Case Of Pneumomediastinum Research Articles

Pneumomediastinum presenting as acute airway obstruction

Pneumomediastinum is an entity with diverse underlying etiologies and variable clinical presentations. We present a case of pneumomediastinum that on initial presentation appeared to be an upper airway emergency most consistent with adult epiglottitis. The pathophysiology of pneumomediastinum involves extravasation of air through perivascular interstitial tissues. Once air has gained access into the soft tissues, it may dissect upward into the neck and distend upper airway structures. This may cause patients with pneumomediastinum to have symptoms such as a sore throat or dysphagia. The patient we describe had such dramatic upper airway symptomatology that adult epiglottitis was the initial suspected diagnosis, and acute airway intervention was required. The various etiologies, presentations, and pathophysiology of pneumomediastinum are discussed.

Radiographic features in 1016 adults admitted to hospital with acute asthma.

A retrospective review was carried out of the radiographic features of 1016 adults admitted to hospital with acute asthma over a 4-year time period. The radiographic features were classified into five groups: (I) normal, 536 patients (52.9%); (II) features compatible with obstructive lung disease, 323 patients (31.8%); (III) complications of asthma including infection, segmental or greater atelectasis, one case of pneumomediastinum and one case of pneumothorax, 83 patients (8.2%); (IV) unimportant incidental findings, six cases (0.6%); and (V) important incidental findings including tuberulosis, heart failure, and bronchial neoplasm, 68 cases (6.7%). We conclude that in this large series of patients presenting with asthma symptoms severe enough to merit admission there is an incidence of clinically significant radiographic abnormalities of approximately 15%. Admission chest radiography is therefore indicated in adults who are hospitalized with acute asthma.

Pneumomediastinum and Bilateral Pneumothoraces in a Patient With Hyperemesis Gravidarum

Hyperemesis gravidarum (HG) is a severe form of the more common nausea of early pregnancy. We report an unusual case of pneumomediastinum and bilatetral pneumothoraces presenting in the tenth week of pregnancy complicating HG.

Pneumomediastinum and subcutaneous emphysema associated with temporomandibular joint surgery

Pneumomediastinum may occur as a result of trauma or surgery of the head and neck. It has been reported in association with various dental procedures and with a variety of maxillofacial surgical procedures. However, this potentially life-threatening problem has not previously been reported in association with temporomandibular joint surgery. This report reviews two cases of pneumomediastinum and subcutaneous emphysema occurring in association with temporomandibular joint surgery and presents an overview of the dental and medical literature concerning this phenomenon occurring in association with injuries and treatment of the maxillofacial complex.

Pneumomediastinum as a complication of upper gastrointestinal endoscopy

Secondary or complex pneumomediastinum following esophagoscopy is due to an esophageal perforation. Primary or simple pneumomediastinum may be caused by maneuvers such as coughing, gagging, swallowing, choking, and valsalva. These maneuvers are common during upper gastrointestinal endoscopy. Esophageal performation is a potentially life threatening event, while simple pneumomediastinum is usually a benign self-limited disorder. Although the presentation may be similar, different morbidities compel prompt evaluation for distinction between these two entities and appropriate management. We present a case of pneumomediastinum that developed immediately following upper gastrointestinal endoscopy. Implications of diagnosis, management, and prognosis are discussed.

Iatrogenic pneumomediastinum after endodontic therapy

An unusual case of pneumomediastinum caused by subcutaneous emphysema occurring after the use of hydrogen peroxide solution during root canal treatment is described in a 30-year-old man. A thorough search of the available literature failed to reveal similar cases. A review of the literature, including pathogenesis, clinical and radiographic features, and management of this condition, is presented.

Pneumomediastinum, Pneumothorax and Subcutaneous Emphysema Following the Measurement of Maximal Expiratory Pressure in a Normal Subject

Mediastinal and subcutaneous emphysema have been reported as a consequence of deliberate manipulations of the breathing pattern producing a Valsalva-like maneuver in healthy subjects. We present a case of pneumomediastinum, pneumothorax and subcutaneous emphysema occurring in a normal volunteer after repeated measurements of the PEmax.

The visible wall of a main bronchus: a new radiological sign of pneumomediastinum.

A new sign of pneumomediastinum (mediastinal emphysema), namely a visible wall of a main bronchus as seen in the mediastinum on frontal radiographs of the chest, is described. This sign was present in eight out of 20 random cases of pneumomediastinum in adolescents and adults.

Pneumomediastinum and subcutaneous cervical emphysema during third molar extraction under general anesthesia

A case of pneumomediastinum and subcutaneous cervical emphysema during the extraction of third molars under general anesthesia has been presented. The most likely cause was pulmonary barotrauma secondary to a faulty expiratory valve. This emphasizes the need for the proper preoperative check of all anesthetic equipment. Although pneumomediastinum and subcutaneous cervical emphysema are usually self-limiting conditions with rapid recovery, the patient must undergo close observation for the possible development of serious complications.

Emphysème sous-cutané, pneumomédiastin et extraction dentaire

One case of pneumomediastinum due to subcutaneous emphysema occurring after using a high speed air turbine drill during dental extraction was described, as only a few cases have been published in the literature. Air may have entered the soft tissues directly by being forced down the gingival crevice. The air may then have passed by way of the fascial planes to enter deeper structures and the mediastinum. The consequences of this condition after general anaesthesia were discussed, more common aetiologies being tracheal or oesophageal rupture, bronchial rupture or pneumothorax.

Pneumomediastinum

HOMEMADE mixtures of dilute hypochlorite solution with other acidic household chemicals may liberate substantial amounts of chlorine gas. In our experience, the most common domestic combination is a mixture of bleach with lavatory cleaners, usually hydrochloric acid. The growing incidence of mixing household cleaning agents has been noted previously.¹The purpose of this report is to draw attention to a possible hazard of such practice. We describe two cases of pneumomediastinum with subcutaneous emphysema following inhalation of chlorine gas liberated from a mixture of 5% sodium hypochlorite with 10% hydrochloric acid. <h3>Report of Cases</h3><h3>Case 1.—</h3> A 27-year-old man was brought to the emergency ward following exposure to gas liberated from a mixture of household cleaners. Four hours before admission, he had mixed 1 L of 5% sodium hypochlorite with 1 L of 10% hydrochloric acid in a large aquarium he meant to clean. He immediately experienced a burning

Air in unusual places: Some causes and ramifications of pneumomediastinum

Five unusual cases of pneumomediastinum are described. In three the probable cause was thoraco-abdominal straining against a closed glottis during violent exercise, in criminal assault, or competitive sport. The resultant increase in intra-alveolar pressure produces an air leak which passes via the pulmonary interstitium into the mediastinum. It can then pass up into the neck to produce widespread subcutaneous emphysema and down through the diaphragmatic hiatuses to produce extraperitoneal emphysema. This may outline the lower surface of the diaphragm to stimulate intraperitoneal air, but it can also leak through the parietal peritoneum to result in actual intraperitoneal air. Therefore, in the patient who has been hospitalised after violent physical stress with or without blunt trauma, pneumomediastinum does not necessarily indicate tracheobronchial or oesophageal rupture and subdiaphragmatic air does not necessarily indicate bowel rupture. Probably any form of exercise in which the Valsalva manoeuvre is performed may cause pneumomediastinum, as may other causes of increased intra-alveolar pressure such as mechanical ventilation, bronchospasm, coughing and vomiting. Vomiting is a likely contributing cause in the pneumomediastinum of diabetic ketosis, of which a case is described. Another case is presented in which air passed in the opposite direction, from perforated extraperitoneal bowel up into the mediastinum.

Pneumomediastinum in Diabetic Ketoacidosis: Comments on Mechanism, Incidence, and Management

We describe three cases of pneumomediastinum associated with diabetic ketoacidosis and give reasons why these disorders may coexist more frequently than heretofore realized. The pathogenesis of pneumomediastinum in such patients remains obscure. Previous authors have considered the pneumomediastinum to be a consequence of vomiting or hyperpnea accompanying diabetic ketoacidosis, but we point out that it sometimes precedes the onset of the metabolic disturbance. We also acknowledge that the appearance of these entities in the same patient could be coincidental. In each of the 11 documented cases so far, primary therapeutic attention to the diabetic ketoacidosis has resulted in an uneventful course and rapid recovery. This experience calls for conservative management of the pneumomediastinum.

Pneumomediastinum in newborn with associated dextroposition of the heart.

PNEUMOMEDIASTINUM IN NEWBORN WITH ASSOCIATED DEXTROPOSITION OF THE HEARTEDMUND A. FRANKEN, JR., M.D.Audio Available | Share

Pneumomediastinum.

The occurrence of four cases of pneumomediastinum in our group in less than nine months seems to indicate that this entity is much more prevalent than has been reported. These cases with their varying signs and symptoms are described and the physiological explanation is discussed. The ease with which this condition may be mistaken for benign pericarditis without roentgenograms and electrocardiograms is shown. A brief review of the literature is also presented.

PULMONARY HISTIOCYTOSIS X

The chest roentgenograms of 18 patients with pulmonary histiocytosis X were reviewed. Correlation of roentgenographic and histologic changes in 6 patients disclosed a spectrum of changes reflecting the evolutionary character of the pulmonary histiocytotic lesion.This spectrum is arbitrarily divided into 3 categories. The first two are based on the site of maximal infiltration by the proliferating histiocyte, either alveolar or interstitial. The third represents the reparative phase, with fibrosis as the dominant feature.[See figure in the pdf file]In addition to the 6 case reports, 4 cases of mediastinal and hilar lymphadenopathy and a single case of pneumomediastinum are added to the literature.

Pneumomediastinum—A Report of 28 Cases and Review of the Literature.

s1 May 1966Pneumomediastinum—A Report of 28 Cases and Review of the Literature.William P. MunsellWilliam P. MunsellSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-5-1180_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe presence of free air within the connective tissue supporting structures of the mediastinum, an entity variously termed pneumomediastinum and mediastinal emphysema, has long been recognized but only recently noted as more than a rarity. The purpose of this report is to add 28 more cases to the 322 previously documented cases of pneumomediastinum. These 28 cases have been collected over a 10-year period and represent an admission incidence of 1 in 7,115. Of the 28 cases reported, there were 3 infants, 2 children, and 23 adults. Of the adults, all were Caucasian with an average age of 18. The... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: William P. MunsellAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1966Volume 64, Issue 5Page: 1180-1180KeywordsChildrenConnective tissueEmphysemaInfants ePublished: 1 December 2008 Issue Published: 1 May 1966 PDF downloadLoading ...

Pneumomediastinum and aspiration pneumonia complicating labor

A case of pneumomediastinum and aspiration pneumonia occurring as a complication of labor is presented. Spontaneous rupture of the esophagus had to be considered in the differential diagnosis. The mechanism of pneumomediastinum and its relation to interstitial pulmonary emphysema are discussed.

Mediastinal emphysema

Three cases of pneumomediastinum occurring in the course of P.P. treatment of pulmonary tuberculosis are described. Other possible means by which air may reach the mediastinum are mentioned, and the symptomatology, diagnosis and treatment discussed.

Pneumomediastinum in the newborn; report of a case.

Pneumomediastinum in the newborn, occurring without pneumothorax, is a rare condition. In 1853, 2 cases of mediastinal emphysema of the newborn were recognized postmortem (1). Gumbiner and Cutler (2) reported several cases and were able to collect 8 additional examples from the literature. Davis and Stevens (3), DeCosta (4), and Heald and Wilder (5) all reported cases of pneumomediastinum associated with pneumothorax. Cases of pneumomediastinum in childhood were also published by Montalvo (6) and Sims (7), but their papers, appearing in foreign journals, were not available for review. In 1945, Lowman and Culotta (8) described 2 cases. One of their patients had a pneumomediastinum associated with a bilateral pneumothorax, which proved fatal. The other had pneumomediastinum alone and survived. During the senior author's residency at St. Joseph's Hospital, Ann Arbor, Mich.,2 1944–48, no proved case of pneumomediastinum was observed in routine anteroposterior and lateral roentgenograms of over 4,000 newborn i...