Intraspinal Air Research Articles

Pneumorrhachis With FDG Uptake Cervical Lesions on PET/CT of a Patient With Suspected Recurrent Hypopharyngeal Cancer.

A 57-year-old man presented with odynophagia for 1 week was referred for FDG PET/CT scan to rule out recurrent hypopharyngeal cancer. The FDG PET/CT showed hypermetabolic lesions in hypopharyngeal area and adjacent cervical spine with pneumorrhachis, the presence of intraspinal air, on attenuation CT images, which might indicate a life-threatening infection. An emergency MRI confirmed the presence of cervical spondylodiscitis with an epidural abscess. The patient rapidly progressed to quadriplegia and difficulty voiding on the same day as the PET/CT scan, leading to emergent operation. The patient received antibiotics treatment and discharged 4 months later without evidence of cancer recurrence.

Computed Tomography Findings in Traumatic Pneumorachis: A Case Report

The phenomenon of air entering the spinal canal is rare and termed pneumorachis. Due to its rarity, the evaluation and management of pneumorachis have not been well understood. Here, the authors describe a case of pneumorachis associated with pneumothorax, pneumomediastinum, subcutaneous emphysema, and traumatic pulmonary injuries in a 21-year-old male patient following blunt chest trauma after a motor vehicle accident. The patient presented with chest pain and difficulty breathing immediately after the vehicle accident, along with a deformed left arm. A bedside Focused Assessment with Sonography in Trauma (FAST) scan was performed, followed by a non-contrast CT of the thorax, which revealed intraspinal air and multiple fractures. The patient recovered without any adverse outcomes with conservative management of the intraspinal air. Pneumorachis is usually secondary to trauma and typically follows a benign course with spontaneous resolution after conservative management. It is important to be aware of this condition to identify it early and prevent complications.

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

RECREATIONAL NITROUS OXIDE INHALATION AS AN UNUSUAL CAUSE OF SPONTANEOUS PNEUMOMEDIASTINUM AND PNEUMORRHACHIS SECONDARY TO BAROTRAUMA

PNEUMORACHIS: COMPLICATION RARE DECOUVERTE CHEZ UN PATIENT CONNU ASTHMATIQUE

The pneumorachis or the presence of intraspinal air, is a rare entity of fortuitous discovery which can be of traumatic, infectious, iatrogenic origin or more rarely associated with a spontaneous pneumomediastinum. This pathology is usually asymptomatic, the air resolvesspontaneously and completely by passing into the bloodstream. Wereport a very rare case of cervico-dorsal pneumorachis complicatingspontaneous pneumomediastinum and cervical subcutaneousemphysema revealed by spinal pain and whose cause was a severeasthma attack.

Spontaneous Pneumocephalus with Meningomyelocele: A Case Report

Spontaneous pneumocephalus is one of the complications of open myelomeningocele with or without clinical signs, reported very rarely in the literature. Pneumocephalus It can associated with several neurosurgical procedures, lumbar puncture, or cranial trauma; But very rarely, the open neural tube defects may lead to spontaneous pneumocephalus. The radiographic appearance of intraspinal air on CT was not described previously. The following report presents a case of spontaneous appearance of internal pneumocephalus in a newborn infant with open myelomeningocele which environmental air could gain access to the cerebrum associated with bi-ventricular hydrocephalus and an Arnold-Chiari type II malformation, revealed on CT images. Spontaneous pneumocephalus should be kept in mind as a rare complication of open meningomyelocele. Any patient with open meningomyelocele should be early evaluated for pneumocephalus with a cranial imaging.

Pneumorrhachis causing cauda equina syndrome: a case report and literature review

BackgroundPneumorrhachis (PR) describes the rare presence of intraspinal air, mainly following traumatic or iatrogenic procedures. According to the localization of air in the spinal canal, PR has been classified into internal (subdural) and external (epidural). PR rarely manifests in neurological deficits and usually resolves spontaneously without recurrence, with air being passed directly into the bloodstream.Here, we report a case of external PR occurring spontaneously (without any underlying trauma or surgical interventions) manifesting as neurological deficits. This is an extremely rare finding with only a limited number of cases in the literature.Case presentationWe report a case of spontaneous external PR manifesting as neurological symptoms in a 62-year-old male diabetic patient with chronic low backpain who developed numbness in his perineal region mainly on the left side. His medical history was normal, without trauma or surgical intervention. Magnetic resonance imaging (MRI) and computed tomography (CT) in the past 2 years demonstrated degenerative changes in the lumbar spine, including end plates and disc spaces, with intervertebral disc vacuum phenomenon (VP); the CT additionally showed intraspinal air in the epidural space at L5-S1 levels compressing the cauda equina. A diagnosis of spontaneous external PR was made. A follow-up MRI upon exacerbation of neurological deficits showed an increase in air locule size. Our patient was managed conservatively on a nonsteroidal anti-inflammatory agent (NSAID) and was advised for regular follow-ups. No aspiration or surgery has been performed to date.ConclusionsSpontaneous external pneumorrhachis manifesting as neurological symptoms is extremely rare. Due to degenerative disc disease producing vacuum phenomenon, we propose that spontaneous PR secondary to intradiscal VP be considered as part of the differential for radicular symptoms, especially with increasing age. The most effective noninvasive investigation for the diagnosis of PR is CT. MRI is less beneficial in the case of PR as gas and calcifications are hard to distinguish, both being of low-intensity signals on all MR sequences.

Intramedullary pneumorrhachis following a cervical epidural steroid injection

Pneumorrhachis (PR) is a rare radiological condition characterized by the presence of intraspinal air. PR is commonly classified as spontaneous (nontraumatic), traumatic, or iatrogenic, and iatrogenic PR is the most common and often occurs secondary to invasive procedures such as epidural anesthesia, lumbar puncture, or spinal surgery. PR is usually asymptomatic, but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of intramedullary cervical PR following a cervical epidural steroid injection (ESI) and include pertinent discussion.

Proportion and Clinical Relevance of Intraspinal Air in Patients With Pneumomediastinum.

The purposes of this study were to determine the incidence of pneumorrhachis among patients with pneumomediastinum, determine whether its proportion correlates with the extent of pneumomediastinum, and ascertain its clinical relevance. The radiologic database was searched for CT reports between January 2009 and September 2013 containing the term "pneumomediastinum" or "mediastinal air." Scans were examined for pneumomediastinum, pneumorrhachis, pneumothorax, sternotomy, and distribution of pneumomediastinum. The age and sex of the patient and probable cause of the abnormality were recorded. Cases that might have had another cause were excluded. The search yielded 422 CT scans. Among these, 242 instances of pneumomediastinum in 241 patients were found. Fifteen of these patients had pneumorrhachis. One was excluded because of recent traumatic spinal penetration. There was no significant difference in age or sex between patients with and those without pneumorrhachis. After application of the exclusion criteria, there were 14 cases of pneumorrhachis, yielding a proportion of 5.8%. Pneumorrhachis was observed more frequently in cases of the most severe grade (grade C) of pneumomediastinum; however, that relationship was not statistically significant (11 cases [8.2%]; p = 0.304). Pneumorrhachis was found significantly more frequently in patients with distribution of air in all three mediastinal compartments (13 cases, 16.2%, p < 0.001). Pneumorrhachis was overrepresented among subjects with spontaneous compared with those with secondary pneumomediastinum, although the trend did not reach statistical significance. Pneumorrhachis was present in 5.8% of patients. It is significantly more common in patients with the broadest distributions of mediastinal air and nonsignificantly more common in association with spontaneous as opposed to secondary pneumomediastinum. Pneumorrhachis in patients with pneumomediastinum is a generally benign, self-resolving condition.

Two Cases of Pneumorrhachis with Different Causes

We present two interesting and rare cases of pneumorrhachis (intraspinal air). The first patient is a 43- year-old male patient who had a road traffic accident and trauma CT showed impressive pneumocephalus and pneumorrhachis within the cervical canal. Treatment was conservative and the patient improved the following weeks with reabsorption of the air. Another 60-year-old female patient had known diverticulitis and developed paraparesis of her legs with associated fever. MRI of her spine showed extensive intraspinal air in the thoracolumbar space. She was operated combined with neurosurgeons and abdominal surgeons with colostomy and laminectomy. After a long treatment on ICU and rehab center 6 months after surgery she was able to walk with help.

An Unusual Association in an Uncommon Disease: Two Cases of Spontaneous Pneumomediastinum Associated with Pneumorrhachis.

Pneumomediastinum, the presence of free air in the mediastinum, is described as spontaneous pneumomediastinum when there is no apparent cause such as trauma, surgery, interventional procedures, or intrathoracic infections. Pneumorrhachis is a rare clinical condition, consisting of intraspinal air. The main causes are iatrogenic, traumatic, and nontraumatic. Spontaneous mediastinum is usually associated with subcutaneous emphysema and, occasionally, with pneumothorax; however, its association with pneumorrhachis is extremely rare. Here, we present two rare cases of spontaneous pneumomediastinum associated with pneumorrhachis caused by vigorous coughing.

Atypical traumatic pneumorrhachis accompanied by paraparesis.

Pneumorrhachis, caused by intraspinal air, is an exceptional but important radiographic finding that is accompanied by different etiologies. Pneumorrhachis, by itself, is usually asymptomatic and gets reabsorbed spontaneously. Therefore, the patients with pneumorrhachis are mostly managed conservatively. We encountered a unique case of atypical traumatic pneumorrhachis accompanied by paraparesis.

Late Prevertebral and Spinal Abscess following Chemoradiation for Laryngeal Squamous Cell Carcinoma

Objective. Advanced primary supraglottic tumors (i.e., T3 or T4) have traditionally been treated surgically and postoperative radiotherapy. In the last 2 decades, some patients were treated with chemoradiation avoiding surgery. Case Report. We describe a 55-year old female who presented with respiratory distress and paraplegia seven years after treatment for a T3N0M0 supraglottic squamous cell carcinoma. CT scan showed prevertebral and intraspinal air descending from C4 to D3 vertebras. Epidural and prevertebral abscesses were confirmed by neck exploration. Necrosis was observed in the retropharyngeal, prevertebral, and vertebral tissues. Conclusion. Prevertebral and spinal abscess may result from chemotherapy and radiotherapy to the head and neck. Physicians caring for head and neck cancer patients treated with chemotherapy and radiation should be aware of this rare severe complication.

Pneumocephalus and Pneumorrhachis after Spinal Surgery: Case Report and Review of the Literature

Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days.

Symptomatic Pneumorrhachis

Pneumorrhachis (PR) is the presence of air within the spinal canal, whether localized in the epidural or in the subarachnoid space. Evidence of intraspinal air, especially in the subarachnoid space, had been thought to be merely a radiological artifact of serious underlying pathology until it was proven that PRs can be related to neurologic symptoms ranging from radicular pain to serious neurologic deficits. The etiologies, pathomechanisms, and natural courses show differences from case to case, with the result that no consistent treatment strategies exist in the literature. Although the conservative treatment modalities seem to be more appropriate in nonsymptomatic cases, treatment strategies in symptomatic cases remain the subject of discussion. In this study, we present two symptomatic cases of PR arising from different causes and review the literature, focusing especially on the symptomatic cases and strategies for treating them.

Traumatic Cervical Pneumorrhachis

Pneumorrhachis (Intraspinal air or intraspinal pneumocele) is a rare association with closed head injury. Iatrogenic causes are well known and are often secondary to diagnostic procedures. However, there are only a few case reports in the literature following trauma. We present a case of traumatic pneumorrhachis following a head injury with base of skull fracture. This was treated conservatively and patient made a full recovery.

Pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumorrhachis as complications of common flu

SummaryBackground:Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with subcutaneous emphysema and occasionally with pneumothorax, but is rarely associated with pneumorrhachis (air within the spinal epidural space).Case Report:We describe the case of a 20-year-old man and discuss a classification system of pneumorrhachis and its pathoanatomy, clinical and radiological presentation and management based on a detailed review of the previous literature. The pathophysiology is multifocal and diagnosis is state-of–the-art, as free intra-spinal air collection and coexistence of it both should be differentiated. Computed tomography with reconstruction of imaging is the method of choice for investigation. Symptoms associated with pneumorrhachis are due to its cause and origin and rarely due to pneumorrhachis, itself. Neurological symptoms and signs due to pressure effect are rarely found, but were present in our case. The management requires a multidisciplinary regimen and has to be individualized. The case was successfully managed conservatively, except for intercostal drainage for symptomatic pneumothorax. The patient stayed at rest and his symptoms improved within a few days. Seven days later the intraspinal air and pneumomediastinum were spontaneously resolved on follow-up chest computed tomography. In spontaneous pneumomediastinum, pneumorrhachis is self-limiting and benign.Conclusions:The same management is advised in spontaneous pneumomediastinum with or without pneumorrhachis in non-complicated, asymptomatic cases.

Pneumorachis of the cervical spine with associated pneumocephalus and subcutaneous emphysema

Pneumorachis, the presence of free intraspinal air, is an exceptional radiological finding. We present a case that sustained injury following an assault and was diagnosed to have diffuse pneumocephalus, pneumorachis and extensive surgical emphysema of the head and neck region secondary to the fracture of the cribriform plate of ethmoid bone. To the best of our knowledge pneumorachis due to fracture of the cribriform plate of ethmoid bone has not been reported before, in the English language literature.

Traumatic Pneumorrhachis

Pneumorrhachis or intraspinal air is an increasingly encountered phenomenon in the management of severe trauma. The case of a 23-year-old soldier, who sustained a gunshot wound to the chest, is...

Pneumorachis: A possible source of traumatic cord compression

The presence of air within the spinal canal secondary to trauma is a rare condition. These rare cases are generally asymptomatic. We report our first case of closed thoracic trauma with pneumorachis associated with neurological disorders. According to a review of the literature and after personal record analysis, neurologic symptoms can be correlated to the occurrence of intraspinal air. Therefore pneumorachis appears as a possible cause of traumatic spinal cord compression. In this particular case, pneumorachis spontaneously resolved and early outcome was favourable.

Air Within the Spinal Canal in Spontaneous Pneumomediastinum

Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with air within the spinal canal. We describe a further case in a 14-year-old girl and suggest a classification system based on a detailed review of the previous literature. Forty-eight patients with spontaneous pneumomediastinum and intraspinal air accumulation (36 men and 12 women, age range 4-72 years, median age 18 years) were grouped into those with underlying lung disease (n = 13), those with other underlying etiologic factors (n = 22), and those arising spontaneously (n = 13). Neurologic symptoms or signs were noted in one case. The remaining cases were successfully managed conservatively. In spontaneous pneumomediastinum, accumulation of air within the spinal canal is self-limiting and benign. The same management is advised in spontaneous pneumomediastinum with and without intraspinal air accumulation.