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Retroperitoneal air, extracorporeal shock wave lithotripsy and epidural anesthesia.

During a 13-month period, 1,344 patients underwent extracorporeal shock wave lithotripsy. Plain x-rays done routinely 24 hours after lithotripsy to assess stone fragmentation revealed evidence of retroperitoneal air in 6 patients. All 6 patients had epidural anesthesia induced by loss of resistance to air in a syringe to identify the epidural space. It was believed likely that this was the cause of the air and 2 types of distribution were identified: 1 showed tracking of air along spinal nerves and 1 along tissue planes. This hypothesis eventually was confirmed by 2 patients in whom the air was identified after epidural anesthesia but before extracorporeal shock wave lithotripsy. Retroperitoneal air is found in a small number of patients undergoing epidural anesthesia and extracorporeal shock wave lithotripsy, and physicians treating these patients in the early postoperative period should be aware of this possible radiological finding and appreciate its benign nature.

Adult↗

Diffuse subcutaneous emphysema, pneumomediastinum, and pneumothorax after dental extraction.

Subcutaneous emphysema, pneumomediastinum, and pneumothorax may result from surgical procedures and trauma and usually do not present a diagnostic dilemma. We present a case of subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum after a dental procedure with an air-and-water-cooled turbine burr drill. This allowed air and water under pressure to be driven into the field and track through the fascial planes. Although this is a common occurrence, these patients frequently go undiagnosed or misdiagnosed as allergic reactions to locally administered anesthetic agents. If a large amount of air is injected, it may track into not only the subcutaneous tissues but also the mediastinum, pleural space, and retroperitoneal space. Patients with significant amounts of air must be admitted, observed for airway compromise, and be provided IV antibiotics and hydration.

Adult↗

Pneumomediastinum: an unusual complication of bronchial asthma in a young man.

We report a patient with bronchial asthma who presented with pneumomediastinum, pneumopericardium, pneumoretroperitoneum, pneumorrhachis and extensive subcutaneous emphysema, after a period of coughing. Pathogenesis, diagnostic procedures and treatment of pneumomediastinum and its complications are discussed.

Adult↗

Benign pneumoperitoneum associated with pneumomediastinum and pneumoretroperitoneum in ambulatory outpatients.

Perforation of a hollow viscus and other dangerous etiologies must always be considered in the evaluation of free peritoneal air. Pneumoperitoneum in the presence of pneumoretroperitoneum and pneumomediastinum, however, often results from air tracking from a pathologic source outside of the abdomen along the mesentery into the peritoneum. This syndrome is relatively benign, and should be considered when there are multiple sites of extraluminal air in order to minimize the risk of unnecessary exploratory laparotomy. Two cases of benign pneumoperitoneum associated with pneumomediastinum and pneumoretroperitoneum are presented.

Adult↗

Pneumatosis [correction of Pneumocystis] cystoides intestinalis with pneumoperitoneum and pneumoretroperitoneum in a patient with extensive chronic graft-versus-host disease.

Pneumatosis cystoides intestinalis is a rare finding of intramural gasfilled cysts in the bowel wall and sometimes free air in the abdomen. A few conditions are reported to cause this disease, one of them being immunosuppression. We describe a 50-year-old Caucasian male with extensive chronic graft-versus-host disease (GVHD) of the gut and skin who developed PCI with pneumoperitoneum and pneumoretroperitoneum. To our knowledge, this is the first report of PCI occurring in a patient with active chronic GVHD which resolved spontaneously.

Bone Marrow Transplantation↗

["Masked" supra-renal tumour (author's transl)].

For the diagnosis of supra-renal tumours or tumours of supra-renal rests, it is necessary to employ all available radiological methods as well as the clinical data. Two cases are described in which a supra-renal tumour had been "masked" and found at operation. In the first case a cyst in the tail of the pancreas had been considered, in the second, a tumour of the renal hilum or ureter had been diagnosed. It is concluded that in the differential diagnosis of a cyst of the tail of the pancreas, supra-renal tumours must be included. Further, vascular lesions in the vicinity of the kidney associated with normal renal vasculature may be due to tumours of supra-renal origin.

Adolescent↗