Severe Mediastinal Emphysema Research Articles

Clinical report of serious complications associated with measles pneumonia in children hospitalized at Shengjing hospital, China.

Despite tremendous progress made toward elimination, measles continues to pose a great threat to the health of children in developing countries. The objective of this study was to summarize and analyze the clinical characteristics and treatment experience of serious complications of measles pneumonia in children. The study group comprised 58 infants with severe measles pneumonia who were admitted to the Second Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, from December 2013 through May 2014. The clinical characteristics of complications such as hypoxemia, acute respiratory distress syndrome (ARDS), sepsis, pneumothorax, multiple organ dysfunction syndrome (MODS), and intracranial infection were retrospectively analyzed; in addition, the death cases were summarized and analyzed. The 58 infants experienced the following: hypoxemia, 100%; ARDS, 21%; sepsis, 34%; pneumothorax, 14%; MODS, 16%; and intracranial infection, 9%. A total of 7 infants developed a secondary bacterial infection, and 12 infants received mechanical ventilation (5 with high-frequency mechanical ventilation and 3 with mechanical ventilation and NO inhalation); the average duration of mechanical ventilation was 10.08 days, and 3 infants expired. Children with measles pneumonia may experience multiple serious complications, among which ARDS and pneumothorax are particularly serious. If a patient's condition changes abruptly, it is crucial to promptly respond to the change and to administer mechanical ventilation and appropriate antibiotics. For patients with a severe pneumothorax, and especially those with severe mediastinal emphysema, timely, continuous, retrosternal, closed thoracic drainage can effectively relieve compression.

Severe Mediastinal Emphysema and Tension Pneumothorax Caused by Cough-Induced Intercostal Lung Herniation

We report a case of cough-induced intercostal lung herniation with severe mediastinal emphysema and pneumothorax. A 60-year-old overweight man was admitted with dyspnea, chest pain, and chest wall bulging. Imaging confirmed left pneumothorax, fractures of the 8th to 10th ribs, and a defect in the 8th intercostal muscles. The presence of protrusion of lung parenchyma outside the intercostal space was unclear. Although the symptoms of tension pneumothorax disappeared after drainage, the subcutaneous emphysema was uncontrollable. Emergency surgery revealed lung injury near the 8th rib wedge not directly related to the rib fracture, and lung herniation was observed. We performed direct approximation of the ribs, and the lung parenchymal surface was encased by absorbable materials, avoiding infection risk. Although the lung herniation recurred 5 months later, the patient did not desire additional surgical repair. Non-absorbable materials should be considered for repair of lung herniation, excluding patients at high infection risk.