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PubMed1990

[Two cases of spontaneous pneumomediastinum due to Xiao-lin Temple boxing vocal exercise].

Two cases of spontaneous pneumomediastinum and subcutaneous emphysema were reported. The first cases was a 21-year-old man who had a past history of recurrent spontaneous pneumothorax. The second was a healthy 20-year-old man. They were admitted to our hospital because of dyspnea and chest pain, which occurred at or after vocal exercise for Xiao-lin Temple boxing. Physically, a mediastinal crunch on auscultation heard over the cardiac apex and the left sternal border (Hamman's sign) was recognized in the first case, and subcutaneous emphysema was palpated in both cases. The chest X-ray films revealed intramediastinal air and subcutaneous emphysema in both cases. We diagnosed these patients as spontaneous pneumomediastinum because of no underlying disease. This is a report of rare cases of spontaneous pneumomediastinum occurring at the same time, and one of the mechanism causing them was considered to be a sudden increase in intrathoracic pressure due to the vocal exercise of chinese boxing.

Adult↗
PubMed1997

Spontaneous pneumomediastinum in a patient with bronchiolitis obliterans after bone marrow transplantation.

After allogeneic bone marrow transplantation for chronic myelogenous leukemia, spontaneous pneumomediastinum and subcutaneous emphysema developed in a patient with bronchiolitis obliterans. Computed tomography scanning of the chest failed to reveal the cause. There was no evidence of a pulmonary process, pneumothorax, or pharyngeal or upper airway leak. Despite the alarming appearance of the patient, conservative management, including high-flow oxygen, resulted in resolution of the pneumomediastinum and subcutaneous emphysema. The cause of pneumomediastinum and subcutaneous emphysema in bone marrow transplant recipients is discussed.

Bone Marrow Transplantation↗
PubMed2000

Tracheal rupture associated with intubation in cats: 20 cases (1996-1998).

OBJECTIVE: To characterize clinical features of tracheal rupture associated with endotracheal intubation in cats and to evaluate the most appropriate treatment for this condition. DESIGN: Retrospective study. ANIMALS: 20 cats with a history of endotracheal intubation that subsequently developed dyspnea or subcutaneous emphysema. PROCEDURE: Medical records of cats with a presumptive diagnosis of tracheal rupture associated with intubation were reviewed. Clinical and clinicopathologic data were retrieved. RESULTS: Cats were evaluated 5 hours to 12 days after a surgical or medical procedure requiring general anesthesia with intubation had been performed. Fourteen (70%) cats were evaluated after dental prophylaxis. All cats radiographed had pneumomediastinum and subcutaneous emphysema. Eighteen of 19 cats were initially treated medically. Duration of medical treatment for cats that did not have surgery ranged from 12 to 72 hours. Cats that had surgery received medical treatment 3 to 24 hours prior to the surgical procedure. Medical treatment alone was administered to 15 cats that had moderate dyspnea, whereas surgical treatment was chosen for 4 cats that had severe dyspnea (open-mouth breathing despite treatment with oxygen) or worsening subcutaneous emphysema. Eighteen cats had improvement of clinical signs, 1 cat died after surgery, and 1 cat died before medical or surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE: Most cats with tracheal rupture associated with intubation can be treated medically. Cats with worsening clinical signs (severe dyspnea, suspected pneumothorax, or worsening subcutaneous emphysema) should have surgery performed immediately to correct the defect.

Animals↗
PubMed2004

Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study.

STUDY OBJECTIVE: Part 1: To describe cases of emphysema (subcutaneous and/or mediastinal) and pneumothorax after percutaneous dilational tracheostomy (PDT) in a series of 326 patients, and to review the existing literature describing the incidence and possible mechanisms. Part 2: To analyze the potential mechanisms for the development of emphysema and pneumothorax in human cadaver models. DESIGN: A retrospective analysis of PDTs, in combination with an anatomic study in human cadavers. MATERIALS AND METHODS: Part 1: All ICU patients who underwent PDT between 1997 and 2002 were enrolled in the study. We analyzed the cases of emphysema and pneumothorax. Similar cases were retrieved from the literature and underwent a systematic review. Part 2: The relevant anatomic structures were studied. We simulated the clinical situation after PDT in a human pathologic study in order to induce subcutaneous emphysema and pneumothorax. MEASUREMENTS AND RESULTS: Part 1: Five cases of subcutaneous emphysema (1.5%) and two cases of pneumothorax (0.6%) are described. In the literature search, we found 41 cases of emphysema (1.4%) and 25 cases of pneumothorax (0.8%) in a total of 3,012 patients. Part 2: Subcutaneous emphysema could easily be induced in a human cadaver model by inflating air in the pretracheal tissues and after posterior tracheal wall laceration. Air leakage was also possible through a fenestrated cannula via the space between the inner nonfenestrated cannula and outer cannula and then through the fenestration. CONCLUSIONS: We conclude that one mechanism for the development of emphysema is an imperfect positioning of the fenestrated cannula, whereby the fenestration is extraluminal. For this reason, fenestrated cannulas should not be used immediately after placement of a PDT. Posterior tracheal wall laceration is another mechanism responsible for emphysema after PDT. After perforation of the posterior tracheal wall, the pleural space can be reached easily. This may result in a pneumothorax.

Adult↗
PubMed1984

Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management.

Subcutaneous emphysema and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating trauma, soft-tissue infections, or any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. A continuum of fascial planes connects cervical soft tissues with the medlastinum and retroperitoneum, permitting aberrant air arising in any one of these areas to spread elsewhere. Diagnosis is made in the appropriate clinical setting by careful physical examination and inspection of the chest roentgenogram. While the presence of air in subcutaneous or mediastinal tissue is not dangerous in itself, prompt recognition of the underlying cause is essential. Certain trauma-related causes may require surgical intervention, but the routine use of chest tubes tracheostomy, or mediastinal drains is not recommended.

Emphysema↗
PubMed2001

Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair.

Carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. Additionally, we discuss the pathophysiology, diagnostic work-up, and management of this malady. Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.

Abdomen↗
PubMed2005

Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair.

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors' experience with a 23-year-old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.

Adult↗
PubMedDate not supplied

Cervicofacial and mediastinal emphysema as the result of a dental procedure.

Cases of cervicofacial subcutaneous emphysema occurring during dental treatment often result from the use of air-water cooled dental drills during tooth extraction. A case is presented in which a compressed air syringe, used to dry the field, caused diffuse cervicofacial emphysema with retropharyngeal and mediastinal extension. The point of entry appeared to be a 4 mm superficial laceration of the buccal mucosa. Despite the size of the wound, a significant amount of air was able to enter the tissues and spread quite distantly. Though many cases of subcutaneous emphysema go unnoticed, diffuse extension, especially with involvement of deep neck structures and with thoracic extension, must be recognized as they can be potentially life-threatening.

Cheek↗
PubMed1990

[Pulmonary lesion of paraquat poisoning on high resolution CT].

It is well known that paraquat causes severe organ-toxicity and pulmonary damage. We observed the progress of a patient who survived paraquat poisoning, and we recorded the changes in the lung by high resolution CT. The patient was a 35-year-old man who attempted suicide by paraquat (Guramoxone 100 ml) ingestion. At the time of hospitalization, there was no respiratory involvement. Five days after ingestion, an X-ray examination showed only indistinct vascularity of both lung fields, but high resolution CT showed increased density in the central part of both lung fields. According to the clinical progress after ingestion, mediastinal and subcutaneous emphysema were noted by chest X-ray examination. On the other hand, severe interstitial pneumonia progression of severe lung fibrosis with a decrease in lung volume and interstitial pulmonary emphysema in addition to mediastinal, subcutaneous emphysema were seen by high resolution CT. High resolution CT is useful for detecting morphologic change and diagnosing clinical stages. Observing the course of changes by high resolution CT is useful for deciding the course of clinical therapy, and we have no hesitation in affirming that it should be used in such cases.

Adult↗
PubMed1977

Air leak syndromes as complications of respiratory disease in infancy and childhood.

Pneumothorax, pneumomediastinum and subcutaneous emphysema are potential complications of a variety of pediatric illnesses. A review by the authors confirms the reports of others that asthma is the primary medical cause of pneumothorax and subcutaneous emphysema and that a variety of inflammatory and obstructive lesions can be associated with extra-vasation of pulmonary air. Pneumothorax infrequently complicates asthma. Asthma-associated pneumomediastinum rarely requires vigorous therapeutic intervention and massive subcutaneous emphysema may necessitate tracheostomy. Pressurized delivery of sympathomimetic aerosols have been condemned by some as an unnecessary cause of iatrogenic air leak. The data of the authors indicate that this form of therapy rarely causes air leak syndromes. The pathophysiology of extravasation of pulmonary air is reviewed.

Asthma↗
PubMed1986

Diabetes mellitus and Fournier's gangrene.

A case is described in which Fournier's gangrene was the presenting feature of diabetes mellitus and in which extensive subcutaneous emphysema prevented the use of spinal anaesthesia for debridement. In the literature four cases have been reported in which Fournier's gangrene was the presenting feature in patients with diabetic ketoacidosis. Diabetes may predispose to a form of Fournier's gangrene in which subcutaneous gas formation is marked, though subcutaneous emphysema to the degree described in this case has not previously been reported in this condition. Diabetes mellitus and subcutaneous emphysema must be sought in patients with Fournier's gangrene as both may have a profound influence on management.

Diabetes Complications↗