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PubMedDate not supplied

Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl.

We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma.

Albuterol↗
PubMed1987

Neonatal pharyngeal perforation diagnosed by xenon 133 imaging.

A premature male infant developed bilateral pneumothorax and generalized subcutaneous emphysema following difficult intubation. Xenon 133 imaging revealed accumulation of radionuclide in those areas of subcutaneous emphysema indicating a large air leak from the upper respiratory tract. Pharyngeal injury was confirmed at endoscopy. Imaging with (133)Xe may offer a means of rapid diagnosis of airway injury.

Emphysema↗
PubMed2003

Tracheobronchial injury by blunt trauma in children: is emergency tracheobronchoscopy always necessary?

PURPOSE: To discuss the usefulness of CT scan in initial management of well tolerated tracheobronchial injuries and the place of tracheoscopy. METHODS: We report our experience of three cases treated for tracheobronchial rupture resulting from three different mechanisms and review the literature. Three boys, aged 4 to 10 years, were referred to our institution for tracheobronchial rupture. Two of them presented with subcutaneous emphysema after a minor trauma, the third was a polytrauma referred after a severe car crash and was already intubated. We emphasise the importance of an initial CT scan, as this allowed us twice to confirm the tracheal wound prior to tracheoscopy. We discuss the necessity of performing a tracheoscopy in the case of a well tolerated lesion, as this procedure clearly worsened the ventilatory state in one of our cases. Moreover, one of our cases illustrates the fact that even a minor trauma can lead to life-threatening respiratory distress. All the lesions observed in our study were linear and were managed by thoracic drainage; they were then closely monitored and required no further surgical procedure. CONCLUSION: Tracheobronchial rupture in children can result from minor cervical traumas and in such cases special attention must be paid to mild discomfort or subcutaneous emphysema on admission. Initial CT scan can be very helpful in visualising the level of the rupture and its consequences with respect to the pulmonary parenchyma. One can question the necessity for tracheoscopy in well tolerated lesion, as its results do not always improve the therapeutic outcome.

Bronchi↗
PubMed2003

Clinical features of medical pneumomediastinum.

PURPOSE: The clinical features of pneumomediastinum are clarified. METHODS: Eight patients with pneumomediastinum, caused by other than trauma or operative, diagnostic, or therapeutic trouble (medical pneumomediastinum), were studied retrospectively. RESULTS: There were seven men and one woman with an average age of 17.5 years. The incidence was about 1:320 in thoracic surgical inpatients. The causes were bronchial asthma in three patients, physical exertion in one, and forced swallowing in one. There were three spontaneous cases. The chief complaints were dyspnea in five patients including three patients with bronchial asthma, chest pain in two, and pharyngeal pain in one. Subcutaneous emphysema was observed in all patients. Hamman's sign was audible in only one patient. Roentgenologically, subcutaneous emphysema was observed in all patients. Pneumomediastinum parallel to the heart was observed in five patients. The continuous diaphragm sign was detected in three patients. Five patients were prohibited from eating and drinking excluding those with pneumomediastinum due to bronchial asthma, considering the esophageal origin. Prophylactic antibiotics were prescribed for all patients. Pneumomediastinum improved within 7 days in all patients. The mean length of hospitalization was 7.8 days, ranging from 4 to 13 days. CONCLUSION: In consideration of air of the esophageal origin, non per oral was prescribed. With the prevention of mediastinitis using antibiotics, all patients recovered. Emergency endoscopic examination was unnecessary.

Adolescent↗
PubMed1995

Bronchial rupture caused by blunt chest injury.

We have surgically treated six patients with bronchial rupture caused by blunt chest injury in the past 5 years. All injuries resulted from traffic accidents, except in one patient who was hit by a crane. Clinical manifestations included chest pain (n = 6), subcutaneous emphysema (n = 4), and dyspnea (n = 6). Roentgenographic findings were tension (n = 3) or nontension (n = 3) pneumothorax, subcutaneous emphysema (n = 4), pneumomediastinum (n = 3), deep cervical emphysema (n = 5), and delayed collapse of the affected lung (n = 3). Three patients had associated injuries: right clavicle and rib fractures in the first; right humeral, scapular, and multiple rib fractures and left sternoclavicular joint dislocation in the second; and left clavicle fracture in the third. These six patients all underwent immediate tube thoracostomy and then bronchoplasty. Bronchoplasty was performed within 3 days in four patients and on days 16 and 30, respectively, in the other two patients. The affected lung demonstrated full expansion in all patients immediately after bronchoplasty. Follow-up bronchoscopy showed good patency of all bronchi.

Accidents, Traffic↗
PubMed1999

Postoperative bilevel positive airway pressure ventilation after tonsillectomy and adenoidectomy in children--a preliminary report.

Obstructive sleep apnea (OSA) in children, characterized by hypoventilation secondary to upper airway obstruction, often results from tonsil and adenoid hypertrophy. Adenotonsillectomy is the standard therapy in this patient population. The immediate postoperative period is complicated occasionally by respiratory difficulties that may require intubation and mechanical ventilation. Recently, physicians have provided temporary airway support using continuous and bilevel positive airway pressure (BiPAP) devices. Reported complications of positive airway pressure devices include local abrasions to the nose and mouth; dryness of the nose, eyes, and mouth; sneezing; nasal drip, bleeds, and congestion; sinusitis; increased intraocular pressure; non-compliance; and pneumocephalus. Subcutaneous emphysema following facial trauma, dental extractions, adenotonsillectomy, and sinus surgery has been reported. There is also a hypothetically increased risk of subcutaneous emphysema following the use of positive airway pressure ventilation in the tonsillectomy patient. Between January 1997 and July 1998, 1321 patients underwent tonsillectomy and/or adenoidectomy at our institution. In reviewing the records of all pediatric intensive care unit admissions during that time period, we identified nine patients, of the 1321, who required BiPAP postoperatively. Of these, four children were obese, four had preexisting neurological disorders, and one underwent endoscopic sinus surgery and adenoidectomy. Three children were asthmatic, and three were less than 3 years of age. Two obese children were discharged with home BiPAP, one of whom had been on BiPAP prior to surgery. All patients tolerated BiPAP without complications. This preliminary report suggests that BiPAP is a safe and effective method of respiratory assistance in the adenotonsillectomy patient with preexisting conditions who is predisposed to postoperative airway obstruction. Furthermore, with BiPAP, the risks of intubation and ventilator dependence are avoided.

Adenoidectomy↗
PubMed1977

Elective caesarean operation in Hereford cattle.

An elective left flank Caesarean operation was performed on 56 Hereford cattle and the influence of various surgical techniques on the postoperative progress assessed. A paravertebral nerve block produced effective analgesia in all layers of the abdominal wall of all cattle. In contrast, tissue infiltration, in the form of an inverted L block, did not produce analgesia of the peritoneum and was generally only partly effective in the muscle layers of fat animals. The use of spasmolytic drug facilitated handling of the uterus. Xylazine, when given to unmanageable animals, noticeably increased uterine tone even when used in conjunction with a spasmolytic. Three animals (5.4%) died from generalised peritonitis. Peritoneal adhesions developed in 29 animals (51.8%) and minor wound dehiscence and/or suture infection occurred in 8 animals (14.1%). Postoperative subcutaneous emphysema developed in ;23 cattle (41%). The absence of sutures in the peritoneum was associated with a significant increase in the occurrence of subcutaneous emphysema. Although the prevalence of retained foetal membranes was high this did not seem to influence the postoperative progress of the animal.

Anesthesia, Obstetrical↗
PubMed1985

Diagnosis and management of spontaneous transmural rupture of the oesophagus (Boerhaave's syndrome).

The presentation, diagnosis and management of 14 cases of spontaneous transmural oesophageal rupture have been reviewed. Analysis suggested that the classical triad of vomiting, chest pain and subcutaneous emphysema was rare (1/14) and therefore misleading. Abdominal pain and tenderness obscured the clinical picture; the temporal relationship of pain to vomiting varied and subcutaneous emphysema was uncommon (4/14). Consequently, only two cases were correctly diagnosed on presentation and diagnosis in the others was markedly delayed (average 4 days). Contrast swallow examination, when eventually performed, was diagnostic. Twelve patients underwent repair: four under 24 h, who all survived and eight over 24 h, amongst whom there were one (12.5 per cent) operative and two (25 per cent) late deaths. Conservative management was successful in the remaining two cases. Oesophageal fistula, empyema and incorrect initial surgery were common and serious complications. Management options are reviewed and their relative merits considered.

Adult↗
PubMed1998

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↗
PubMed1996

[Pneumoscrotum after air leak from tension pneumothorax].

Pneumoscrotum is a rare condition which may accompany retroperitoneal ruptures of air-filled gastrointestinal organs, endoscopic and surgical procedures and widespread subcutaneous emphysema. A case of pneumoscrotum as a complication to treatment of tension pneumothorax is reported, and the literature is reviewed.

Drainage↗
PubMed1975

Pneumomediastinum complicating pregnancy.

Pneumomediastinum and subcutaneous emphysema is a rare complication of the second stage of labor. Although this entity runs a benign course, fatalities have been reported. Clinical findings of subcutaneous emphysema necessitate a chest X-ray to document pneumomediastinum. If pneumomediastinum is present, rapid delivery via elective forceps or even surgery may be considered to prevent serious complications.

Adolescent↗
PubMed1996

Pneumothorax complicating laparoscopic ureterolysis.

In a 71-year-old female marked left-sided ureteral stenosis secondary to retroperitoneal fibrosis was diagnosed. Since conservative therapy with cortisone had failed, laparoscopic ureterolysis was performed. Following tracheal intubation the lungs were ventilated with 40 vol% O2 in air and isoflurane 0.5-2%, using a positive end-expiratory pressure of 6 cm H2O. A CO2 pneumoperitoneum was established with a pressure-controlled high-flow insufflator; the intraabdominal pressure during the procedure was 14 mm Hg. Two hours after gas instillation, the peak airway pressure increased from 22 to 40 cm H2O, and the PaCO2 from 45 to 70 mm Hg. Breath sounds over the right lung were no longer heard, and subcutaneous emphysema was noted over the neck and face. An intraoperative chest X-ray confirmed a right pneumothorax. Following peritoneal gas evacuation, the PaCO2 returned to 35 mm Hg, the subcutaneous emphysema diminished, and a repeat chest X-ray showed complete resolution of the pneumothorax. The course of this event led us to the conclusion that the pneumothorax was due to diffusion of CO2 from the peritoneal to the pleural cavity through congenital defects in the diaphragm. Ureterolysis could be continued by laparotomy.

Aged↗
PubMed2000

Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery.

BACKGROUND: Pneumomediastinum can be a sign of esophageal perforation. During laparoscopic esophageal surgery, the mediastinum is exposed to carbon dioxide gas under pressure that can cause pneumomediastinum. METHODS: Forty-five patients undergoing laparoscopic esophageal procedures had erect, inspiratory, single-view chest radiographs (CXR) performed in the recovery room (RR). Patients with extraabdominal gas underwent daily erect, inspiratory, single-view CXR until resorption of the gas or discharge from the hospital. Insufflation time and pressure were recorded, and morbidity was evaluated. Results are expressed as mean +/- SEM. RESULTS: Twenty-five men (56%)and 20 women (44%) aged 33.0 +/- 2.9 years underwent 10 Heller myotomies (22.2%), 27 Nissen fundoplications (60.0%), six Toupet fundoplications (13.3%), and two paraesophageal hernia repairs (4.4%). Twenty-four patients (53.3%) had normal CXR in RR, and 21 (46.7%) had extraabdominal gas. Eighteen (85.7%) of the 21 had pneumomediastinum, three (14.3%) had pneumothorax, and 12 (57.1%) had subcutaneous emphysema in RR. Sixteen of these 21 remained hospitalized and had repeat CXR on postoperative day 1. Of these 16, five (31.3%) had normal CXR, 11 (68.8%) had pneumomediastinum, and seven (43.8%) had subcutaneous emphysema. There were no esophageal perforations and no chest tube insertions, and there was no morbidity related to pneumomediastinum. CONCLUSION: Pneumomediastinum is observed frequently following laparoscopic esophageal operations and often persists past 24 h. After these operations, pneumomediastinum is not necessarily indicative of esophageal perforation. In this group, it caused no clinically significant events that altered the course of the patients.

Adolescent↗
PubMed1996

Pneumomediastinum complicating diabetic ketoacidosis.

A 24-year-old previously healthy man presented with a 3-week history of progressively intensifying symptoms of diabetes mellitus. He had become increasingly unwell during the night preceding his admission to hospital and had developed central pleuritic chest pains with nausea; he had vomited once. On admission, he was clinically dehydrated and acidotic with Kussmaul's respiration. A diagnosis of diabetic ketoacidosis was confirmed by laboratory tests (arterial pH 7.21; bicarbonate 11.6 mmol l-1; blood glucose 40.5 mmol l-1, and heavy ketonuria). Subcutaneous emphysema was palpable in the neck tissues and a chest X-ray revealed mediastinal emphysema. There was no clinical or radiological evidence of acute or chronic pulmonary disease and a barium swallow confirmed the integrity of the oesophagus. He made an uneventful recovery from the ketoacidosis with conventional therapy. The subcutaneous emphysema and pneumomediastinum had completely resolved at review 4 weeks later.

Adult↗
PubMedDate not supplied

[Spontaneous pneumomediastinum].

Spontaneous pneumomediastinum is a relatively rare disease, the clinical signs of which may be misleading, and the physiopathology is still unknown. The authors report 7 cases collected over a period of 3 years and note the etiology, the clinical findings and the X-ray findings. The disease often affectsyoung sybjects, without any sex predominance. The initial symptom is thoracic pain and is often accompanied by dispnea. Subcutaneous emphysema only appears secondarily and may be mild. The association with pneumothorax is not rare. Among the etiological circumstances, pneumomediastinum often occurs after an effort or a respiratory infection with dyspnea. The diagnosis depends on the discovery of subcutaneous emphysema and on radiological signs in A.P. and lateral chest views. Treatment should be as conservative as possible in the usual benign forms. It should be limited to bed rest, analgesics and sedatives. In severe cases, supra-sternal drainage permits decompression of the mediastinum. The physiopathological mechanisms are discussed, but the usually accepted theory is rupture of an alveolus into the pulmonary interstitial tissue. The pressure gradient necessary for this rupture may be due to variations in alveolar or vascular pressure.

Adolescent↗