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PubMed1992

[A case of mediastinitis and bilateral pyothorax, following acute epiglottitis with concurrent Aspergillus infection].

Life threatening mediastinitis as a complication of acute epiglottitis is very rare. A 38-year-old male in previously good health was admitted to our hospital in a state of unconsciousness. Seven days prior to admission he had complained of a sore throat, dysphagia, high fever and dyspnea. A chest X-ray on admission showed widening of the mediastinum, mediastinal emphysema, subcutaneous emphysema and left pleural effusion. Bronchoscopy showed the swelling of supraglottic structures. He was diagnosed as having acute mediastinitis and pyothorax as a complication of acute epiglottitis, but pathogens were not identified. The blood was hyperglycemic and insulin therapy was started. Though he gradually improved by massive antibiotic therapy, steroid therapy, tracheotomy and surgical drainage of both the left thoracic cavity and the mediastinum, he died suddenly of massive hemoptysis. Autopsy revealed that the acute mediastinitis had healed, but that the Aspergillus infection was present in both lungs and the pericardium. The Aspergillus infection was not lethal in the present case, and it seemed that death had resulted from arterial hemorrhage caused by erosion of the trachea. The present case suggests the need for antifungal therapy even in non-immunocompromised patients in particular when massive doses of antibiotics and steroids are administered.

Acute Disease↗
PubMed1959

Mediastinal emphysema.

Mediastinal emphysema may occur due to migration of air from the lungs, from the esophagus or tracheobronchial tree and from the abdomen. Of especial interest is the mechanism starting with the rupture of the perivascular alveoli due to a rapid decrease in intrathoracic pressure from any cause, the development of pulmonary interstitial emphysema and migration of the air into the mediastinum. In one case the patient had severe interstitial emphysema of the left lung, mediastinal emphysema and subcutaneous emphysema without pneumothorax and rapid improvement followed tracheotomy. In another case the patient had interstitial emphysema of the left lung that did not progress to mediastinal emphysema and subcutaneous emphysema. Pneumothorax was not present. Recovery was more rapid than in the first patient.

Abdominal Cavity↗
PubMed1999

Subcutaneous tissue emphysema of the hand secondary to noninfectious etiology: a report of two cases.

Subcutaneous emphysema of the hand can be benign and noninfectious in origin. Emphysema from gas-forming organisms is associated with systemic symptoms, whereas benign subcutaneous emphysema is not. High-pressure pneumatic tool injuries are a well-known cause of subcutaneous emphysema. Minor wounds in the web space skin may result in a transport of air across the defect, acting like a ball valve mechanism to trap and then force the air into the subcutaneous tissue, as illustrated by 1 of our patients. In the second patient, use of a high-vibration tool without apparent breach of skin was associated with extensive subcutaneous emphysema. The benign nature of the emphysema was revealed by a lack of local pain and inflammation in the presence of extensive crepitus and a lack of systemic symptoms. A noninfectious cause should always be considered. This may prevent unnecessary surgical intervention, which occurred in 1 of the 2 cases presented here.

Adult↗
PubMed1992

[Pneumomediastinum and subcutaneous cervical emphysema as signs of rectosigmoid perforation].

Pneumomediastinum and subcutaneous emphysema of the neck occur exceptionally in spontaneous, retroperitoneal perforation of the sigmoid colon. These signs, in association with a septic syndrome and multiple organ failure, mandate the search of a gastrointestinal tract perforation, even in the absence of digestive symptoms. Careful deep palpation of the abdomen may determine the abdominal origin of the septic focus and thereby provide justification for exploratory laparotomy without further diagnostic investigations.

Aged↗
PubMed1982

Subcutaneous facial emphysema complicating dental anaesthesia.

A 20 year-old female developed swelling and protrusions of the tongue and marked facial swelling while under general anaesthesia for dental restoration and gigivectomy. The initial diagnosis was angioedema; however x-rays showed marked subcutaneous emphysema more extensive in the perimandibular area with a minimal amount in the neck. There was no evidence of pneumomediastinum or pneumothorax. The iatrogenic subcutaneous emphysema was felt to be due to air-driven dental equipment. Tracheal intubation was maintained for 21 hours to prevent airway obstruction. The patient was treated with oxygen and antibiotics. Subcutaneous emphysema may occur following root canal therapy, tooth extraction, periodontal surgery and operative dentistry, due to the use of air-driven dental equipment. It has the potential to cause obstruction.

Adult↗
PubMed2006

Surgical indications for spontaneous pneumothorax in patients over 50 years of age.

BACKGROUND: Surgery is often required in cases of spontaneous pneumothorax. This situation can pose considerable difficulty with correct preoperative estimate of pulmonary function. Simple indications for surgery are mandatory, especially in aged patients. METHODS: To examine the indications and safety of surgery in patients over 50 years, 23 operations in 22 patients over a 6-year period from 1998 to 2003 were reviewed retrospectively. All 23 cases had a grade 2 or better performance status. In all cases, operations were performed with bullectomy or pneumonorrhaphy by a limited thoracotomy with videothoracoscopy in 5 cases. RESULTS: All patients recovered to the same performance status as before the onset of the pneumothoraces, with the exception of one who died, and changes between pre- and postoperative arterial oxygen or carbon dioxide tension were not significant. Lung-related postoperative complications, including 1 mortality (4%), occurred in three cases who required emergency operation because of massive air leaks with incomplete lung reexpansion, obvious mediastinal emphysema or severe subcutaneous emphysema. CONCLUSIONS: Surgical interventions may be safely performed when the patient's performance status is grade 2 or better, but care must be taken to avoid postoperative complications in preoperative conditions as massive air leaks with incomplete lung reexpansion, obvious mediastinal emphysema or severe subcutaneous emphysema.

Age Factors↗
PubMedDate not supplied

Spontaneous subcutaneous temporal emphysema.

The presence of air in the temporal regions is an uncommon presentation of spontaneous pneumomediastinum. As terminal alveoli rupture, air dissects along bronchovascular shafts. Usually, air travels either in a superior or inferior direction. Thus, extensive spontaneous subcutaneous emphysema accompanied by both cervical and retroperitoneal emphysema is rarely encountered. We present an unusual case of spontaneous pneumomediastinum, pneumoretroperitoneum, and cervical and facial emphysema presenting as bilateral painless temporal swelling. To our knowledge, this association has not been reported. Treatment involves observation for potentially life-threatening sequelae.

Adult↗
PubMed1984

Pneumomediastinum, pneumothorax, and cervical emphysema following mandibular fractures.

Subcutaneous emphysema of the neck and pneumomediastinum following facial trauma in the absence of neck, chest, or abdominal injuries is a rare entity. A case report of bilateral cervical subcutaneous emphysema, pneumothorax, and pneumomediastinum secondary to mandibular fractures is presented. The anatomic mechanism of injury, diagnosis, and treatment modalities are discussed.

Adult↗
PubMedDate not supplied

[Subcutaneous cervical emphysema secondary to tooth extraction].

Cervical emphysema is rare and its diagnosis involves the ENT specialist. A case of cervical subcutaneous emphysema secondary to lower molar extraction is reported. The patient had no signs or symptoms other than cervical emphysema. Simple radiography and CT are recommended for early diagnosis. The etiopathogenic mechanisms of subcutaneous cervical emphysema are reviewed. Recent literature contains few cases of dental origin.

Cervical Vertebrae↗
PubMed2002

Comparative study of mediastinal emphysema as determined by etiology.

OBJECTIVE: To evaluate the difference in the clinical features of mediastinal emphysema as classified into three groups based on etiology; patients in whom it was spontaneous with unknown etiology (A group), those in whom it was secondary to bronchial asthma (B group), and those in whom it was secondary with other respiratory diseases (C group). PATIENTS: Forty-three cases (45 episodes) with mediastinal emphysema treated at Kawasaki Medical School Kawasaki Hospital between April 1985 and March 2000 (A group: 17 cases, B group: 17 cases, C group: 9 cases). RESULTS: The average ages of the A and B groups were of little significance. Most of the patients in the A group were males with a thin body. Three patients in the A group had episodes of pneumothorax or mediastinal emphysema in their past history. Five patients in the A group had Hamman's sign on physical examination. In all of the patients in the C group, mediastinal emphysema was accompanied by subcutaneous emphysema, whereas only eight patients in the A group had subcutaneous emphysema. The prognosis was good for A and B groups because the mediastinal emphysema disappeared within 10 days, but was poor in the C group because its disappearance was very late compared with that in the other two groups and skin incision was required in three patients in the C group due to severe subcutaneous emphysema. CONCLUSIONS We suggest that the existance and kind of underlying diseases significantly affect the method of treatment and the prognosis.

Adult↗
PubMed2005

Diffuse soft tissue emphysema in anorexia nervosa: a case report.

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder that occurs mainly among young females and its prevalence has increased in recent decades. METHODS: We reported a patient with AN with spontaneous diffuse soft tissue emphysema and bicytopenia, both of which are very rare complications of AN. Our patient, a 20-year-old woman, had lost 41.6% of her previous body weight within 9 months. Her body mass index was 10.8 and amenorrhea had persisted for 5 months. RESULTS: After admission, she was diagnosed with AN-restrictive subtype. She was noted to have crunching sounds in the neck and upper chest wall during hospitalization. A chest X-ray and chest computed tomography scan both revealed diffuse soft tissue emphysema including subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. DISCUSSION: Diffuse soft tissue emphysema improved gradually and completely resolved on the 21st day of hospitalization. This condition seems to be benign and only a short period of hospitalization is required.

Adult↗
PubMed1998

[Tracheal injuries during percutaneous tracheotomy].

Subcutaneous emphysema associated with impossible tracheobronchial aspiration occurred in a patient several hours after percutaneous tracheostomy. Misplacement of tracheal cannula was diagnosed and a tube exchanger was used to replace the cannula in a normal position. Twenty hours later a tracheal tear was recognized. This paper considers the pathophysiology and prevention of such a complication.

Aged↗
PubMed1993

Pulmonary barotrauma after a free dive--a possible mechanism.

Pulmonary barotrauma during scuba diving is a life-threatening event. In a skin diver, who does not use compressed air, this complication is rare and its pathophysiology is not readily understood. We present a young, healthy skin diver who suffered pneumomediastinum and subcutaneous emphysema after a sequence of free dives to 5 m, and suggest a possible mechanism.

Adult↗
PubMed1990

Cervicofacial subcutaneous air emphysema after dental extraction.

A patient was seen by a general practitioner for surgical removal of his third molar. A standard high-speed handpiece was used to remove the tooth. During the procedure, subcutaneous emphysema developed. Later the same day, the patient's swelling increased and his airway was compromised. The patient's condition, the differential diagnosis, etiological factors, and treatment of this condition are all detailed within this clinical report.

Adult↗
PubMed2004

[Diplopia and blepharoptosis associated with orbital emphysema following thoracotomy with lung cancer; report of a case].

BACKGROUND: Orbital emphysema is a common complication of trauma and fracture of orbital bones. However, subcutaneous emphysema also can rarely lead to orbital emphysema. We reported the clinical and radiological findings in a patient with diplopia and blepharoptosis following thoracotomy for lung cancer. CASE: A 76-year-old man had undergone left inferior lobectomy and ND 2 a in October 2002, based on the clinical diagnosis of stage IB lung squamous cell carcinoma. He presented with diplopia and blepharoptosis several days following thoracotomy. Chest X-ray demonstrated extensive subcutaneous emphysema, and physical examination also revealed diffuse subcutaneous emphysema including face and palpebrae. Head computed tomography (CT) revealed subcutaneous emphysema in the infratemporal fossa bilaterally. His diplopia and blepharoptosis gradually resolved, and he was discharged with no visual complaints on the fourteenth postoperative day. CONCLUSIONS: Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Early surgical intervention for air leakage is highly recommended to avoid both the orbital emphysema and the visual complications in the event that subcutaneous emphysema should get to including face or palpebrae.

Aged↗
PubMedDate not supplied

Cervicofacial and mediastinal emphysema complicating a dental procedure.

Cervicofacial subcutaneous emphysema is an infrequently reported sequela of dental surgery. It may be caused by the inadvertent introduction of air into the soft tissues during procedures using high-speed, air-driven handpieces or air-water syringes. In this paper, we present a case in which subcutaneous emphysema developed in a middle-aged woman following routine restorative treatment. We review the features of the condition and its treatment and discuss means of prevention.

Adult↗
PubMed1995

[Subcutaneous cervical emphysema: complication of constipation. Review of the literature].

We report the case of a sixty-eight year old woman with chronic constipation, admitted in the emergency unit for respiratory deficiency and cervical subcutaneous emphysema. Endoscopy of the supradiaphragmatic air and digestive tracts was normal. Acutization of an abdominal syndrome required a laparotomy revealing a fissuration of the subperitoneal rectum on a fecal obstruction. This revealing complication may be explained by the topography of the cervico-thoraco-abdominal diffusion spaces.

Aged↗