinum and assisted ventilation was supposed as a predisposing factor, the other case was diagnosed as spontaneous pneumomediastinum without underlying lung disease or predisposing factors. The definitive diagnosis was made by combination plain and lateral chest x-rays without further imaging method was required. Both patients received conservative treatment with close observation clinically and radiologically and were discharged after several days in good condition.

PNEUMOCYSTIS JIROVECI-ASSOCIATED PNEUMOMEDIASTINUM AND PNEUMOPERICARDIUM: A SYSTEMATIC REVIEW OF THE PUBLISHED CASE REPORTS

PNEUMOCYSTIS JIROVECI-ASSOCIATED PNEUMOMEDIASTINUM AND PNEUMOPERICARDIUM: A SYSTEMATIC REVIEW OF THE PUBLISHED CASE REPORTS

Clinical observation of pneumomediastinum in a case of severe COVID-19-associated pneumonia in a teenager

Aim. Demonstration of the clinical case of pneumomediastinum in a teenager with severe COVID-19- associated pneumonia.Materials and methods. The clinical case of spontaneous pneumomediastinum was presented, which was a complication of the severe course of COVID-19 pneumonia in a teenager.Results. Patient Ch., 15 years old, with obesity of the 1st degree, was admitted to the hospital of infectious diseases for patients with a COVID-19 on the 7th day of the illness in a severe condition and had complaints of an increase in body temperature to 40ºC, pronounced cough and weakness, dyspnea when walking and at rest. The PCR test for SARS-CoV-2 gave a positive result. Multispiral computed tomography showed polysegmental interstitial lesion of both lungs, which had multiple areas of “ground glass”, signs of pneumomediastinum, subcutaneous emphysema of the upper third of the chest, left-sided pleural effusion. The volume of lung tissue lesion was 50% on the right and 85% on the left. The positive effect of treatment was not observed after 2-3 days in the hospital. The condition of heavy severity continued due to intoxication syndrome, respiratory failure, inflammatory changes in lung tissue syndrome. In this regard, the patient was injected intravenously with tocilizumab (Actemra®) 400 mg. The child was released on the 20th day of hospitalization with a positive clinical effect.Conclusion. The above clinical case demonstrates that in children a novel coronavirus infection can occur not only in severe form, but also with the possible development of complications in the form of pneumomediastinum and low effectiveness of antibacterial and antiviral therapy, which required the use of humanized monoclonal antibodies (tocilizumab).

Urgent decompression of tension pneumomediastinum in a patient to relieve elevated intracranial pressure: a case report

Background: Timely recognition and intervention for venous outflow obstruction due to intrathoracic pathology are critical for controlling elevated intracranial pressure.Case Report: A 26-year-old man with pectus excavatum and a posterior fossa tumor requiring biopsy, decompression, and cerebrospinal fluid diversion developed pneumomediastinum following intubation with tension physiology and progressive elevation of intracranial pressure. Emergent tracheostomy was performed to decompress intrathoracic pressure, augment venous return, and ultimately expedite the patient’s definitive cancer therapy. Conclusion: Recognition of the mediastinal pathology leading to venous obstruction may be required for the management of malignant intracranial hypertension. Tracheostomy may be a means to decompress mediastinal pressure and augment venous outflow in rare cases of pneumomediastinum with tension physiology.

Trachea and Laryngeal Rupture Induced Pneumomediastinum in Psychiatric Patients : A Case Report

Introduction: Laryngeal rupture is a potentially life-threatening aerodigestive injury, especially in cases with slow treatment, which can occur spontaneously, iatrogenic or as a result of trauma.Case: We present a case of pneumomediastinum due to sharp trauma causing a laryngeal rupture in a patient with psychiatric disorders. Pneumomediastinum is one of the complications that occur.Discussion: Trauma history and clinical complaints are very helpful in establishing the diagnosis, and imaging has an important role in describing pneumomediastinum and other air leak syndromes so that early treatment can be done immediately.Conclusion: The approach to diagnosing pneumomediastinum with imaging in psychiatric patients has an important role because of the lack of information about complaints and mechanisms of pneumomediastinum.

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the United Kingdom (POETIC) survey.

BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum (PTM). We aimed to determine its incidence among patients hospitalised with COVID-19 in the UK and describe factors associated with outcome.MethodsA structured survey of PTM and its incidence was conducted from September 2020 to February 2021. UK-wide participation was solicited via respiratory research networks. Identified patients had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and radiologically proven PTM. The primary outcomes were to determine incidence of PTM in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of PTM in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 PTM was 195 out of 377 (51.7%). PTM in COVID-19 was associated with high rates of mechanical ventilation. 172 out of 377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 PTM at the time of diagnosis and thereafter (p<0.001), along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airway pressure support to oxygen or high-flow nasal oxygen after the diagnosis of PTM was not associated with difference in mortality.ConclusionsPTM appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom PTM was identified had not been mechanically ventilated at the point of diagnosis.

Pneumomediastinum is a poor prognostic factor in COVID-19 patients – case series and review

During the second wave of COVID-19, a number of patients requiring invasive or noninvasive pressure support ventilation rose significantly. The cases of pneumomediastinum (PM), pneumothorax (PTX), and subcutaneous emphysema (SCE) were also reported, largely attributed to barotrauma with observation of some spontaneous cases. Here, we present seven moderate-to-severe COVID-19 cases with variable severity developing PM with or without PTX and SCE during the course of hospitalization. Five received noninvasive ventilation, of whom two required invasive mechanical ventilation. The remaining two patients received oxygen therapy alone. Two patients required insertion of intercostal chest drainage tubes for pneumothoraces. Appropriate medical management was given to all patients. Three patients improved and were discharged from the hospital, while four expired. The case series highlights need of early diagnosis, constant monitoring, and judicious use of pressure support ventilation to prevent air leak complications in COVID-19 patients in order to improve their prognostic outcomes.

Airway injury and pneumomediastinum associated with less invasive surfactant administration in a premature neonate: a case report

BackgroundThe use of less invasive surfactant administration (LISA)/minimally invasive surfactant therapy (MIST) has increased due to its potential advantage over traditional surfactant delivery methods through an endotracheal tube. Known complications for this procedure include failure of the first attempt at insertion, desaturation, and bradycardia. To the best of our knowledge, this is the first reported case of pneumomediastinum and subcutaneous emphysema following LISA.Case presentationA preterm newborn born at 27 weeks of gestation presented with respiratory distress syndrome requiring surfactant replacement. LISA using the Hobart method was completed. There was a report of procedural difficulty related to increased resistance to insertion of the 16G angiocath. The newborn was subsequently noted to have subcutaneous emphysema over the anterior aspect of the neck and substantial pneumomediastinum on radiological assessment. Associated complications included hypotension requiring inotropic support. The newborn was successfully managed conservatively, with complete resolution of the air leak.ConclusionsUpper airway injury leading to air leak syndrome is a rare complication of the Hobart method for LISA. Awareness of such procedural complications is important as the use of the LISA method increases.

In-hospital clinical complications of COVID-19: a brief overview.

In-hospital clinical complications of COVID-19: a brief overview.

Foreign body inhalation as a rare cause of pneumomediastinum

Despite the fact that Pneumomediastinum owing to a foreign body is uncommon, it might present a difficult clinical scenario in the absence of any suggestive history. Foreign bodies that are radiolucent are more challenging to diagnose. We present a case report of an eight-year-old boy from Bangladesh who developed pneumomediastinum and subcutaneous emphysema due to organic foreign body inhalation which was initially misdiagnosed in immediate clinical setting. We discussed how a thorough history and a high level of suspicion aided us in diagnosing and treating such a case. • Pneumomediastinum owing to a foreign body is uncommon. • It might present a difficult clinical scenario in the absence of any suggestive history. • We present a case of pneumomediastinum and subcutaneous emphysema due to organic foreign body. • A focused history with a high index of suspicion is required to diagnose.