Concomitant Pneumothorax Research Articles

Pneumatosis: Appearances on CT Imaging.

Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments. In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues. On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema. Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum. Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.

Pneumomediastinum as a predictor of negative prognosis in patients with coronavirus pneumonia

Aim of the study was to analyze the course of coronavirus pneumonia in patients with pneumomediastinum. Material and methods. The study included 139 patients, 71 of whom developed spontaneous pneumomediastinum against the background of coronavirus pneumonia. Laboratory, clinical and radiological data were analyzed and compared. Results. The relationship between the severity of viral pneumonia (3rd–4th degree of severity according to MSCT) and pneumomediastinum was revealed. It was found that spontaneous mediastinal emphysema in patients with COVID-19 signifcantly more often leads to the development of acute respiratory distress syndrome, multiple organ failure and can be a predictor of negative prognosis of the disease outcome. Conclusions. Pneumomediastinum in patients with viral pneumonia caused by a new coronavirus infection is a predictor of severe disease and poor prognosis. With an increase in spontaneous mediastinal emphysema without pneumothorax, it is recommended to perform mediastinotomy according to Razumovsky’s indications, and in case of clinically signifcant concomitant pneumothorax – drainage and revision of the mediastinum.

CLINICAL CHARACTERISTICS AND OUTCOME OF PNEUMOTHORAX IN PATIENTS WITH COVID-19 PNEUMONIA

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pneumothorax (PTX) is characterized by the presence of air within the pleural space. The association between PTX and COVID-19 has not been well established in the current literature. We sought to better characterize the presentation and clinical outcomes of PTX in patients with confirmed SARS-COV-2 pneumonia at our institution to better define the incidence, cause, outcomes and available treatment for this condition. METHODS: All patients with a proven diagnosis of COVID19 and concomitant PTX between March 17, 2020 and May 5, 2020 were identified through hospital records. Retrospective analysis of radiology records and chart review was conducted. Clinical characteristics and outcomes were collected and descriptive statistics were analyzed. RESULTS: 63 patients met inclusion criteria. Median age was 65.5 years (IQR 54-74.75). The most prevalent medical comorbidities were hypertension (53%, n=33), diabetes mellitus (47.6%, n=30), and hyperlipidemia (31.7%, n=20). 55 patients (87.3%) required mechanical ventilation. Of these PTX was diagnosed after intubation in 54 (98.2%). This reflected 20.83% of the total 264 intubated patients at our institution during the study period. Median positive end –expiratory pressure on the day of PTX diagnosis was 10 (IQR10-15).An invasive procedure with potential to cause iatrogenic PTX had been performed in only 15.6% (n=10) of the 63 patients on the day of or the day prior to the PTX. Chest tubes were placed in 57 (90.4%) patients. 51 patients were admitted to the ICU (81.0%) patients and of those 40 (78.4%) died. Median ICU and Hospital Lengths of stay were 16.5 (5-24.5) and 17 (5-26) days, respectively. At the end of data collection (6/1/2020), 8 (12.6%) patients remained admitted to the hospital, 8 patients (12.6%) were discharged, and 47 patients (74.6%) had died. Risk factors associated with mortality were Age >65 years (OR 16.0 (1.5-170.22) p=0.022) and concurrent renal failure (OR 11.11 (2.5-49.13) p-0.002). CONCLUSIONS: Compared to historical series in acutely ill patients with ARDS, PTX was found in higher incidence among patients with COVID-19. Older age and concurrent renal failure were found as significant contributors to mortality. Compared to all intubated patients with COVID-19 at our institution, the ICU mortality associated with this condition is elevated (59% vs 78.4%, p=0.0099). CLINICAL IMPLICATIONS: With the looming possibility of a second wave of COVID-19, we feel that this information is vitally important to share with the scientific community as Pneumothorax may be associated with worse clinical outcomes. DISCLOSURES: No relevant relationships by Victor Gazivoda, source=Web Response No relevant relationships by MUDATHIR IBRAHIM, source=Web Response No relevant relationships by Aaron Kangas-Dick, source=Web R

The management of occult hemothorax in adults with thoracic trauma: A systematic review and meta-analysis.

Hemothorax is a common sequelae following thoracic trauma and is associated with significant morbidity and mortality. Current guidelines recommend all traumatic hemothoraces be considered for drainage with tube thoracostomy (TT), regardless of size. With increasing use of computed tomography, smaller hemothoraces not seen on x-ray (defined as an occult hemothorax) are frequently detected. This systematic review was performed to gather data on patients with occult hemothorax managed with TT or without TT (termed expectant management [EM]). MEDLINE, EMBASE, and Cochrane databases from inception to October 2019 were searched for relevant articles. The primary outcome was rates of failure of expectant (conservative) management. Secondary outcomes of interest included predictors of TT insertion, predictors of failure of EM, and morbidity and mortality in patients with occult hemothorax. We screened 1,329 abstracts from which 6 articles reporting 1,405 patients with occult hemothorax were included. Of these patients, 601 (43.68%) were managed initially with TT, and 802 (56.32%) were managed expectantly. Of the 802 patients managed expectantly, 212 failed conservative management and underwent TT insertion (23.1% pooled failure rate estimate [95% confidence interval, 17.1-29.1%]). The presence of concomitant pneumothorax predicted upfront TT insertion. Of the patients who failed EM, the need for mechanical ventilation and the presence of a large hemothorax predicted failure. Mortality was similar in both groups. Conservative treatment of occult hemothorax fails in 23.1% of patients. The presence of hemothorax greater than 300 mL and the need for mechanical ventilation predicted failure of conservative treatment and the need for TT. There was no difference in mortality between EM and TT cohorts. These data suggest that it may be possible to safely observe patients with occult hemothoraces less than 300 mL (1.5 cm pleural stripe) secondary to blunt trauma without upfront TT insertion. Systematic review and meta-analysis, level III.

Spontaneous Pneumomediastinum in Connective Tissue Diseases.

Spontaneous pneumomediastinum (SP) is an uncommon disorder but has been described in cases with connective tissue diseases (CTDs), most commonly dermatomyositis and polymyositis. We aimed to explore this relationship by analyzing the characteristics of CTD patients with SP. Using a computer-assisted search, we identified 25 patients with CTD and SP evaluated between January 1997 and December 2016 at our institution. Clinicoradiologic characteristics, treatment, and outcomes were extracted and chest computed tomography studies analyzed. We identified 25 patients with CTD and SP. Median (range) age at SP occurrence was 55 (18-82) years, and 60% of the patients were women. Smoking history was present in 37%. Spontaneous pneumomediastinum was symptomatic in 56% of patients. Eighteen patients (72%) had a known CTD diagnosis, and 20 patients (80%) manifested radiologic evidence of interstitial lung disease. Spontaneous pneumomediastinum diagnosis was achieved with chest radiography in 20% of cases and chest computed tomography in the other cases. Spontaneous pneumomediastinum was managed with expectant observation alone in 22 cases (88%). Four patients (16%) had concomitant pneumothorax, 1 of whom required chest tube drainage. There were no deaths attributable to SP during the median (range) follow-up of 13 (0-174) months. Cumulative survival was 52% at 1 year and 40% at 2 years. Spontaneous pneumomediastinum is an uncommon manifestation of CTD and usually occurs in the presence of interstitial lung disease. Although SP seems to be associated with a relatively benign short-term course, occurrence of SP in CTD patients may be a poor prognostic factor.

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

Spontaneous pneumomediastinum: Experience in 13 adult patients.

Spontaneous pneumomediastinum is an uncommon disorder. There is a lack of information on spontaneous pneumomediastinum in India. We aimed to understand the clinical profile, hospital course, and long-term outcome of such patients. We retrospectively reviewed all patients (aged ≥15 years) diagnosed with spontaneous pneumomediastinum in the respiratory ward of a tertiary care hospital over a 7-year period from 2005. Of the 3326 patients hospitalized during the study period, 13 (10 male) were diagnosed with spontaneous pneumomediastinum, constituting 0.39% of all hospitalizations. The median age was 37 years (interquartile range 20-55 years). The most common presenting symptom was dyspnea in 85% followed by neck swelling (69%), chest pain (69%) and cough (54%). Subcutaneous emphysema and preexisting lung diseases were identified in 11 (85%) patients each. Post-tubercular pulmonary sequelae (5 patients) and asthma (4 patients) were the most common underlying lung diseases. Pneumothorax was identified in 6 (46%) patients; 4 required tube thoracostomy. Chest radiography was diagnostic in 92% of patients. The median length of hospital stay was 9 days (interquartile range 6-12 days). No recurrence was reported in 11 patients followed up for a median of 1550 days (interquartile range 691-1909 days). Spontaneous pneumomediastinum is a benign disorder, but underlying lung diseases and concomitant pneumothorax are likely to complicate the disease course. Exacerbation of post-tubercular obstructive airway disease is a common risk factor for spontaneous pneumomediastinum in a tuberculosis endemic country.

Pneumomediastinum in blunt trauma: A review

Pneumomediastinum (PM) is an uncommon finding after blunt trauma to the neck or chest. Motor vehicle collisions are the most common cause in adults, while falls are the most common in children. The majority of traumatic PM results from medial tracking of air from a concomitant pneumothorax. The Macklin effect, of air tracking medially along peribronchial sheaths from alveolar rupture, is responsible for most other cases. Chest pain is the most common symptom, and crepitus the most common sign. The majority of PM will resolve spontaneously, and requires no specific intervention. Only 1—6% of cases result from rupture of the larynx, trachea, bronchi or oesophagus. Hoarseness, dyspnea, persistent lung collapse or air leak should increase suspicion for aerodigestive injury. Computed tomography (CT) can help differentiate benign etiology from those that require surgical correction. High suspicion for aerodigestive injury based on clinical and/or CT findings should prompt diagnostic bronchoscopy and/or oesophagram.

Efficacy of Alveolar Recruitment Maneuvers in Patients With Complicated Thoracic Trauma

The objective of this study was to measure the efficacy of biphasic positive airway pressure (BIPAP) and synchronized intermittent mandatory ventilation (SIMV) with alveolar recruitment maneuvers (ARMs) in patients with acute lung injury (ALI) and concomitant pneumothorax. Seventy-four patients with ALI and concomitant pneumothorax secondary to blunt thoracic injury were studied. All patients fulfilled criteria for the first stage of acute respiratory distress syndrome, which consisted of acute onset dyspnea, isolated rales, an extravascular lung water index >7 mL/kg, and an oxygenation index <300 mm Hg in the absence of left-ventricular dysfunction. After evacuation of the pneumothorax, ARMs were performed using BIPAP or SIMV 3 to 5 times a day with a peak pressure of 33.4 ± 0.2 cm H(2)O and a positive end-expiratory pressure of 16.1 ± 0.2 cm H(2)O. The use of BIPAP in patients with ALI and concomitant pneumothorax reduced the time to resolution of the air leak allowing application of earlier ARMs. ARMs with peak pressures of 35 to 40 cm H(2)O effectively improved oxygenation and biomechanical properties of the lungs and did not cause pneumothorax relapse. In conclusion, BIPAP allowed for spontaneous ventilation during the breathing cycle and limited P (peak). Its use was associated with more rapid sealing of air leaks with the ability to conduct earlier ARMs. The use of BIPAP compared with SIMV improved outcome in the presence of complex thoracic trauma.

A Case of Concomitant Pneumothorax and Pneumoperitoneum

Pneumothorax associated with pneumoperitoneum is rare. There are scattered case reports of this syndrome in the pediatric literature but very few reports in the adult literature. Several possible causes exist. Maurer at al. suggested that it results from air entering the pleural space through a diaphragmatic defect. In this paper, we report a patient with a perforated diverticulum and a concomitant pneumothorax.

Effectiveness of Alveolar Opening in Patients with Acute Lung Injury and Concomitant Pneumothorax

Objective: to study the efficiency of a lung opening maneuver in patients with acute lung injury (ALI) and concomitant pneumothorax, who were on biphasic positive airway pressure ventilation (BIPAP) and synchronized intermittent mandatory ventilation. Subject and methods. Seventy-three patients with acute lung injury and concomitant pneumoth-orax resulting from blunt chest trauma were examined. Their condition was an APACHE II of 18—24 scores. After elimination of pneumothorax, an open lung maneuver was made using different modes of lung support 3—5 times daily. Results. The study has shown that BIPAP used in patients with ALI and concomitant pneumothorax reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be applied earlier. The employment of the latter in patients with ALI and pneumothorax permits a prompter recovery of lung function during different types of respiratory support, which is attended by reductions in the number of complications, artificial ventilation, and mortality. When the lung opening maneuver is combined with BIPAP, its efficiency considerably increases. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.

Pneumopericardium after attempted left ventricular lead insertion

Cannulation of the coronary sinus (CS) and its branches is the cornerstone of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation. In the present case, the CS was cannulated using a Daig fixed-curve CS decapolar catheter (Daig Corporation, USA). Cannulation of the CS was extremely difficult, most likely due to the presence of a valve occluding the CS ostium (extreme tortuosity or an acute takeoff were not observed). A Rapido sheath (Boston Scientific, USA) was advanced into the CS, followed by withdrawal of the CS diagnostic catheter. A CS dissection was noted following the injection of noncontrast dye into the CS ostium. No hemodynamic deterioration occurred, and careful attempts to cannulate the true lumen were subsequently made with noncontrast dye injections for sheath guidance. After several failed attempts to cannulate the true lumen of the CS, contrast was evident in the pericardial space on fluoroscopy; thus, attempts at CS lead placement were abandoned. A postoperative chest x-ray was performed and pneumopericardium was noted (Figure 1A). In the lateral view, an air-fluid level could be seen (Figure 1B). The most reasonable explanation for this complication is that the CS was dissected with the mapping catheter or by advancing the Rapido sheath; further contrast injection likely introduced air and contrast into the pericardium. A chest x-ray was repeated two days later and the pneumopericardium had spontaneously reabsorbed (Figure 2). CS dissection is a relatively common (6% to 7%) complication of biventricular pacing insertion (1); however, usually a left ventricular lead can advance through the true lumen. Pneumopericardium in the absence of concomitant pneumothorax is a rare complication of device implantation (2). Once CS dissection is detected, a postoperative chest x-ray is recommended to exclude pneumopericardium. In the present case, there were no symptoms or clinical sequelae, and no interventions were required.

Respiratory Therapy in Patients with Acute Lung Injury and Concomitant Pneumothorax

Objective. To comparatively study the efficiency of respiratory support using biphasic positive airway pressure (BIPAP), spontaneous intermittent mandatory ventilation (SIMV), and intermittent positive pressure ventilation (IPPV) in patients with acute lung injury (ALI) and concomitant pneumothorax. Subjects and materials. Sixty-eight patients were examined. The severity of disease was 18 to 24 APACHE II scores. After elimination of pneumothorax, lung opening maneuver was made by the routine procedure 1—2 times daily on different types of respiratory support. Results. The study has indicated that in patients with ALI and concomitant pneumothorax, BIPAP reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be earlier used. Conclusion. BIPAP leads to a better adaptation of a patient to respiratory support, to the limited use of sedatives, and to better gas exchange in the lung and accelerates transfer from total respiratory support to spontaneous breathing. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.

Potential foramen to allow communication between the pleural cavity and retroperitoneal space during laparoscopic surgery: a cadaver study of Bochdalek’s triangle

The indications for laparoscopic retroperitoneal surgery have recently been greatly extended and the technique has become popular, but concomitant pleural injury or pneumothorax has been reported from numerous hospitals in Japan. Which anatomical information is useful to avoid surgical injury of the suggested weak portion of the diaphragm? We identified a diaphragm-free triangular area or Bochdalek's triangle in 90.1% of elderly Japanese cadavers (100/111 cadavers), comprising about 622.8 mm(2) in area (height 47.9 mm, base 25.0 mm). In most cases (80.1%; 129/161), the entire triangle was restricted to the superior side of the 12th rib in addition to the medial side of the distal end of the rib. A "potential foramen" (PF) was defined as the diaphragm-free triangle >100 mm(2) in area on the parietal pleura. Most triangles (77.6%, 125/161) met this criterion. The PF was often covered by the kidney (93.3%), and had a mean area of 318.9 mm(2). The PF was located 42.3 mm from the distal end of the 12th rib, while the inferior pleural margin was 27.8 mm superior to the rib end. When the triangle was large, the PF was also large, with the PF often occupying >50% of the triangle area (62/125; 49.6%). To avoid the distal end of the 12th rib, in laparoscopic retroperitoneal surgery, we recommend making a transverse skin incision at the midpoint between the end of the 12th rib and the iliac crest.

Tension Pneumopericardium: A Case Report and a Review of the Literature

Pneumopericardium, or air within the pericardial sack, generally occurs after high-speed blunt deceleration injuries. Although it is generally relatively benign, in rare instances, it can become hemodynamically significant. The diagnosis is easily made on plain chest radiography. More recently, chest computed tomography has been helpful in making the diagnosis. Injury to vital structures such as the tracheobronchial tree or esophageal tears require operative fixation. However, in most instances, pneumopericardium is secondary to dissection of air through the adjacent structures to the pericardial space. The air is trapped as a one-way valve. The pneumopericardium is usually self-limited, requiring no specific therapy. In patients where there is a concomitant pneumothorax, chest tube drainage suffices. We present a case of hemodynamically significant tension pneumopericardium that occurred in association with blunt carotid injury and aortic

The Management of Chest Tubes in Patients With a Pneumothorax and an Air Leak After Pulmonary Resection

Placing chest tubes to water seal is superior for patients with an air leak, but when a patient has a pneumothorax and an air leak the best chest tube setting is unknown. This is a retrospective analysis of a prospective database on a consecutive series of patients who had a pneumothorax and air leak on the same day. Patients underwent elective pulmonary resection by one surgeon and had their chest tubes placed to water seal on postoperative day 1. Daily chest radiographs were obtained, and the size of the pneumothorax and air leak were measured. Tubes were left on seal unless there was a symptomatic enlarging pneumothorax or subcutaneous emphysema (defined as failing water seal). The primary objective was to evaluate the efficacy of water seal. We also wanted to identify risk factors that predicted failure of water seal. There were 838 patients > or = 21 years old who underwent elective pulmonary resection, and 86 patients (10%) had an air leak and a concomitant pneumothorax on the same day. Fourteen patients (16%) failed water seal. Multivariate analysis showed that a large air leak (greater than or equal to expiratory 3 in our classification system; odds ratio [OR], 16.5; p < 0.001) and a pneumothorax > 8 cm in size (OR, 4.9; p < 0.005) were predictors of failing water seal. Keeping chest tubes on water seal is safe for most patients with an air leak and a pneumothorax. However, if the leak or pneumothorax is large, then subcutaneous emphysema or an expanding symptomatic pneumothorax is more likely. A prospective randomized trial is needed to compare water seal to suction in these patients.

Pneumomediastinum and Subcutaneous Emphysema from Pacemaker Placement

Percutaneous insertion of permanent pacemaker leads through the subclavian vein is an alternative to the cephalic vein approach. A rare occurrence and successful conservative management of extensive pneumomediastinum and subcutaneous emphysema without concomitant pneumothorax resulting from permanent transvenous pacemaker insertion in an 80-year-old man with syncope and arrhythmia is reported.

Pulmonary Mycobacterium bovis infection in a dog

dAim: To describe the clinical course of a dog infected with Mycobacterium bovis causing a granulomatous pneumonia. dClinical findings: The dog initially presented with a persistent cough, inappetence and weight loss. Clinical findings included a fever, dyspnoea and tachypnoea, with haematological evidence of a mild neutrophilia and hypoalbuminaemia. Radiographs of the chest demonstrated a concomitant pneumothorax, pleural effusion, and a consolidated area within the left caudal lung lobe. An exploratory thoracotomy revealed this to be a ruptured granulomatous lesion. Subsequent histopathological, microbiological and genetic studies identified M. bovis as the causal agent. dClinical significance: Mycobacterium bovis infections should be included in the differential diagnosis of pulmonary disease and pleural effusions in dogs living in regions of New Zealand known to have a high incidence of mycobacterial infection in wildlife and farm animals.

Pneumopericardium associated with high-frequency jet ventilation during laser surgery of the hypopharynx in a child

A case of pneumopericardium, without concomitant pneumothorax, resulting from high frequency jet ventilation during laser surgery of the hypopharynx is described. The patient, a four-year-old boy, suffered cardiac arrest as a consequence of the incident. The pneumopericardium was likely to have been caused by obstruction to the expiratory flow during surgery. Other possible explanations for the incident are discussed.

Tension pneumoperitoneum after heart-lung transplantation

Tension pneumoperitoneum is a medical emergency. We report 2 cases in which tension pneumoperitoneum occurred after heart-lung transplantation and was related to positive-pressure ventilation and a transdiaphragmatic passage of omentum used to wrap the airway anastomosis. Management in these patients was targeted toward decompression of intraperitoneal air with percutaneous needle or tube placement without exploratory laparotomy, and tube thoracostomy for the concomitant pneumothorax.