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PubMed1997

Pneumomediastinum following penetrating oral trauma.

Pneumomediastinum can result from a puncture wound or laceration to the hypopharynx. This is a case report of an 18-month-old child who fell with a pen in his mouth. Initial physical examination was unremarkable, but the child developed neck swelling, fever, and irritability over the next 12 hours. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema. The pathophysiology and treatment of pneumomediastinum are reviewed.

Humans↗
PubMed1995

Epidurual pneumatosis: a benign complication of benign pneumomediastinum.

Subcutaneous emphysema and pneumomediastinum are well-known complications of barotrauma. There are no fascial barriers between the posterior mediastinum and the retropharyngeal and epidural spaces; thus, air can diffuse freely to the epidural space and produce an epidural pneumatosis. We report a case of epidural pneumatosis caused by a pneumomediastinum following nasotracheal intubation for an attempted suicide. This benign complication of air leakage was easily recognized on computed tomography (CT) scan.

Adult↗
PubMed1989

Tears of the trachea and main bronchi caused by blunt trauma: radiologic findings.

Although most of the radiologic changes that have been described in transection or laceration of the trachea or main bronchi are nonspecific, they can be of diagnostic importance in the appropriate clinical setting. In order to reassess the significance of these findings, and to determine the presence of any other changes that might lead to a definitive diagnosis, we retrospectively reviewed the chest radiographs of nine patients who had tears or transection of the trachea and/or main bronchi as a result of blunt chest trauma. The diagnosis was proved by bronchoscopy in all patients and reconfirmed at surgery in five. The predominant findings on the chest radiographs were related to air leak and included subcutaneous emphysema (seven patients), pneumomediastinum (seven patients), pneumothorax (six patients), and air surrounding a bronchus in one patient. Upper thoracic fractures that involved the clavicles, scapula, sternum, and ribs were present in four patients. Abnormalities in the appearance of an endotracheal tube in two patients (overdistention of the cuff or extraluminal position of the tip), and the presence of the fallen lung sign (collapse of the lung toward the lateral chest wall) in two others provided specific evidence of tracheobronchial injury. We conclude that, although the major importance of the chest radiograph in patients with tracheobronchial transection may be to verify the existence of air leak, the presence of the fallen lung sign and endotracheal tube abnormalities is a reliable indication of airway injury.

Adolescent↗
PubMed2006

[Spontaneous pneumomediastinum].

We encountered 3 patients with spontaneous pneumomediastinum. The patients were a 14-year-old female, a 16-year-old male and an 18-year-old male. All 3 were previously healthy. They complained of chest pain or dyspnea. On admission, physical examination revealed subcutaneous emphysema. Chest computed tomography (CT) revealed pneumomediastinum and subcutaneous emphysema. All patients were treated with rest and all recovered in 7 to 9 days without any complication. Spontaneous pneumomediastinum is an uncommon, usually benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. Most patients require only conservative treatment.

Adolescent↗
PubMed1985

[Tracheo-bronchial fissures from external trauma in children. Apropos of 3 cases].

The authors report three cases of tears in the tracheal or bronchial membrane in children resulting from an accidental external trauma of the trachea. Those children ranged from 3, to 5 and 10 years old. Those lesions showed a clinical gaseous syndrome associated with mediastinal and subcutaneous emphysema, in one of these cases complicated by unilateral pneumothorax and pneumomediastinum. After a symptomatic resuscitation, tracheobronchial endoscopy gives evidence each time of a crack of the posterior face of the trachea = cervix trachea in one case, end of the thorax trachea in the two other cases. Among them one was injured at the stem bronchi. These tracheobronchial lesions were treated nonoperatively and had a post-operative course uncomplicated. The author's attitude--except in case of extreme urgency--in front of a severe, isolated cervix thorax contusion in children, is to give systematically the indication for tracheobronchial endoscopy, in the view of knowing whether there is a tracheobronchial lesion or not and, if so, to five precisions about its location, its anatomic size, and its type (tear, fracture, disruption). An endoscopy performed immediately after cardiorespiratory rebalancing imposes the therapeutic conduct to be adopted, which is not always operative. Such is the case for the authors, especially in the case of children for whom the diagnosis of tracheobronchial lesion is sure, and in whom the stability of the vital signs are doubtless. In such cases, one is imposed not to operate.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMed2007

[Unilateral cervicofacial emphysema after dental treatment. Case report].

Subcutaneous emphysema is characterized by the presence of air or other gases in the subcutis after a spontaenous or traumatic interruption in a air-carrying structure. We describe a patient who developed unilateral facial swelling after dental treatment. Considering the history, differential diagnostic possibilities and the physical examination, we diagnosed cervicofacial emphysema.

Dental Implantation↗
PubMed1980

Subcutaneous and mediastinal emphysema following respiratory tract complications in measles.

Three cases of subcutaneous emphysema and 1 of subcutaneous and mediastinal emphysema following the bronchopneumonia and upper respiratory tract infection so common in measles are presented. This is a rare complication which occurred in only 0,59% of our measles patients during a period of 3 years, in spite of the fact that many of them had severe respiratory tract involvement. The pathogenesis and management of this type of emphysema in measles are discussed and the role of tracheotomy which can be helpful when airway obstruction is severe, is indicated.

Emphysema↗
PubMed1999

[The topicality and use of the radiological exam in gunshot wounds of the limbs. An assessment of 132 cases].

INTRODUCTION: Gunshot wounds of limbs are frequent injuries especially in Western countries. They can be single or associated with other penetrating gunshot wounds, for instance to the chest, abdomen and skull. PURPOSE: We investigated the current role and usefulness of conventional radiography in the assessment of gunshot injuries to limbs because, despite major advances in diagnostic imaging, this method remains the examination of choice in this condition. We stress the valuable contribution of conventional radiography to detection of bone blow-out fractures, multifocal traumatic bone changes, bone and joint injuries, bullet retention, and finally subcutaneous emphysema. MATERIAL AND METHODS: We retrospectively reviewed 132 cases of firearm injuries of limbs submitted to radiography March 1996 to July 1999. All the patients were men ranging in age 17-66 years (mean: 35). Radiography followed a preliminary physical examination, and follow-ups were carried out in the following days after orthopedic reduction of bone fractures or surgery with metal osteosynthesis. Emergency CT was performed first when chest, abdomen, or skull were involved. RESULTS: The lower limbs were involved three times as much as the upper ones; the leg was most frequently involved (61%), followed by thigh (61%), forearm and hands (24%), and feet (15%). The right lower limb was wounded in 65% of cases, especially tibia (55 cases) and femur (46 cases). Spiral injuries to bone diaphysis were the most frequent ones, followed by mixed fractures caused by cortical bone sinking from bullet impact. Bullets were retained in 60% of cases; subcutaneous emphysema was found in 78% of cases and vascular injuries in 25 cases in relation to disarranged fractures. We observed 4 arteriovenous fistulas during 3 years' follow-up. DISCUSSION AND CONCLUSIONS: Gunshot wounds to the limbs need a different clinical, diagnostic and therapeutic approach than thoracoabdominal and skull injuries, which require immediate and quick diagnosis and emergency treatment. The cases with injury to a primary artery from open and splintered fractures require emergency surgical reconstruction with vascular anastomosis and reduction of compound fractures, to prevent necrosis and amputation. Conventional radiography does depict the bullet and its site, subcutaneous emphysema, blow-out fractures, and the location of bone splinters. This permits adequate emergency surgery and an efficacious orthopedic approach, as well as selection of the cases to be submitted to clinical monitoring.

Adolescent↗
PubMed2005

Pneumomediastinum due to intractable hiccup as the presenting symptom of multiple sclerosis.

Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra-thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.

Adult↗
PubMed1998

[Carbon monoxide in the expiratory gas during laparoscopic surgery].

One of the complications of laparoscopic surgery is carbon monoxide (CO) production under the use of electrocautery. We experienced a case in which high levels of CO were detected in the expiratory gas. An 80-year old, 33 kg female was scheduled for laparoscopic nephrectomy. Anesthesia was induced with thiopental and vecuronium and maintained with nitrous oxide 60% in oxygen and isoflurane. The concentrations of CO in the anesthetic circuit were examined with CO sensor (XC-341, Shinkosumosudenshi, Tokyo). The CO concentrations were not detected at the start of operation. About 140 minutes after carbon dioxide pneumoperitoneum, the CO concentration increased up to 170 ppm accompanying a high Paco level. The high concentrations, however, decreased immediately after ending of pneumoperitoneum. The HbCO levels were unchanged. Subcutaneous emphysema was noted at the end of surgery. This is because CO is more absorbable in the subcutaneous tissue than in the peritoneal cavity. We consider that CO was absorbed in subcutaneous emohysema during pneumoperitoneum and exhausted in the expiratory gas. When subcutaneous emphysema occurred during laparoscopic surgery, we should be aware of absorption of CO.

Aged↗
PubMed2003

[Spontaneous pneumomediastinum as a cause of chest pain].

Two patients, both 16 years old, presented because of chest pain after extended sports activity. The thoracal X-ray showed trapped air in the mediastinum especially around the cervical vessels in one patient. In the thoracal X-ray of the other patient a vertical lucent streak along the left side of the heart, showing the pleura as a fine opaque line, was found. Both developed subcutaneous emphysema after a few hours, which led to the diagnosis spontaneous pneumomediastinum. The chest pain resolved under analgetic medication, and after resorption of the subcutaneous emphysema both patients recovered completely. The main differential diagnosis of the spontaneous pneumomediastinum is besides pericarditis and myocarditis, the spontaneous esophageal perforation (also called Boerhaave syndrome), with the high morbidity, it has to be ruled out consequently.

Adolescent↗
PubMed2006

A case of polymyositis complicated with interstitial pneumonitis and pneumomediastinum.

Pneumomediastinum as a complication of interstitial pneumonia with leakage of air into the mediastinum or subcutaneous tissues is a rare complication of dermatomyositis (DM). Herein we report a case of pneumomediastinum complicating polymyositis (PM), which is usually associated with DM. A 61-year-old man was hospitalized in our department because of deterioration of interstitial pneumonia. Treatment with high-dose corticosteroid and cyclosporin A steadily improved his interstitial pneumonia. Two weeks later, he developed subcutaneous emphysema and chest X-ray showed pneumomediastinum. Both subcutaneous emphysema and pneumomediastinum improved gradually without any additional treatment.

Anti-Inflammatory Agents↗
PubMed1981

[Transtracheal aspiration in pulmonary infections].

Transtracheal aspiration (TTA) was performed 35 times in 33 patients with acute pulmonary infections. The indications for the procedure included pulmonary infection in immune-depressed or debilitated patients in whom the pathogenic organism could not be identified, either because of lack of sputum or suspected over-colonization of the oral cavity. The procedure was performed under full sedation with diazepam (Valium), by introducing a catheter (Intracath) through the cricothyroid membrane into the trachea, without local anesthesia. This modification markedly reduces the cough reflex and complications like subcutaneous emphysema and bleeding. Only two of our cases developed subcutaneous emphysema. The procedure enables the physician to make accurate and rapid therapeutic decisions and is recommended as a diagnostic tool.

Diazepam↗
PubMed1995

[Three patients with spontaneous pneumomediastinum, including one in whom pneumomediastinum recurred].

We encountered three patients with spontaneous pneumomediastinum. All three (two men and one woman) were previously healthy. They complained of chest pain or dyspnea. On admission, physical examination revealed subcutaneous emphysema. Chest roentgenograms and computed tomograms revealed pneumomediastinum and subcutaneous emphysema. All other findings were normal. All patients were treated with bed rest and all recovered in 7 to 9 days. Pneumomediastinum recurred in one patient after 20 months.

Adolescent↗
PubMed1992

Management of an unusual presentation of foreign body aspiration.

Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.

Bronchi↗
PubMed1998

[A case of endotracheal tube obstruction caused by pneumoperitoneum during laparoscopic cholecystectomy].

A 56-year-old man with cholecystolithiasis was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with pentazocine and propofol i.v., and the trachea was intubated using vecuronium i.v. Anesthesia was maintained with 70% nitrous oxide and 1-3% sevoflurane in oxygen, and vecuronium was used for muscle relaxation. The lungs were mechanically ventilated with a tidal volume of 600 ml and a respiratory rate of 8 cycles.min-1. Following induction of carbon dioxide pneumoperitoneum, blood pressure, PETCO2 and peak inspiratory pressure gradually increased. PETCO2 increased from 33 mmHg to 48 mmHg despite increase in the respiratory rate to 20 cycles.min-1. By 45 minutes after the beginning of surgery, PETCO2 had increased to 60 mmHg, and ventilation of the lungs was impossible. Bronchofiberscopy revealed obstruction of the endotracheal tube by tracheal mucosa. The endotracheal tube was then drawn out by 2 cm with slight recovery of ventilation. After 1 h 16 min of surgery, it was observed that the patient had developed pneumoscrotum and subcutaneous emphysema extending from femoral area, abdomen, and thorax to the right neck. Chest rentogenography revealed a slight tracheal shift and subcutaneous emphysema. One hour after the end of surgery, PaCO2 was 48.9 mmHg under spontaneous respiration. We speculate that the pneumoperitoneum shifted the tracheal carina cephalad, causing obstruction of the endotracheal tube. Our findings show that displacement of the endotracheal tube must be carefully monitored during laparoscopic cholecystectomy.

Anesthesia, Inhalation↗
PubMed1992

Spontaneous pneumomediastinum: clinical and natural history.

STUDY OBJECTIVE: To evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum. DESIGN: A retrospective case series was conducted to identify patients diagnosed with spontaneous pneumomediastinum. ICD-9 discharge codes were used for 1984 to 1990 at two institutions, and emergency department records of a third hospital were reviewed for 1981 to 1986. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. SETTING: Three university tertiary care hospitals. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of spontaneous pneumomediastinum. INTERVENTIONS: None. RESULTS: Seventeen cases were identified. Age range was 15 to 41 years (mean, 25 years). Presenting symptoms were chest pain in eight (47%), dyspnea in three (18%), both symptoms in three (18%), and neither in three (18%). Three patients complained only of throat discomfort. Nine (52%) had a Hamman's crunch, 11 (65%) had subcutaneous emphysema, and two (11%) had a small pneumothorax. Five (29%) were smokers, and five (29%) had normal esophograms. Thirteen of 17 (76%) cases were associated with illicit inhalation drug use. Twelve cases (70%) had history of a "Valsalva-type" maneuver. All but three were admitted to a hospital, with a mean stay of 2.5 days (range, one to six). No patient suffered complications or required interventions for spontaneous pneumomediastinum. Specifically, no patient developed a subsequent pneumothorax or airway compromise. The three patients not admitted were followed up by telephone contact. All did well with rapid resolution of their symptoms. CONCLUSION: Most spontaneous pneumomediastinum cases occur in the setting of inhalational drug use. One hundred percent of patients will have a symptom directly related to the spontaneous pneumomediastinum, with 82% presenting with either dyspnea or chest pain. Most (88%) will present with either subcutaneous emphysema or a Hamman's crunch on examination. Simple spontaneous pneumomediastinum has a very benign course and does not require hospitalization. Serial radiographs, likewise, did not change the medical management of spontaneous pneumomediastinum.

Administration, Inhalation↗
PubMed2006

[Cheek swelling after surgical removal of third molar].

A 55-years-old man visited his family doctor because of a one-day existing, not painful, right-sided swelling of the cheek. It appeared to be a subcutaneous emphysema, caused at an attempt to remove mandibular third molar roots, using a water- and air-cooled air rotor. Rare potential seũelae resulting from subcutaneous emphysema are venous air embolism, airway obstruction because of neck swelling, pneumomediastinum, and mediastinitis. Using air-cooled instruments in surgical orofacial treatments should be avoided because of the possible atrogenic life-threatening complications.

Cheek↗