Subcutaneous Emphysema Research Articles

Boerhaave Syndrome Rare Pathological Entity: About 2 Cases

Boerhaave syndrome is a rare emergency spontaneous rupture of the esophagus as a consequence of barotrauma. Its incidence is estimated at 1.3/1,000,000 per year in the United States, and the diagnosis should be made in the presence of chest pain preceded by intense vomiting, and confirmed by imaging. Our clinical cases have just shown that symptomatology depends on the extent of the lesions, with a normal clinical examination in the first case and subcutaneous emphysema in the second. A CT scan remains the gold standard for confirming the diagnosis.

A fatal complication of tracheostomy cannula exchange: Bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema

A fatal complication of tracheostomy cannula exchange: Bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema

A retrospective analysis of patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis, over a 10-year period

IntroductionLaryngotracheal stenosis encompasses a diverse range of diagnoses, encompassing complete or partial narrowing of various subgroups of the upper airways, including the laryngeal structures and trachea, due to pathological scar formation. This increasingly prevalent pathology is of significant importance due to its potential for life-threatening consequences. Among the defined treatment modalities, tracheal resection and end-to-side anastomosis remain a valuable therapeutic alternative in appropriate indications. ObjectiveThe objective of this study was to retrospectively evaluate the outcomes of patients who underwent tracheal resection and end-to-end anastomosis at our clinic over the past decade. Material & methodAll patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis at the Department of Otolaryngology, Mustafa Kemal University Hospital between 2013 and 2023 were included in the study. The diagnosis of tracheal stenosis was based on endoscopic examination and computed tomography results. Interventions without postoperative symptoms and without the need for additional surgical intervention were considered successful. The study was approved by Hatay Mustafa Kemal University Ethics Committee with decision number 2023/27. ResultsA total of 29 patients were included in the study. The mean age of the patients was 26.48 years. 3 patients (10.35 %) had a comorbidity. In all patients orotracheal intubation or intubation and tracheotomy was the aetiological cause. There were no intraoperative complications. In the postoperative period, wound infection was observed in 3 patients (10.35 %) and subcutaneous emphysema in 2 patients (6.9 %). In 1 patient (3.45 %) recurrent respiratory distress was observed, restenosis was considered and tracheotomy was performed. Our complication rate was 20.69 %. When all patients were evaluated at the end of the postoperative follow-up period, the surgical success rate was calculated to be 96.55 %. ConclusionWith a surgical success rate of 96.55 % and a low complication rate in our study, we believe, in parallel with previous studies, that open surgery is a reliable, physiologically appropriate and successful method among the current treatments for tracheal stenosis.

Pneumomediastinum Mistaken as Angioedema: Case Report

Pneumomediastinum and massive subcutaneous emphysema are clinical conditions that can occur during head and neck surgeries, bronchoscopy and tracheostomy, after thoracic trauma, rarely during dental procedures and sometimes spontaneously. Patients often present with symptoms such as swelling of the face, neck and sometimes the whole body, difficulty swallowing, shortness of breath, chest pain and skin crepitus. These findings usually develop suddenly and sometimes may occur within hours or days. A 48-year-old man is applies to the hospital with complaint chest pain due to a fall in the garden. If no pathology is thought to be present as a result of the X-ray, the patient is prescribed ibuprofen for pain relief and discharged. Patient who presents with what appears to be angioedema after taking ibuprofen is found to have pneumomediastinum. In the cases mentioned in the report and initially thought to be angioedema, seeing that the lips are not swollen and feeling subcutaneous crepitation, i.e. even just inspecting and palpating the patient, will distract the clinician from angioedema in a few seconds and direct him/her to the correct diagnosis and perform examinations in the direction of pneumomediastinum.

Management of Respiratory Failure in Shoulder Arthroscopy: A Case Report

Subcutaneous emphysema is a known but rare complication in shoulder arthroscopies. Addition of complications like bilateral hydrothorax confuse the situation to the intensivist. We report the case of a patient posted for shoulder arthroscopy who developed subcutaneous emphysema but later diagnosed to have bilateral hydrothorax. The perplexity in the diagnosis was cleared by investigating further. This case report attempts to resolve the diagnostic confusion involved in managing complications after shoulder arthroscopy.

Post-intubation tracheal injury during esophagectomy

Post-intubation tracheal injuries are rare complications with serious consequences. Several factors increase the risk of tracheal injuries which may be attributed to patient, or procedure related. Majority of the tracheal injuries are managed surgically, however, role of less invasive and conservative treatment are also emerging. Case: we report a case of an elderly lady who underwent minimally invasive esophagectomy for esophageal carcinoma. She developed significant surgical emphysema within hours after surgery and massive air leak through underwater seal chest drainage tube. She was taken for emergency re-exploration. On table bronchoscopy confirmed 5 cm longitudinal tear of membranous part of cervical and upper thoracic trachea. Thoracoscopic repair along with transcervical-transtracheal repair of membranous wall of trachea and a tracheostomy was performed. She made significant recovery with few complications which were managed successfully.

A modified Tseng algorithm approach to restoring thoracic diseases' computerized tomography images.

It is well-known that the Tseng algorithm and its modifications have been successfully employed in approximating zeros of the sum of monotone operators. In this study, we restored various thoracic diseases' computerized tomography (CT) images, which were degraded with a known blur function and additive noise, using a modified Tseng algorithm. The test images used in the study depict calcification of the Aorta, Subcutaneous Emphysema, Tortuous Aorta, Pneumomediastinum, and Pneumoperitoneum. Additionally, we employed well-known image restoration tools to enhance image quality and compared the quality of restored images with the originals. Finally, the study demonstrates the potential to advance monotone inclusion problem-solving, particularly in the field of medical image recovery.

Recurrent spontaneous pneumothorax secondary to lung cystic lesions in a case of convalescent COVID-19: a case report and literature review

BackgroundWhile spontaneous pneumothorax has been documented in COVID-19 patients, reports on recurrent spontaneous pneumothorax due to cystic lesions in convalescent COVID-19 patients are scarce. The progression of these lung cystic lesions remains inadequately explored.Case presentation and literature reviewAn 81-year-old male, a non-smoker with a history of rheumatoid arthritis, presented with fever, cough, and expectoration for 14 days. Initially diagnosed with moderate COVID-19, he deteriorated to severe COVID-19 despite adherence to local treatment guidelines. Successive identification of three cystic lesions termed “bulla” or “pneumatocele”, and one cystic lesion with air-fluid level, referred to as “pneumo-hamatocele” (PHC), occurred in his lungs. Gradual improvement followed anti-inflammatory therapy and optimal supportive care. However, on day 42, sudden worsening dyspnea prompted a computed tomography (CT) scan, confirming a right spontaneous pneumothorax and subcutaneous emphysema, likely due to PHC rupture. Discharge followed chest tube implementation for pneumothorax resolution. On day 116, he returned to the hospital with mild exertional dyspnea. Chest CT revealed recurrent right pneumothorax from a remaining cyst in the right lung. Apart from our patient, literature retrieval identified 22 COVID-19 patients with spontaneous pneumothorax due to cystic lesions, with a male predominance (95.6%; 22/23). Diagnosis of pneumothorax and lung cystic lesions occurred around day 29.5 (range: 18–35) and day 26.4 (± 9.8) since symptom onset, respectively. Except for one patient whose pneumothorax occurred on day seven of illness, all patients eventually recovered.ConclusionsRecurrent spontaneous pneumothorax secondary to lung cystic lesions may manifest in convalescent COVID-19 patients, particularly males with COVID-19 pneumonia. Chest CT around 2 to 3 weeks post-symptom onset may be prudent to detect cystic lesion development and anticipate spontaneous pneumothorax.

445nm Blue Laser for Cricopharyngeal Myotomy/Zenker's Diverticulotomy: Proof of Concept and Use.

Treatment for Zenker's diverticulum and cricopharyngeal dysfunction has evolved to include flexible endoscopic approaches. Currently, no flexible modalities combine the precision cutting of CO2 laser and the hemostasis of knife electrocautery. We present the first series describing fiber-based 445nm blue light (BL) laser for endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. We describe usage characteristics and laser parameters with rigid esophagoscopy to determine the feasibility of use with flexible endoscopy. Retrospective review and literature review. The first nine cases of endoscopic diverticulotomy (n = 5) and cricopharyngeal myotomy (n = 4) with BL were reviewed. Rigid exposure was achieved with the Dohlman Slimline diverticuloscope. Mean age was 75.6 years. Average diverticulum depth was 0.89 cm ±1.0 cm. Pulsed mode was used in seven cases with mean of 6.86 W, 54 ms pulse on, and 286 ms pulse pause and overall mean of 6.00 W and 405 J. Complete myotomy with intact buccopharyngeal fascia and without bleeding limiting view was achieved in all patients. One of two patients in whom continuous wave setting was used developed subcutaneous emphysema following vigorous cough on POD0; this resolved after 7 days nothing per oral (NPO). Eight patients were started on oral intake without evidence for leak. Pulsed mode with fiber-to-tissue contact provided effective muscle cutting without disruption of buccopharyngeal fascia. Literature review yielded three articles examining flexible approach with laser for Zenker's and none with BL. BL provides safe and effective fiber-based cutting and hemostasis in endoscopic cricopharyngeal myotomy/Zenker's diverticulotomy. Future use in flexible endoscopic approaches appears feasible, though continuous wave should be avoided. 4 Laryngoscope, 134:4620-4624, 2024.

The role of the pressure in the endotracheal tube cuff in the development of iatrogenic tracheal injuries

Background. The endotracheal tube insertion, which is a veritable patient care procedure, carries risks and possible adverse effects. Such complications vary in severity and range from mild symptoms such as sore throat or cough, which are often considered normal post-intubation events, to severe damage, including damage to the vocal cords, trachea, malacia, and fistula formation. A critical factor influencing the manifestation of these complications is the pressure exerted by the endotracheal tube cuff on the trachea. The purpose was to study the influence of high pressure of the intubation tube cuff on the incidence and severity of complications in an in vivo model. Materials and methods. A total of 12 rabbits were studied and divided into three groups according to target cuff pressure: 30, 50, and 100 cm H2O. Sevoflurane was used to maintain anesthesia, monitoring of vital functions included heart rate, pulse oximetry, capnography, and electrocardiography. Intubation was performed after induction with ketamine and administration of relaxants, and cuff pressure was measured with a mechanical manometer. The duration of pressure exposure was 20 minutes for each group, then the degree of tracheal damage was assessed by autopsy. Results. Increasing pressure generally leads to an increased risk of injury. In the third group (pressure of 100 cm H2O), all subjects had damage to the trachea, in 75 % of cases, it was a complete tracheal rupture. However, the dependence on pressure is not unambiguous for all types of injuries: the frequency of pneumothorax does not correlate directionally with the incidence of iatrogenic injuries and does not increase proportionally to pressure. So, for example, subcutaneous emphysema developed only in a third of cases of tracheal rupture. This emphasizes possible difficulties in timely diagnosis of this type of complications. Conclusions. The work highlights the risks associated with endotracheal intubation and emphasizes the need to maintain recommended practices and individual approach to each case. The most severe damage was observed at a pressure of 100 cm H2O, while at a pressure of 30 cm H2O, a smaller proportion of rabbits showed signs of damage.

Etiology, Diagnosis, and Treatment Strategy of Dental Therapy-related Subcutaneous Emphysema

Subcutaneous emphysema (SE) is defined as localized tissue swelling caused by gas entering subcutaneous tissue through a tissue gap. Although SE is usually a nonfatal and self-limiting disease, in severe cases, the gas may spread to the neck, mediastinum, and chest, leading to mediastinal emphysema and other serious complications. This article aims to explore the etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment strategy of SE related to dental therapy, to provide some reference for dentists.

Spontaneous pneumomediastinum and surgical emphysema presenting as rhinolalia following ecstasy ingestion: a case report

BackgroundWe present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use.Case presentationThis case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved.ConclusionsThis case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use.

Nuevos dispositivos, nuevos problemas. Neumomediastino secundario a terapia con Renuvion/J-Plasma®. Reporte de caso

The incorporation of new technologies such as ultrasound, J-Plasma (helium plasma) and MicroAire (energy-assisted liposuction) has facilitated liposculpture procedures, resulting in greater patient satisfaction. The benefits of these technologies are accompanied by low reported complications; this case is the fourth description of pneumomediastinum secondary to the use of Renuvion® (J-Plasma) after liposuction for fat removal in the arms and thighs. This rare complication should be considered as part of the differential diagnosis during the study of clinical dyspnea and subcutaneous emphysema in the postoperative period.

Spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no clinical signs: 12 cases

Pneumomediastinum denotes the presence of gas within the mediastinum and generally occurs by leakage of air from an aerated viscus that traverses or abuts the mediastinal plane. The Macklin effect has been described in several veterinary studies and describes gas tracking along the perivascular interstitium following alveolar rupture causing interstitial emphysema, pneumomediastinum and subsequently cervical subcutaneous emphysema. This retrospective case series describes incidental spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no related clinical signs. Twelve dogs were identified from the author’s institution, of which 75 % were Sighthounds (Greyhounds, Whippets or Lurchers). Pulmonary interstitial emphysema had a predominantly paravascular distribution, although in some cases a parabronchial distribution was also identified. We conclude that incidental pulmonary interstitial emphysema, pneumomediastinum and secondary cervical subcutaneous emphysema can be incidental, presumed secondary to the Macklin effect and that Sighthound breeds may be overrepresented.

Screening and assessment of nutritional status and some related factors in patients who have laparoscopic surgery for colon cancer

Background: Preoperative malnutrition is a significant problem for cancer and colon cancer patients, so screening, monitoring, and supporting this condition becomes increasingly essential in the surgical field. In colorectal cancer, malnutrition is significantly associated with several consequences, including mortality and increasing the length of hospital stay after surgery. The NRS 2002 and SGA scores are practical malnutrition assessment tools widely used in clinical practice today. Materials and methods: A cross-sectional descriptive study was performed on 53 patients undergoing laparoscopic surgery due to colon cancer at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. The NRS-2002 tool was used for risk screening, and the SGA was used to assess the patient’s nutritional status. Information about the disease and related factors are referenced from medical records combined with asking the patient. Results: The average age was 61.5±14.5, of which 50.9% were male. ASA 1 accounted for the majority at 66.0%. Complications of surgical site infection accounted for 11.3%. Two patients with subcutaneous emphysema accounted for 3.8%, and one with urinary retention accounted for 1.9% were treated with conservative treatment. One patient had early postoperative small bowel obstruction due to abdominal drainage and was successfully treated medically, accounting for 1.9%. There were no major complications requiring reoperation and short-term mortality. The average hospital stay was 7.4 ± 2.1 days. According to the 2002 NRS score, there were 19 (35.8%) cases of nutritional at-risk; the SGA rating had 1.9% SGA-C and 15.1% SGA-B cases. There was a relationship between NRS-2002 and the patient’s blood albumin concentration. Conclusion: The prevalence of patients at nutritional risk and malnutrition is quite common. It is necessary to carry out routine screening and nutritional risk assessment to support colon cancer treatment. Key words: malnutrition, colorectal cancer, NRS 2002, SGA score.

Retracted: “Acute subcutaneous emphysema: A rare clinical presentation of large bowel perforation”

Retracted: “Acute subcutaneous emphysema: A rare clinical presentation of large bowel perforation”

Ensuring Patient Safety in Pediatric Dental Care

This review aims to examine safety concerns in pediatric dental care and underscore the need for comprehensive patient safety initiatives within the Korean Academy of Pediatric Dentistry. Drawing insights from the prevailing patient safety policies of the American Academy of Pediatric Dentistry, case reports, and systematic reviews, this review elucidates issues such as dental fires during sedation, ocular complications from local anesthesia, and surgical emphysema. This review highlights the significance of safety toolkits encompassing infection control, medical error reduction, dental unit waterline infection, and nitrous oxide safety in pediatric dental settings, underscoring the need to foster a safety culture. Furthermore, this study explores the curriculum for pediatric dentistry residency programs, emphasizing concepts such as high-reliability organizations and mortality and morbidity conferences. The study suggests the need for initiatives to enhance patient safety, including establishing safety committees, expanding reporting systems, policy development, and supporting research related to patient safety. In conclusion, this study underlines key messages, emphasizing the utmost priority of patient safety, acknowledging the inevitability of human error, promoting effective communication, and cultivating a patient safety culture. These principles are vital for advancing patient safety in pediatric dental care and improving outcomes among pediatric patients.

Post traumatic disruption of the trachea: About three adolescents’ cases with literature review

Introduction: Tracheal lesions are rare but potentially serious and can cause significant morbidity and mortality. Early diagnosis is essential for optimal management. We report 3 cases of adolescents who were victims of external cervicothoracic trauma. All three patients presented with neck pain, inspiratory dyspnea, and polypnea with subcutaneous cervical emphysema in clinical examination. Nasofibroscopy showed normal appearance and mobility of the vocal cords. Cervical and thoracic CT scan with contrast enhancement was carried out in all our patients that showed tracheal breach in various localizations. The first patient underwent surgical exploration of the penetrating wound in the cervical area. The surgical exploration revealed no damage to the anterior and lateral faces of the trachea. In this case, a sagittal discontinuity on the posterior wall of the trachea was revealed using a rigid bronchoscope. All patients were admitted to the intensive care unit for monitoring and follow-up for 24 to 72 hours and received antibiotics and corticosteroids for 10 days. The patient's symptoms improved throughout the evolution. Conclusion: Early diagnosis is necessary to prevent complications. The gold standard for diagnosis is bronchoscopy. Conservative management is recently considered the best therapeutic choice which also allows the morbidity of surgical treatment to be avoided

Hemodynamic instability caused by pneumorrachis and pneumomediastinum following epidural analgesia: a case report

BackgroundPneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations.Case presentationWe present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia.ConclusionAnesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.

Low-level LASER therapy accelerates fungal lesions cicatrization by increasing the production of Th1 and Th2 cytokines.

Our study focused on the resolution of lesions caused by fungal infection using a subcutaneous air pouch model of infection. We evaluated cell profile and cytokines, fungi viability, and the presence of fibroblasts and fibrocytes at the site of infection. Inoculation of P. brasiliensis (Pb) was performed using a subcutaneous air pouch model and the LLLT irradiation was performed on alternate days on the rear paws of mice for 10days, after which the cells from the air pouch were collected and analyzed. In animals irradiated with LLLT, the influx of cells to the air pouch was reduced, but they were more activated and produced pro-inflammatory (IL-12, IL-17 and TNF-α) and neutrophil (PMN) activating cytokines (IL-8, GM-CSF and γ-IFN). A better resolution of the infection, evidenced by the reduction in the number of viable fungi with preserved morphology in the air pouch, and an increase in the number of fibrocytes, indicating a healing profile were also observed. LLLT decreased the influx of PMN, but those presents were highly activated, with increased fungicidal activity. LLLT irradiation also resulted in earlier cicatrization at the site of infection, leading to a better outcome of the infection. These data are favorable to the use of LLLT as a complementary therapy in PCM.