Case Of Spontaneous Pneumomediastinum Research Articles

A case of spontaneous pneumomediastinum, pneumothorax with subcutaneous emphysema in a preschool child

Spontaneous subcutaneous emphysema is the presence of gas or air beneath the skin and soft tissues. Pneumothorax and pneumomediastinum are identified by the existence of free gas or air in the associated spaces. 4-year-old with progressive body swelling of 12-hour duration, started just after nebulisation with bronchodilators prescribed for his cough and cold. Examination revealed conscious, anxious, irritable child and obvious superficial swelling of face, scalp, neck, chest and both upper limbs. tachycardia, tachypnoea and his oxygen saturation were 82% at the time of admission. There was crepitus on palpation. Investigations were done; A diagnosis of spontaneous pneumomediastinum, left pneumothorax with spontaneous subcutaneous emphysema was made. Managed with emergency implantable cardioverter-defibrillator (ICD) insertion, oxygen, intravenous antibiotics, intravenous fluids, analgesics, and nebulisation.

Spontaneous Pneumomediastinum Secondary to Undiagnosed Asthma inMilitary Adult.

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence.

A Case of COVID-19 with No Pulmonary Involvement; but with Mediastinal and Subcutaneous Emphysema

Spontaneous pneumomediastinum (SPM) is a rare clinical entity. In the normal population, it is more likely to occur in people with conditions including chronic obstructive pulmonary diseases and asthma. In the context of COVID-19 few cases of SPM have been reported which most of them were patients with severe lung parenchymal inflammation or patients under mechanical ventilation. In this case, we report a young male with a history of minor childhood asthma who presented with acute dyspnea, forceful coughs, and subcutaneous emphysema. Chest computed tomography had no clues for COVID-19, however, pneumomediastinum and subcutaneous emphysema were obvious. He was primarily diagnosed with acute asthma exacerbation causing SPM but eventually, he tested positive for SARS-COV-2, therefore, he underwent the standard treatment for COVID-19 and the SPM was managed conservatively. Finally, after 12 days of hospitalization, he was discharged in favorable clinical condition.

A Case of Spontaneous Pneumomediastinum Following Exacerbation of Bronchial Asthma in Adolescents

Lack of knowledge in the management of spontaneous pneumomediastinum condition is attributable to its scarcity. Hypothetically, this condition arose during the exacerbation of bronchial asthma, leading to a recurrent forceful cough that increased the intraalveolar pressure and alveoli perforation. We present a 14-year-old boy with three days history of progressively worsening shortness of breath and chest pain radiating to the neck following exacerbation of bronchial asthma. Clinically, he was stable, despite remarkable subcutaneous emphysema over the anterior chest wall and the neck. Lung examination was unremarkable. There was substantial radiological evidence of subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumorrhachis. He was managed expectantly with oxygenation, control of bronchial asthma symptoms and analgesia. Subsequently, his symptoms resolved, and a complete resolution was seen as evident by radiological assessment. Spontaneous pneumomediastinum with pneumopericardium, pneumorrhachis and subcutaneous emphysema is a rare condition that requires prompt identification to prevent if from becoming a life-threatening condition.

Reentry spontaneous pneumomediastinum at high altitude: a two-case report

We describe two cases of spontaneous pneumomediastinum (SPM) that occurred in healthy, high-altitude native adolescent males when returning to their home from sea level. Both attended the Emergency Department of the Hospital Víctor Ramos Guardia in Huaraz, Ancash (3,052 m a.s.l.), in February 2020. Case 1 was a 16-year-old man who returned home (2,964 m a.s.l.) after twelve days at sea level (Lima). Six hours after returning, he went to work in the field. He then presented fatigue, cough, chest pain, dyspnea, and subcutaneous emphysema. Case 2 was a 17-year-old man who returned home (3,140 m a.s.l.) two weeks after staying at sea level (Barranca). Twelve hours after returning, he went to work in the field. He then presented cough, dyspnea, chest pain, sore throat, and subcutaneous emphysema. Both patients developed hypoxemia, and SPM was diagnosed with the help of chest X-rays. Case 2 was associated with mild high-altitude pulmonary edema. Both patients had no previous history of trauma, illicit drug use, comorbidity, and high-altitude-related diseases. Disease management was conservative, symptomatic, supportive, and based on clinical observation. When a healthy young patient comes to an emergency department because of chest pain, dyspnea, and subcutaneous emphysema, we should consider the possibility of SPM and immediately request frontal and lateral chest X-rays that include the cervical region. A differential diagnosis enables physicians to provide adequate and accurate treatment to patients with SPM.

SPONTANEOUS PNEUMOMEDIASTINUM IN COVID-19 PNEUMON

Spontaneous pneumomediastinum (SPM) is the collection of air within the mediastinal cavity, which is commonly described in the literature for mechanical ventilation and perforation of hollow viscera. Coronavirus disease 2019 (COVID-19) is a rare but salient etiology of this complication in the current pandemic. Here, we are narrating a case of a 46-year-old male, in whom COVID-19 pneumonia was complicated by SPM. The complication was identified on chest computed tomography (CT) and was managed conservatively, leading to a favorable outcome. SPM has undemanding management, but timely identification and appropriate treatment institution are crucial in this milieu. A literature search revealed similar cases of SPM in COVID-19 with different outcomes and the important ones are included in this report.

Neumomediastino en pacientes con COVID-19

Se considera neumomediastino a la presencia de aire libre en el mediastino. Puede clasificarse en primario o secundario, asociado a entidades torácicas o extratorácicas. Se ha detallado casos eventuales de neumomediastino espontáneo en pacientes con COVID-19 que podría considerarse un indicador potencial de agravamiento de la infección. En la presente revisión se generó una exploración en repositorios como Google Scholar, PubMed, SiELO, Redalyc y Scopus. Aunque se desconoce el mecanismo exacto delneumomediastino en pacientes con neumonía por COVID-19 se detalla el aumento de la presión alveolar y la lesión alveolar difusa, que resulta en mayor propensión de los alvéolos a romperse. Además, la trombosis y la inflamación local alteran la respuesta vasoconstrictora a la hipoxia alveolar y la vasoreactividad.

Dégradation respiratoire et COVID-19… Et si c’était un pneumomédiastin ?

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2), whose first cases occured in China in November 2019, caused a large global outbreak conducting the World Health Organisation to declare SARS-Cov2 pandemic in March 2020. To pulmonary parenchyma damages, adds up the occurrence of pneumomediastinum.Two cases of spontaneous pneumomediastinum are here described. None of these patients required mechanical ventilation.Although it does not seem to affect the prognosis of the disease, the pneumomediastinum should be investigated before an increasment of dyspnea, the apparition of a chest pain or of a subcutaneous emphysema.

COVID-19 Pneumonia Pneumomediastinum. Clinical Cases

Spontaneous pneumomediastinum is a rare complication of viral pneumonia. The prevalence of pneumomediastinum among coronavirus infection patients is unknown.Subjects and methods. Three cases of spontaneous pneumomediastinum among the COVID-19 pneumonia patients were analyzed. The researchers investigated and compared clinical, radiological and laboratory data.Results. According to the research results, no correlation was found between the development of pneumomediastinum and changes in values of blood laboratory tests. As well as there were no signs of correlation between drug treatment and pneumomediastinum frequency.Conclusion: The researchers suggest that the leading cause of spontaneous pneumomediastinum is viral pneumonia-associated severe alveolar damage.

Clinical analysis of 71 spontaneous pneumomediastinum cases: an observational study from a tertiary care hospital in Japan

Spontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any underlying disease. Some cases of spontaneous pneumomediastinum have been reported in the past, although only few reports are available, and its management remains uncertain. This study reviewed our experience in the diagnosis and treatment of spontaneous pneumomediastinum. A retrospective study of 71 cases treated for spontaneous pneumomediastinum at the Yodogawa Christian Hospital between April 2005 and March 2020 was conducted. The patients' mean age was 19.3 years (range, 7-48 years). A triggering event was noted in 69% of the cases. Seventy-six percent of the patients were admitted to the hospital, and 24% were outpatients. Treatment included analgesia, rest, antibiotics, and/or oxygen therapy. Thirty-six patients (51%) were treated with antibiotics. None of the cases presented any complications, including mediastinitis or worsening respiratory condition. Two patients (3%) had a recurrence of spontaneous pneumomediastinum. All the patients, with or without antimicrobial treatment and hospitalization, had favorable outcomes. We should therefore reconsider the need for hospitalization and antimicrobial therapy for patients with mediastinitis prophylaxis.

Spontaneous Subcutaneous Emphysema and Pneumomediastinum Associated With Influenza B Virus in a Young Male Adult: A Case Report

In this report, we present a case of influenza B-associated spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) in a young male patient. Although there are several causes responsible for this condition, it is considered extremely rare to occur spontaneously with no prior trauma or predisposing factors, especially in older age groups.Rare cases of SPM and SE, as described in several case reports worldwide, have been reported to have a benign course for the most part. Nevertheless, implementing unified management guidelines with clear protocols is highly recommended to prevent the potential unfavorable complications associated with these conditions.

Spontaneous Pneumomediastinum in an Asymptomatic COVID-19 Patient

Spontaneous pneumomediastinum is a rare and life-threatening complication in patients with COVID-19. Although there are a few reports of spontaneous pneumomediastinum related to COVID-19 in literature, most involve patients who have been followed up in intensive care units (ICUs) or COVID-19 clinics for a period due to mild to severe COVID-19 disease. We present here a case of spontaneous pneumomediastinum that developed in an asymptomatic COVID-19 patient with no medical history.

Síndrome de Hamman na infância - relato de caso

OBJECTIVE: To report a rare case of spontaneous pneumomediastinum that occurred in childhood. CASE REPORT: Male patient, eight years old, with cough, dyspnea, and goring, with no improvement in asthma treatment, venous corticoid base and inhaled bronchodilator. Patient underwent extensive investigation with imaging tests that suggested and confirmed a diagnosis of pneumomediastinum, excluding external causes - such as trauma or chest surgery - that could be clearly related to the observed characteristics. The patient had spontaneous involution with supportive treatment. CONCLUSION: Diagnostic confirmation syndrome by image, usually of benign evolution, with spontaneous resolution and only need of supportive treatment.

SPONTANEOUS PNEUMOPERICARDIUM: A CASE REPORT OF AN UNUSUAL AND A RARE PRESENTATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous pneumopericardium is defined as the presence of free air in the pericardial sac without apparent precipitating cause. It is more common in young adults without pre-existing pulmonary disease (1). Although often asymptomatic, it can cause chest pain and shortness of breath. Progression of this condition into Tamponade can be life-threatening. We describe the case of a 21-year-old female who presented with shortness of breath and was incidentally found to have pneumopericardium. CASE PRESENTATION: A 21-year-old female with obstructive sleep apnea and asthma presented with cough with blood-tinged sputum production and shortness of breath for 3 days. On examination, she was tachypneic, had muffled heart sounds and bilateral wheezes. A chest x-ray showed pneumomediastinum along with pneumopericardium (figure 1). EKG without evidence of ischemic changes or tamponade. A CT scan of the chest was done that showed pneumopericardium with pneumomediastinum and extensive soft tissue gas insulating to the deep fascial planes of the neck and upper chest (figure 2 & 3). There were no signs of esophageal rupture. She was initially treated with broad-spectrum antibiotics and intravenous steroids. Antibiotics were later stopped as no infectious etiology was found. The patient remained hemodynamically stable throughout the hospital course. Repeated chest x-ray imaging on day 2 showed improving pneumopericardium and pneumomediastinum. She was eventually discharged from hospital and imaging during her office follow-up showed complete resolution of the pneumopericardium and pneumomediastinum (figure 4). DISCUSSION: Spontaneous pneumopericardium is rare. Common causes include trauma- secondary to perforation of the pericardium, infection by a gas-forming organism, viscus perforation such as the esophagus, stomach, liver abscess, iatrogenic. ‘’Macklin effect’’ describes the mechanism of air collection in the mediastinum. The increased pressure gradient between the alveoli and the interstitial space leads to the rupture of the alveolar structure resulting in air leakage. A tinkling sound superimposed over a succession splash can be heard, as a result, called “Bruit de Moulin”, which is French for “Millwheel murmur”.(2) Symptoms include dyspnea, precordial chest discomfort, upper abdominal pain or syncope. Physical examination may be absent or may include subcutaneous emphysema, Hamman sign, Millwheel murmur or Beck’s triad (if Tamponade develops). CONCLUSIONS: All the patients should be admitted to the hospital and should be monitored. The initial therapy should be targeted at underlying disease processes. Supplemental oxygen will enhance the reabsorption of the free air by increasing the gradient of nitrogen between the alveoli and the tissues. Symptoms typically resolve within 24-48 hours and follow up CXR should be done to look at progression/resolution or for the complications. (1) Reference #1: Young-Jung Lee, M.D., Seung-Won Jin, M.D., Sung-Hee Jang, M.D., Yi-Sun Jang, M.D., Eun-Kyoung Lee, M.D., Yong-Joo Kim, M.D., Man-Young Lee, M.D., Jun-Chul Park, M.D., Tai-Ho Rho, M.D., Jae-Hyung Kim, M.D., Soon-Jo Hong, M.D., and Kyu-Bo Choi, M.D. A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Young Adult. Korean J Intern Med. 2001 Sep; 16(3): 205–209. Reference #2: R S Baum, T G Welch, and A L Bryson. Spontaneous pneumopericardium. West J Med. 1976 Aug; 125(2): 154–156. DISCLOSURES: No relevant relationships by NIRAJAN ADHIKARI, source=Web Response No relevant relationships by Subash Ghimire, source=Web Response

S1954 Hamman’s Syndrome or Boerhaave Syndrome? A Curious Case of Pneumomediastinum Triggered by Cannabinoid Hyperemesis Syndrome

INTRODUCTION: Spontaneous pneumomediastinum (SPM) (Hamman’s syndrome), resulting from alveolar barotrauma, is a rare entity with a reported incidence ranging from 0.001% to 0.01% of all adult inpatients. It mainly affects young males with a tall, thin body habitus and the most common triggers are acute asthma exacerbation and lower respiratory tract infection. Despite typically being a self-limited condition with an excellent prognosis, SPM is frequently misdiagnosed as Boerhaave Syndrome (spontaneous perforation of the esophagus), which is associated with high mortality even with aggressive interventions. Here we report a curious case of SPM from cannabinoid hyperemesis syndrome as an uncommon trigger that confused clinicians during the initial presentation. CASE DESCRIPTION/METHODS: A 41-year-old African-American man (height 182.9cm, BMI 19.1kg/m2) with a history of tetrahydrocannabinol use disorder, cannabinoid hyperemesis syndrome, bipolar I disorder, and asthma was admitted involuntarily to the inpatient psychiatric unit for acute psychosis. During hospitalization, he developed worsening nausea and intractable vomiting and had more than 20 episodes of non-bilious, non-bloody vomitus over 12 hours. He denied fever, dysphagia, odynophagia, shortness of breath, cough, or chest pain. On the physical exam, the patient was alert and oriented, afebrile, not hypoxic, and not wheezing or stridorous. Abdominal exam revealed epigastric tenderness without rebound tenderness. Initial labs were unremarkable. CT chest, abdomen, and pelvis with contrast showed extensive pneumomediastinum with air tracked up into the soft tissues of the neck and supraclavicular region. The patient was transferred to a monitored medical bed, made nil per os, and started on broad-spectrum antibiotics. Both gastroenterology and cardiothoracic surgery were consulted given concern for esophageal perforation. The patient reported resolution of nausea and vomiting with anti-emetics and intravenous hydration. Formal review of the CT scan demonstrated no evidence of esophageal rupture. He remained hemodynamically stable and tolerated an advanced diet within 48 hours. DISCUSSION: We report a rare case of SPM resulting from intractable vomiting in a patient with cannabinoid hyperemesis syndrome, which was initially confused with Boerhaave syndrome. Increased awareness among physicians of the differential diagnosis of pneumomediastinum and early recognition of the clinical characteristics of SPM may aid in better utilization of resources.Figure 1.: Extensive pneumomediastinum on CT scan with air tracked up into the soft tissues of the neck and supraclavicular region.

Spontaneous pneumomediastinum: a complication of Mycoplasma pneumonaie infection

To show relationship of Mycoplasma pneumonaie infection with spontaneous pneumomediastinum. Reviewed case notes of patients and gathered important data pertinent to case report. We report two cases of spontaneous pneumomediastinum which were associated with Mycoplasma pneumonaie infection. The

A Case of Spontaneous Pneumomediastinum

Introduction:
 Spontaneous pneumomediastinum is described as the
 presence of air in the mediastinum without any specific etiological factor or
 trauma, and it is a rare clinical situation. In this case report, a rare
 case of spontaneous pneumomediastinum was presented. Case
 report: A
 23-year-old male patient was admitted to our emergency department with the
 complaints of throat congestion, difficulty in breathing and chest pain while playing soccer. An increase of
 linear-type transparency starting from the right paratracheal area and
 extending to the mediastinum, and a subcutaneous emphysema in the neck region
 were detected on the posteroanterior (PA) chest X-ray of the patient, which is
 compatible with pneumomediastinum (PM).  
 
 
 
 
 
 
 
 Conclusion:
 History, systemic examination and radiological imaging are very important for
 the patients with chest pain. Spontaneous pneumomediastinum should be taken into consideration in
 the differential diagnosis of chest pain and breathing distress.

A case of spontaneous pneumomediastinum with unknown etiology

A case of spontaneous pneumomediastinum with unknown etiology

Spontaneous Pneumomediastinum in Connective Tissue Diseases

SESSION TITLE: Systemic Disease and Pulmonary Manifestations SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Spontaneous pneumomediastinum (SP) is an uncommon manifestation of connective tissue diseases (CTD) but has been associated with the diagnosis of dermatomyositis/polymyositis (DM/PM). We aimed to explore this relationship by identifying consecutive adult patients with CTD and SP and analyzing the presenting features and clinical course associated with this complication. METHODS: Using a computer-assisted search, we retrospectively identified and reviewed the medical records of all CTD patients diagnosed with SP between January 1997 and December 2016. We extracted data regarding demographics, clinical manifestations and treatment of the underlying CTD. We also gathered information regarding clinical-radiological presentation and treatment of SP, and its outcome. Chest CT studies were reviewed to investigate the presence and describe the pattern of the underlying interstitial lung disease (ILD). RESULTS: We identified 27 patients affected by CTD who developed SP (8 cases of DM/PM, 6 rheumatoid arthritis, 6 systemic sclerosis, 4 overlap syndromes, 2 systemic lupus erythematosus and 1 unclassifiable CTD). Median age at SP presentation was 53 (range 18-82) years and 59% were women. Sixty-two per cent of patients were never smokers, 27% were former smokers and 11% were current smokers. SP occurred before the diagnosis of CTD in 3 patients while SP led to the diagnosis of CTD in 5 additional patients; remaining 19 patients (70%) had a known CTD including associated ILD in all but one patient. SP-related symptoms were present in 58% of patients and included dyspnea (46%), followed by chest pain (27%) and cough (12%); 42% were asymptomatic. The precipitating factors included pulmonary function testing in 31% of patients, severe coughing due to exacerbation or respiratory infection in 15%, vomiting in 8%, air travel in 8%; in 46% no potential precipitating factors were identified. Seventy-eight per cent of patients were on immunosuppressant therapy at the time of SP onset. The initial diagnosis of SP was achieved by chest radiography in 20% of cases, chest CT in 64% and CT pulmonary angiography in 16%. Concomitant pneumothorax was present in 4 cases (17%). Only 2 cases (8%) of SP occurred in the absence of CTD-associated interstitial lung disease (ILD). The most common ILD pattern on chest CT was NSIP in 45%, followed by BOOP superimposed on NSIP in 18%, unclassifiable ILD in 23%, and possible UIP in 5%. SP was treated with observation alone in 23 cases (88%). Eleven patients (42%) were hospitalized. Chest tube drainage was instituted in one of 4 patients with pneumothorax. The median hospital stay was 11 (range 1-20) days. There were no deaths attributable to SP nor were there any relapses of SP in a median follow up of 14 (range 0-183) months. The cumulative survival at 1 and 2 years was 56% and 44% respectively. CONCLUSIONS: SP is an uncommon manifestation of CTD related ILD but sometimes it can lead to the diagnosis of CTD. SP is associated with a relatively benign course in patients with CTD. CLINICAL IMPLICATIONS: SP is an uncommon manifestation seen in patients with CTD and can usually be managed conservatively with observation alone. DISCLOSURE: The following authors have nothing to disclose: Federica De Giacomi, Misbah Baqir, Christian W. Cox, Jay Ryu No Product/Research Disclosure Information

Pneumomediastino espontâneo (síndrome de Hamman) relato de dois casos

Objetivo: Descrever dois casos de pneumomediastino espontâneo na mesma unidade de serviço, em pacientes jovens de sexo diferentes e que apresentaram boa evolução com tratamento conservador. Métodos: O primeiro caso é de um paciente do sexo masculino, 18 anos, com queixa de cervicalgia à direita e disfonia há 2 dias. Negou traumatismos ou ingesta de corpos estranhos, esforços físicos intensos, acessos de tosse e vômitos ou uso de drogas. TC de tórax e pescoço revelou presença de enfisema subcutâneo cervical anterior bilateral, presença de pneumomediastino e ausência de pneumotórax. O segundo caso a ser analisado trata-se de uma paciente do sexo feminino, 16 anos, com queixa de dispneia súbita e mudança do padrão de voz (nasalada). Identificou-se crepitação fina à palpação cervical sugestiva de enfisema subcutâneo. Negou qualquer causa provável de pneumomedisatino secundário. TC de tórax e pescoço revelou pneumomediastino acentuado com extensão para os espaços cervicais profundos. Resultado: Ambos os casos partilham de sinais e sintomas previamente descritos na literatura e tiveram seus diagnósticos obtidos por meio de tomografia computadorizada de tórax. O tratamento sintomático associado a repouso foi eficaz em ambas situações. Conclusões: Pneumomediastino espontâneo pode ser subdiagnosticado devido aos seus sinais e sintomas inespecíficos, contribuindo para seu caráter raro. É importante estabelecer-se os diagnósticos diferenciais e eventos a que os pacientes estiveram expostos. Uma anamnese detalhada acompanhada de aparatos radiológicos permitem o diagnóstico preciso e tratamento correto.