Finding Of Pneumomediastinum Research Articles

Epidemiology, Risk Factors and Outcomes of Pneumomediastinum in Patients with Coronavirus Disease 2019: A Case-Control Study.

Background: Since the beginning of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, pneumomediastinum has been reported in patients with COVID-19 pneumonia and acute respiratory distress syndrome. It has been suggested that pneumomediastinum may portend a worse outcome in such patients although no investigation has established this association definitively. Research Question: We hypothesized that the finding of pneumomediastinum in the setting of COVID-19 disease may be associated with a worse clinical outcome. The purpose of this study was to determine if the presence of pneumomediastinum was predictive of increased mortality in patients with COVID-19. Study Design and Methods: A retrospective case-control study utilizing clinical data and imaging for COVID-19 patients seen at our institution from 3/7/2020 to 5/20/2020 was performed. 87 COVID-19 positive patients with pneumomediastinum were compared to 87 COVID-19 positive patients without pneumomediastinum and to a historical group of patients with pneumomediastinum during the same time frame in 2019. Results: The incidence of pneumomediastinum was increased more than 6-fold during the COVID-19 pandemic compared to 2019 (P = <.001). 1.5% of all COVID-19 patients and 11% of mechanically ventilated COVID-19 patients at our institution developed pneumomediastinum. Patients who developed pneumomediastinum had a significantly higher PEEP and lower P/F ratio than those who did not (P = .002 and .033, respectively). Pneumomediastinum was not found to be associated with increased mortality (P = .16, confidence interval [CI]: 0.89-2.09, 1.37). The presence of concurrent pneumothorax at the time of pneumomediastinum diagnosis was associated with increased mortality (P = .013 CI: 1.15-3.17, 1.91). Conclusion: Pneumomediastinum is not independently associated with a worse clinical prognosis in COVID-19 positive patients. The presence of concurrent pneumothorax was associated with increased mortality.

PNEUMOMEDIASTINUM AS A COMPLICATION OF COVID-19: MAY NOT NEED INTERVENTION

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Evaluate patients with pneumomediastinum (PTM) as a complication of coronavirus 2019 (Covid-19) infection and their outcomes. METHODS: Data was obtained by retrospective analysis of a database of Covid-19 patients, admitted to two New York hospitals from March 25th to April 26th, 2020. Identified 13 patients with PTM as a complication of Covid-19. RESULTS: Median age of patients was 67 years, 7 (54%) were men, and 1 patient had pre-existing emphysema. Presenting symptoms included dyspnea (13/13, 100%), fever (10/13, 77%), and cough (9/13, 69%); none had chest pain. Median presenting SaO2/FiO2 ratio was 359. Pneumomediastinum was diagnosed on presentation in 2 patients (15%), during hospitalization but prior to invasive mechanical ventilation in 4 patients (31%), and after invasive mechanical ventilation in 7 patients (54%). Six patients had CT scans confirming the diagnosis of PTM. Twelve of the 13 patients were initiated on mechanical ventilation at median 5.5 days. Four patients (31%) developed pneumothoraces and 1 patient required bilateral chest tube drainage. Tension pneumothorax, tension pneumopericardium, and chest wall compartment syndrome were not observed in our cohort. Pneumomediastinum self-resolved in 5 patients (38%) while on mechanical ventilation. (Fig. 1) Seven out of 12 intubated patients (58%) underwent prone ventilation without worsening of PTM. One patient was discharged home, 10 patients expired, and 2 patients remain hospitalized. CONCLUSIONS: Pneumomediastinum is a known sequelae of noncompliant lungs in severe acute respiratory distress syndrome (ARDS), typically in the setting of positive pressure delivered with invasive mechanical ventilation. Our cohort had a low prevalence of predisposing risk factors such as emphysema, and a high mortality. Pneumomediastinum was not strongly associated with mechanical ventilation, as nearly half (6/13) of the patients developed PTM prior to intubation. CLINICAL IMPLICATIONS: In our cohort, findings of PTM may be attributed to two main etiologies converging: damage from Covid-19 and self-inflicted increases in transpulmonary pressures. We postulate that impaired surfactant production from type II pneumocytes may predispose to atelectrauma leading to diffuse alveolar injury and risk of rupture, unlike in typical ARDS where barotrauma occurs in the context of poorly compliant lungs. Moreover, the increased work of breathing and pronounced cough seen in Covid-19 pneumonia may lead to increased transpulmonary pressures resulting in PTM. Reductions in transpulmonary pressures after intubation with initiation of sedation and neuromuscular blockade may explain the resolution of PTM in spite of invasive ventilation. Given the high mortality we observed, early identification and initiation of methods to reduce transpulmonary pressures is imperative to reduce risk of further complications. DISCLOSURES: No relevant relationships by Young Im Lee, source=Web Response No relevant relationships by Nan Li, source=Web Response No relevant relationships by Joseph Mathew, source=Web Response No relevant relationships by Lina Miyakawa, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Vishad Sheth, source=Web Response No relevant relationships by David Steiger, source=Web Response No relevant relationships by Jigna Zatakia, source=Web Response

Postmortem imaging identified pneumomediastinum in two cases of diabetic ketoacidosis

Abstract Pneumomediastinum is defined as the presence of extraluminal gas within the mediastinum. Hamman described a diabetic ketoacidosis (DKA) patient with subcutaneous emphysema and spontaneous pneumomediastinum, a case known in current times as Hamman's syndrome and now pneumomediastinum is known to be one of the accompanying findings of DKA. We describe two cases with diabetes mellitus in which postmortem computed tomography (CT) could detect pneumomediastinum prior to autopsy. One was a woman in her 40 s, who had type II diabetes mellitus with bronchopneumonia in the middle and lower lobes of the right lung (Case 1) and the other also aged in her 40 s with type I diabetes mellitus (Case 2). In these cases with diabetic mellitus, the finding of pneumomediastinum at postmortem CT gave differential diagnostic considerations of DKA in addition to common cause such as decomposition or cardiopulmonary resuscitation. Autopsy with histopathological and biochemical examination suggested the cause of death in both cases were fatal DKA. The main cause of pneumomediastinum in Case 1 was pulmonary emphysema, and DKA was an exacerbation factor of pneumomediastinum. In contrast, DKA could have caused pneumomediastinum in Case 2, so called Hamman's syndrome. Pneumomediastinum is an obvious morphological abnormality, and thus we should pay attention to the information of pneumomediastinum from postmortem CT scanning.

The radiological manifestations of the aberrant air surrounding the pleura: in the embryological view.

The radiological manifestations of the aberrant air surrounding the pleura are varied because of the air outlining the organs in and out of the visceral space. The continuity of the visceral space from the neck, mediastinum to the retroperitoneum is originated from embryological development, which is compatible with the findings through laboratory experiments, cadaveric anatomy, and thoracic computer tomography image. We reviewed the embryo development to understand the anatomy of body cavity, which can determine the radiological findings of pneumomediastinum and pneumothorax.

An unusual case of bronchial rupture—pneumomediastinum appearing 7 days after blunt chest trauma

We present a case of bronchial disruption after blunt chest trauma, which is unusual because the pneumomediastinum on the chest radiograph was detected 7 days after the injury. The first day imaging methods of the thorax showed only the fractures of the first and third left rib without any complications. A computed tomography (CT) scan was done following control chest radiograph and it revealed a rupture of the left main bronchus with pleural effusion, subcutaneous emphysema and pneumomediastinum. This case shows that a finding of pneumomediastinum after blunt chest trauma should always merit further investigation of its cause, even in cases of postponed detection of pneumomediastinum and regardless of the absence of other indicators of tracheobronchial disruption. Although fiber-optic tracheobronchoscopy is considered a diagnostic golden standard, in this case, diagnosis was clearly confirmed by spiral CT scan, due to thin slices and continuous data acquisition.

Atrial Lead Perforation: A Case Report

We report a patient in whom a chronic atrial lead perforated the right atrium and the right lung. This resulted in an hemopneumothorax and pneumomediastinum which was clearly documented by a chest computerized tomographic scan. The finding of pneumomediastinum should suggest atrial lead perforation. The utility of the chest computerized tomographic scan in diagnosing lead perforation is well illustrated by this case.