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PubMed1997

Pneumomediastinum during relapse of ulcerative colitis.

Pneumomediastinum can be caused by gas dissecting along fascial tissue planes into the mediastinum from remote locations, including the retroperitoneum. One potential source of retroperitoneal gas is the colon. We present the third reported case of pneumomediastinum (plus pneumothorax and subcutaneous emphysema) without free intraperitoneal gas developing during an attack of ulcerative colitis. Because there was no colonic perforation noted at colectomy, the extracolonic gas was presumed to originate from a microscopic or partial thickness perforation of the colon. GI perforation must be considered not only in patients who have free intraperitoneal gas but also in those who present with symptoms, signs, or studies consistent with retroperitoneal gas, such as subcutaneous emphysema, pneumomediastinum, or pneumothorax.

Adult↗
PubMed1979

[The chest roentgenogram during artificial respiration (author's transl)].

Chest roentgenography of artificially ventilated persons not only reveals morphological changes in the lungs but may also provide information regarding their pathogenesis and prognosis. To safeguard against misinterpretation of the findings they should be supplemented by blood gas analyses and function tests (e.g. effective compliance of the respiratory system). The chest roentgenogram also apprises of the development, and consequently of the need for treatment, of such complications as interstital emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum and subcutaneous emphysema.

Humans↗
PubMed1997

CT findings of bronchial transection.

A case of right bronchial rupture demonstrated by computed tomography (CT) is reported. Chest radiographs of a 55-year-old man who sustained blunt chest trauma showed bilateral pneumomediastinum, hydropneumothorax, and subcutaneous emphysema with fracture of the left 3rd and 4th ribs. CT showed wall defect over the right main bronchus with the air in airway contiguous to that in the mediastinum. Bronchoscopy and thoracostomy confirmed the CT findings and the patient was treated by bronchorrhaphy with end-to-end anastomosis. The airway should be meticulously evaluated in cases of mediastinal and subcutaneous emphysema, especially after trauma.

Bronchi↗
PubMed2006

"Punk" rock can be bad for you: a case of surgical emphysema from a "punk" rocker's leather jacket.

Stab wounds to the thorax are seen in the emergency department (ED) and can be caused by a variety of mechanisms. This case highlights an unusual cause of injury: a leather jacket with spikes on the back of it. This type of jacket is often worn by "punks" as a fashion statement. We report that falling onto such a jacket may result in accidental thoracic injury leading to subcutaneous emphysema. A thorough clinical assessment is mandatory to exclude underlying lung injury or pneumothorax. In patients with subcutaneous emphysema and an otherwise normal chest radiograph, an in hospital observation period of 24 hours to check for any delayed complications is adequate if the patient remains clinically stable.

Adult↗
PubMed1997

Iatrogenic ruptures of the tracheobronchial tree.

We did a retrospective study in 12 patients with iatrogenic tracheal or tracheobronchial ruptures treated since 1975. Ten female subjects, one male subject, and one child (age range, 8 to 72 years), all of whom had undergone intratracheal intubation, were admitted to the hospital. Four patients had been intubated with a double-lumen catheter (two Carlens type with carinal spur, two Robertshaw without spur), and seven had had "high volume-low pressure" tubes, placed under emergency conditions in three of those seven cases. In one further case, an unsuccessful attempt of percutaneous tracheostomy had been made. The localization of the ruptures (all of them longitudinally in the membranaceous wall; length, 2 to 13 cm; mean, 7 cm) comprised both cervical and intrathoracic trachea in seven, the intrathoracic trachea in three instances, and the left main stem bronchus in two cases. Ten patients had mediastinal and subcutaneous emphysema, seven presented with a pneumothorax, and nine had intratracheal bleeding. The interval until the onset of symptoms and diagnoses differed widely: twice diagnoses were made intraoperatively, during thoracic surgery. The longest interval until diagnosis was 5 days; only then did the patient show subcutaneous emphysema and have retrosternal pain. All patients had surgical repair. Nine recovered without sequelae, and three died of septic multiorgan failure.

Adult↗
PubMed1999

[Rupture of larynx or trachea resulting from injuries sustained at birth].

Four newborn boys developed respiratory insufficiency and pneumothorax, pneumomediastinum or subcutaneous emphysema as the result of a laryngeal or tracheal rupture. These ruptures were due to birth injuries after difficult labour resulting from shoulder dystocia or a large lymphangioma and to a birth weight of at least 4500 g. The three children with shoulder dystocia also had a clavicular fracture, a Horner's syndrome, Erb paralysis or phrenic nerve paresis. Treatment consisted of surgical repair followed by a few days' intubation. The children with a shoulder dystocia recovered well, although in one of them a tracheal stenosis had to be resected a few months later. The child with the lymphangioma died from a bifurcation embolus. In newborns with respiratory insufficiency and pneumomediastinum or subcutaneous emphysema after a difficult delivery an emergency laryngotracheoscopy has to be performed to exclude rupture of larynx or trachea.

Birth Injuries↗
PubMed2001

Extra-abdominal pneumodissection after laparoscopic antireflux surgery.

The presence of pneumoperitoneum during laparoscopic antireflux surgery can lead to the dissection of carbon dioxide into the mediastinum, retroperitoneum, subcutaneous tissues, and neck (pneumodissection). The purpose of this study is to describe the incidence, extent, duration and pathways of pneumodissection during laparoscopic antireflux surgery. Twenty patients who underwent laparoscopic antireflux surgery from August 1998 through May 1999 were studied. Physical examination and chest radiographs were performed in the recovery room and each day postoperatively. Noncontrast computerized tomography (CT) of the neck, chest, and upper abdomen was also performed on postoperative day one. Subcutaneous emphysema and radiologic evidence of pneumodissection occurred commonly and typically resolved within 4 days postoperatively. The incidence of pneumomediastinum (85%) seen on CT scan was similar to that of pneumodissection into the neck (80%). The most common pathway of dissection of gas was through the anterior mediastinum and into the neck through the carotid space. Other findings on CT scan revealed pneumoperitoneum in 70 per cent, pneumoretroperitoneum in 10 per cent, and pneumothorax in 0 per cent. The dissection of gas into the mediastinum, neck, and subcutaneous tissues is very common after laparoscopic antireflux surgery. Subcutaneous emphysema on physical examination and radiographic pneumodissection typically resolves within 3 to 4 days. After this time one should consider the presence of any substantial amount of gas as a potential complication related to the procedure.

Carbon Dioxide↗
PubMed2006

Hamman's syndrome (spontaneous pneumomediastinum) in a parturient: a case report.

BACKGROUND: Subcutaneous emphysema and pneumomediastinum in labour and delivery is a rare but potentially serious occurrence that must be identified and managed appropriately to avoid unnecessary investigations and interventions. Published reports indicate that subsequent pregnancies pose no additional risk for recurrence. CASE: A 27-year-old primiparous patient with an uneventful pregnancy and delivery developed subcutaneous emphysema but remained stable clinically. Chest radiography confirmed a pneumomediastinum. She was managed conservatively with supportive measures and anxiolytics and showed complete resolution after five days. A future pregnancy is planned. CONCLUSION: Recognition of spontaneous pneumomediastinum and its potential consequences during labour and delivery requires vigilance. Supportive measures alone may be the only requirement for resolution. Recurrence of the condition is rare, but the appropriate management of subsequent pregnancies is unclear. Expectant management with epidural analgesia to minimize active pushing is suggested in a subsequent spontaneous vaginal delivery.

Adult↗
PubMed2003

Use of positive contrast rhinography and intranasal sinography for diagnosis of a nasofacial sinus tract in a dog.

Twelve days after a dog fight, a 2-year-old sexually intact female Bulldog was evaluated because of subcutaneous emphysema of increasing severity throughout the dogs body. Thoracic radiography revealed severe pneumomediastinum from which free air had extended into the retroperitoneal space, resulting in pneumoperitoneum. Tracheoscopic examination did not reveal a discontinuity of the trachea, pharynx, or larynx. A breach between the nasal cavity and subcutaneous tissues of the nasal region was suspected. Further diagnostic investigations included positive contrast rhinography and intranasal sinography. Via an angiographic catheter inserted into the left naris, positive contrast intranasal sinography revealed a sinus tract extending between the left nasal cavity and the subcutaneous tissue of the dorsal aspect of the nasal planum. Resolution of subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum began 1 day after surgical closure of the intranasal opening of the sinus tract. To the authors' knowledge, this radiographic technique has not been reported.

Animals↗
PubMed2001

Medical causes of pneumomediastinum in children.

The purpose of this study was to determine the possible causes, clinical findings, and associated complications of pneumomediastinum in children. Medical records from January 1985 to December 1994 were retrospectively reviewed at Children's Hospital Medical Center of Akron using International Classification of Diseases, ninth revision, codes to identify cases of pneumomediastinum. The medical causes, nontraumatic and noniatrogenic, of pneumomediastinum were studied; intubated or trauma patients and patients having undergone procedures were excluded. Neonates were also excluded. Twenty-nine cases of pneumomediastinum were identified. Two patients (7%) had recurrent pneumomediastinum. Only the first episode of pneumomediastinum was included in the data analysis. Twenty males (69%) and nine females (31%) were affected. The most common medical causes of pneumomediastinum were asthma exacerbations (17/59%) and infections (8/28%). Over the 10-year period, the prevalence of pneumomediastinum in children with asthma exacerbations was 0.2% (21/10,472); 1% (1/126) in children with airway foreign bodies and 0.2% (1/351) in children with esophageal foreign bodies. The most common signs and symptoms were subcutaneous emphysema (22/76%), sore throat or neck pain (11/38%), and Hamman's crunch (3/10%). The most common complication was pneumothorax with small pneumothoraces in 2 patients (7%) and a tension pneumothorax in 1 asthmatic with recurrent pneumomediastinum. Patients without sore throat or neck pain and patients admitted to the intensive care unit had greater hospital lengths of stay. Pneumomediastinum appears to be uncommon in children. The most common medical causes were asthma and infections. The most common signs and symptoms were subcutaneous emphysema, sore throat or neck pain, and Hamman's crunch. The most common complication was pneumothorax. The clinical significance of pneumomediastinum is its cause and association with significant complications.

Adolescent↗
PubMed2004

Air entrapment in the cervicofacial region due to injury.

Air entrapment in the soft tissues of the cervicofacial region is a benign entity occasionally developing after a fracture of the facial bones or ribs. Characteristic clinical findings of air entrapment are the sudden onset of edema and crepitation of the respective region. Possible complications are respiratory obstruction or contamination of the mediastinum. Treatment includes precautionary administration of antibiotics. In regard to the region of injury, air may enter the anterior cranial fossa where it compresses the brain, resulting in pneumocephalus, which may cause meningitis as an imminent complication. After a fracture at the zygomatic or nasal bones, subcutaneous emphysema may result in the middle third of the face. It is also possible for air to penetrate into the retrobulbar fat and damage the eye. In other cases, air traverses the parapharyngeal space and causes pneumomediastinum. Moreover, after a fracture at the mandible, it is possible that air passes through the floor of the mouth and the submandibular area to the deep tissue layers again causing pneumomediastinum. Alternatively, after rib fracture, air could follow an upward course, resulting in subcutaneous emphysema of the thoracocervicofacial region. In this article, patients who suffered from air entrapment were categorized into four groups, and the methods used to diagnosis and treat these patients are presented.

Airway Obstruction↗
PubMed2002

[Subarachnoid anesthesia in the repair of urinary stress incontinence using a Burch-type colposuspension by means of extraperitoneal laparoscopy].

UNLABELLED: Extraperitoneal laparoscopy does not lead to increased intra-abdominal pressure, meaning that the mainly respiratory physiological changes that develop derive from CO2 absorption from the extraperitoneal cavity that is created. Therefore, subarachnoid anesthesia might possibly be appropriate for this type of procedure. OBJECTIVE: To assess the efficacy of subarachnoid anesthesia for correcting urinary incontinence by extraperitoneal Burch laparoscopic colposuspension. PATIENTS AND METHODS: Six consecutive patients undergoing extraperitoneal Burch laparoscopic colposuspension under intradural anesthesia. A lateral decubitus puncture was made and 12 mg of 0.5% hyperbaric bupivacaine was infused with 20 micrograms of fentanyl. We monitored hemodynamic variables, end-tidal CO2 and respiratory frequency. Complications occurring during surgery and recovery were recorded. RESULTS: Four patients presented intraperitoneal CO2 leaks upon insufflation of the extraperitoneal cavity, with dyspnea and chest-shoulder pain in addition to anxiety and agitation, such that general anesthesia had to be provided. Subcutaneous emphysema was observed to the cervical zone after surgery but discharge was not delayed. The study was halted in view of the results obtained. CONCLUSION: Subarachnoid anesthesia was not effective for extraperitoneal Burch laparoscopic colposuspension because of the impossibility of alleviating discomfort from intraperitoneal leakage and subcutaneous emphysema that can develop during the procedure.

Adult↗
PubMed2003

Use of a silicone T-tube for management of a tracheal injury in a patient with cervical blunt trauma.

A 71-year-old woman fell forward hitting the anterior part of her neck against a table. Bronchoscopy revealed deformation of the cartilage crescent in the cervical trachea (suggestive of cartilage contusion) and a longitudinal tear in the membranous region. Because subcutaneous emphysema and dyspnea developed and progressed, we made a tracheostomy and inserted a silicone T-tube through the stoma to relieve intraluminal pressure. This then served as a stent for the airway after the patient had progressed through the acute stage. The subcutaneous emphysema and pneumomediastinum abated gradually during the 7 days after insertion of the T-tube, which remained in the cervical trachea as a tracheal stent for 2 months thereafter. The T-tube is easy to manage and can be inserted through the stoma without major surgery. As an alternative to tracheotomy, the T-tube is nonirritating, allows speech, aspiration of sputum, and respiration through the nasopharynx, and in general requires little if any special maintenance or cleaning. Furthermore, a relatively long T-tube can be used, and so the stent can occupy a longer section of the trachea than can a tracheostomy tube. We recommend the placement of a T-tube to provide a useful stent for cervical tracheal injury.

Aged↗
PubMed2004

A severe complication after laser-induced damage to a transtracheal catheter during endoscopic laryngeal microsurgery.

UNLABELLED: Subcutaneous emphysema and pneumothorax is a rare and severe complication of percutaneous transtracheal jet ventilation, usually caused by obstruction of the upper airway or displacement of the tracheal catheter. Nevertheless, it is our preferred technique for endoscopic laryngeal laser surgery. We report a patient with acute subcutaneous emphysema and pneumothorax during laser surgery, caused by unobserved laser damage and discuss the associated risk factors. IMPLICATIONS: The percutaneous transtracheal jet ventilation for elective laryngeal laser surgery reduces the risk of airway fires and gives a free endoscopic operative field. This case report suggests that, even when using a teflon catheter, laser-induced damage with severe complications might occur.

Catheterization↗
PubMed1979

Transtracheal aspiration. Guidelines for safety.

A four-year experience with transtracheal aspiration was reviewed in order to determine those patients at risk for developing life-threatening complications. One hundred procedures were performed by at least 20 different physicians trained according to an established protocol. Complications were limited to minimal subcutaneous emphysema in 19 percent (10/52), pneumomediastinum in 3 percent (3/93), and gross but self-limited hemoptysis in 1 percent (one patient); occasional unifocal premature ventricular contractions were noted in one patient. We conclude that patients not at risk of developing life-threatening complications from transtracheal aspiration can be identified. They (1) are able to cooperate and have a clearly identifiable and normal cricothyroid membrane, (2) have the procedure performed only by well-trained or supervised physicians, (3) have an arterial oxygen pressure of at least 70 mm Hg with administration of supplemental oxygen, and (4) have a prothrombin activity of at least 65 percent of the control value or a normal bleeding time or a platelet count of at least 100,000/cu mm. To minimize subcutaneous emphysema or pneumomediastinum, no patient should have therapy with intermittent positive-pressure breathing or any other procedure that might induce coughing for the subsequent 24 hours.

Exudates and Transudates↗
PubMed2002

Rupture of the larynx in a newborn.

BACKGROUND: Lesions of the laryngotrachea due to repeated intubation trauma after birth are reported. CASE: A macrosomic neonate was born at term after uneventful pregnancy. On the basis of diminished uterine contractions and arrest of descent, the head was delivered by using obstetric forceps. No intubation was attempted after birth. Ten hours later, the infant developed acute life-threatening respiratory distress and subcutaneous emphysema. Intubation was impossible. Open surgical exploration of the neck revealed a rupture of the cricothyroid ligament within the larynx. The defect was closed immediately, and after artificial ventilation for 7 days, the infant was extubated. One year later, the child is developing satisfactorily, without stridor or hoarseness. CONCLUSION: In macrosomic neonates after traumatic delivery, a laryngotracheal lesion should be considered when respiratory distress syndrome combined with subcutaneous emphysema occurs.

Birth Injuries↗
PubMed1996

Iatrogenic "respiratory acidosis" during laparoscopic preperitoneal hernia repair.

This is the first report, to our knowledge, of a case of massive subcutaneous emphysema during totally preperitoneal laparoscopic hernia repair causing a "respiratory acidosis" with a systemic pH 7.20 and a pCO2 of 64 and PO2 of 84. The acidosis was corrected by increased mechanical ventilation. It appears that because of its lack of defined borders, the preperitoneal space is particularly vulnerable to the formation of massive subcutaneous emphysema. Thus, there is a large potential surface area for CO2 absorption. The complication may be prevented by increased attention to the length of fascial incisions, inflation of balloon expanding devices, and securing gripping devices in the port sites.

Acidosis, Respiratory↗
PubMed1996

Traumatic cervical tracheal disruption: report of two cases.

We report herein the cases of two patients who suffered tracheal disruption, both of whom underwent successful surgical treatment. The first patient was a 48-year-old truck driver who suffered severe dyspnea after jamming his neck in a truck door. An endotracheal tube was unable to be inserted due to bleeding and thus, an emergency tracheostomy was performed. On admission massive subcutaneous emphysema was noted in the neck and anterior chest, and tracheal disruption was confirmed by a lateral neck X-ray, computed tomography (CT), and fiberscopy. An emergency end-to-end anastomosis of the trachea with insertion of a T-type silicon tube into the lower trachea was performed. The second patient was a 36-year-old man who suffered severe dyspnea after having his neck caught in a chain while driving a motorcycle. On admission, marked subcutaneous emphysema in the neck and paradoxical movement of the trachea were noted. Tracheal disruption was confirmed by a lateral neck X-ray and CT, and a similar operation to that of the first patient was performed. This type of injury is rare; however, lateral neck X-ray, CT, and fiberscopy proved extremely useful for making an accurate diagnosis following which successful emergency surgery was able to be performed, achieving good long-term results.

Adult↗