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PubMed1991

[Dissecting emphysema].

We report six observations of pneumomediastinum, due to dental extraction and use of high speed air turbine drill, aspiration of a nut with air trapping, labor in delivery, status asthmaticus, mechanical ventilation, and rectal perforation. Some patients showed widespread extension of dissecting air presenting as subcutaneous emphysema, pneumopericardium or pneumoretroperitoneum. The mediastinum is thought to be a central pump, the diaphragm and the lung acting like bellows, which distribute interstitial air from and into communicating layers on both sides of the diaphragm. Pneumomediastinum does not prove an air leak in the thoracic cage nor does pneumoretroperitoneum absolutely indicate bowel rupture. Review of the literature.

Adolescent↗
PubMed1997

[Thoracoscopic surgery for pneumothorax with bullous emphysema in an elderly patient: a case report].

Recent advances in optical and endoscopic operating instruments have made thoracoscopic surgery easier. The authors report the case of an 83-year-old patient who was referred to our hospital for right spontaneous pneumothorax associated with severe bullous emphysema. Chest X-ray films showed 40% collapse of right lung and the right spontaneous pneumothorax was treated by chest tube drainage for 3 weeks. However air leak was not decreased and subcutaneous emphysema appeared. Chest computerized tomography revealed multiple bullae. Thoracoscopic surgery was performed because of preservation of the respiratory function. The ruptured bulla was resected by using ENDO GIA and the other multiple bullae were resected similarly in order to improve the pulmonary function. A surgical drain was removed on the 14th postoperative day because of a little air leak continuing. His postoperative course was uneventful after removal of the chest drain. He was discharged on 27th postoperative day and had no shortness of breath in daily life. From our experience, thoracoscopic surgery appears to be much better than thoracotomy for spontaneous pneumothorax because of much less postoperative disability and preservation of respiratory function.

Aged↗
PubMed1975

Spontaneous mediastinal emphysema: hamman's syndrome.

A case of spontaneous mediastinal emphysema (Hamman's syndrome) is described. The patient was a 21-year-old man, who had a sudden onset of substernal chest pain at rest associated with typical findings of Hamman's syndrome: subcutaneous emphysema of the neck, a precordial crunching sound synchronous with the heart beat and air in the mediastinum on chest x-ray. He recovered uneventfully. The pathogenesis and clinical picture of this rare condition are discussed.

Adult↗
PubMed1993

[Complications in urological laparoscopic surgery].

Laparoscopic surgery is often associated with complications which never occur in open conventional surgery. We investigated operative and postoperative complications in urological laparoscopic surgery. From February 1990 to November 1992, 91 laparoscopic operations were performed, including 62 varicocelectomies, 5 pelvic lymphadenectomies, 6 adrenalectomies, 5 simple nephrectomies, 2 radical nephrectomies, 1 staged Fowler-Stephens operation and 10 laparoscopies for cryptorchidism or other disorders. The patients ranged from 3 months to 77 years old. Nine (9.9%) of the 91 patients had complications associated with laparoscopic procedures and 4 (4.4%) of them had major complications. Pneumoextraperitoneum occurred in 3 patients. Two patients, who suffered from preperitoneal insufflation or pneumothorax associated with pneumomediastinum, failed to undergo laparoscopy. A small amount of scrotal emphysema developed in one patient, which subsided within 12 hours. Another patient, who underwent radical nephrectomy and para-aortic lymphadenectomy for left renal cell carcinoma, complained of symptoms due to persistent pneumoperitoneum and subcutaneous emphysema, which subsided 2 weeks after the operation. Respiratory acidosis caused by carbon dioxide absorption, which was difficult to be controlled, occurred in the other two patients; one was an adult male with reduced respiratory function and the other was a 1-year-and-8-month-old child. Bleeding during or after the procedure was another serious complication. Vena caval laceration occurred during right simple nephrectomy for pyonephrosis with renal calculi and was managed with laparotomy. Two patients, one after simple nephrectomy and the other after right adrenalectomy, suffered from postoperative bleeding about 300 ml through the penrose drain, which subsided following a bed rest.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy.

This trial prospectively compares two methods of percutaneous tracheostomy, both routinely used in ICU: the Ciaglia progressive dilational tracheostomy and the Griggs forceps dilational tracheostomy. One hundred patients were randomized using a single-blinded envelope method to receive progressive or forceps percutaneous tracheostomy performed at the bedside. Operative time, the occurrence of hypoxaemia or hypercapnia and complications were recorded. The progressive technique took longer than the forceps technique (median 7 (range 2-26) vs. 4 (1-16) minutes, P = 0.0005). Hypercapnia occurred in both groups but was more marked with the progressive technique (56 (16) vs. 49 (13) mmHg, P = 0.0082). Minor complications (minor bleeding, transient hypoxaemia, damage to posterior tracheal wall without emphysema) were also more frequent with the progressive technique (31 vs. 9 complications, P < 0.0001). Six major complications occurred with the progressive technique, none with the forceps technique (P = 0.0085): tension pneumothorax, posterior tracheal wall injury with subcutaneous emphysema, loss of airway with hypoxaemia, loss of stoma with impossible re-catheterization, and two conversions to another technique. In conclusion, progressive dilational tracheostomy took longer, caused more hypercapnia and more minor and major difficulties than forceps dilational tracheostomy.

Adult↗
PubMed1994

[A case of mediastinal emphysema due to blunt trauma that a continuous drainage to the extrapleural space took effect].

A 70-year-old male was admitted to our hospital with chest bruise, resulting in fracture of the right rib. Nine hours later, the patient came to use again with a chief complaint of dyspnea and chest oppression. He had extensive subcutaneous emphysema in the upper half of the body. Chest X-ray films revealed remarkable mediastinal emphysema and collapse in a part of right lung. Chest CT scan disclosed enlargement of extrapleural cavity. These findings suggested progression of mediastinal emphysema. Continuous drainage to the extrapleural cavity was performed and the clinical course was uneventful. Thus, a satisfactory result can be obtained by extrapleural drainage in a patient with severe mediastinal emphysema.

Aged↗
PubMed1992

[Systemic gas embolism in the greater circulation in a ventilated premature infant].

BACKGROUND: Pneumothorax is common complication in newborns; its incidence is increased by intubation, particularly when high pressure ventilation is necessary. Systemic air embolism is a rare and usually fatal form of "displaced air". CASE REPORT: A preterm newborn, 27 weeks of gestational age, weighing 940 g, with respiratory distress syndrome was treated by intubation at 1 min of life and high pressure ventilation (Peak 36 cmH2O, PEP 6 cmH2O, FiO2 = 1). Bilateral pulmonary interstitial emphysema was seen on X-rays at 4 hr of life. Acute cyanosis and bradycardia occurred at 7 hr of life; large amounts of air mixed with blood were withdrawn from the umbilical vein catheter. There was no pneumothorax, pneumomediastinum or subcutaneous emphysema. The newborn died at 9 hr of life. Post mortem injection of contrast fluid into umbilical vein catheter indicated no cardiac perforation: this finding was confirmed by autopsy. CONCLUSION: This is a new case of systemic air embolism that may be due to high pressure ventilation in an extremely underweight newborn. Preventive measures consist of monitoring ventilation, possibly using new techniques, but their efficacy remain to be demonstrated.

Embolism, Air↗
PubMed1989

[A case of spontaneous pneumomediastinum in a trombonist].

A case of spontaneous mediastinal emphysema in a 21-year-old female trombonist was reported. During light work, she experienced pain in her neck which later radiated into her chest. She had neither causal disease nor episode of straining at the onset of her work. On admission, physical examination revealed subcutaneous emphysema over the upper part of the chest and neck, and mediastinal crunch on auscultation (Hamman's sign). Roentgenograms revealed the presence of a considerable amount of air in the mediastinum and this extended upward through the mediastinum into the soft tissue of the neck bilaterally. The chest and neck CT yielded clearer information concerning the location and degree of mediastinal emphysema. She was treated with bed rest and recovered completely within five days. Spontaneous mediastinal emphysema without causal disease or apparent precipitating episode is infrequently recognized. In our case, though the trombonist had no apparent straining episode, the causative factor can be assumed to be the tenderness of the alveoli originating from frequent over-inflations of the lungs and high intra-alveolar pressures of about 150 cmH2O during trombone performance, which may result in alveolar rupture under normal intralveolar pressures.

Adult↗
PubMedDate not supplied

[Spontaneous esophageal rupture in three patients].

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.

Aged↗
PubMed1993

[Tracheal and bronchial rupture after blunt thoracic trauma].

Airway disruptions after blunt chest trauma are rather infrequent with an incidence of about 1%. Even in large centers with many such casualties they are episodical. The clinical picture is not an uniform one, and typical clinical signs occur often without an airway lesion. Therefore, the correct diagnosis may be delayed. Two case reports, one with a tracheal rupture, the other with complete disruption of the main right bronchus are presented. Both patients showed significant soft tissue emphysema, increasing dyspnea and hypoxia respectively within a few hours after their accident. The diagnosis was established bronchoscopically after time intervals of 8 and 32 hours respectively, followed by immediate surgical correction. Both patients experienced a smooth recovery with good longterm results. In blunt chest trauma presenting with subcutaneous emphysema, pneumomediastinum, pneumothorax, hemoptysis and respiratory distress, tracheobronchial disruption should be considered. In this case, expert bronchoscopy, preferably by a surgeon with large thoracic experience, is mandatory.

Adolescent↗
PubMed1998

Emergent bronchofiberoptic bronchial occlusion for intractable pneumothorax with severe emphysema.

Emergent bronchofiberoptic bronchial occlusion using fibrin glue and woven polyglycolic acid mesh for persistent pneumothorax with severe emphysema is described. A 74-year-old man who had severe pulmonary dysfunction accompanying chronic emphysema was admitted with a complaint of sudden severe dyspnea. The chest X-ray on admission revealed collapse of the right lung. The patient was placed on a mechanical ventilator because of acute respiratory failure. In spite of continuous suction through a chest drainage tube, air leakage persisted. On the seventh hospital day, subcutaneous emphysema was apparent in the face and scrotum in addition to the chest. First, a double-lumen catheter was inserted into the right B5 bronchus, and fibrin glue was infused into the drainage bronchus via the double-lumen catheter. However, the procedure failed. Next, a combination of fibrin glue and woven polyglycolic acid mesh which had been cut into small pieces was introduced and pushed into the B5 bronchus using forceps. The air leakage stopped immediately after the administration. This procedure is simple and a minimally invasive method for the treatment of intractable pneumothorax in a compromised patient on a mechanical ventilator.

Aged↗
PubMed2001

A case of spontaneous pneumomediastinum and pneumopericardium in a young adult.

Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.

Adult↗
PubMedDate not supplied

[Subcutaneous, pneumomediastinal, pneumopericardial emphysema and pneumothorax following retrosigmoid resection].

Pulmonary alveolar rupture can occur spontaneously or as a result of mechanical ventilation or other causes, and may give rise to bullae or emphysema without producing extrapulmonary air. Most but not all cases occur in patients with underlying lung disease. We describe a patient with no history of lung disease who underwent anterior sigmoid resection under combined (general/epidural) anesthesia. Soon after the patient awoke from anesthesia, subcutaneous, pneumomediastinal and pneumopericardiac emphysema developed, along with bilateral pneumothorax. We discuss the possible causes of extra-alveolar air was well as ways to detect and treat it.

Adult↗
PubMed1990

[A case of bronchial asthma complicated with mediastinal, subcutaneous, peritoneal and epidural emphysema].

A case of a 16-year-old female with bronchial asthma complicated with mediastinal, subcutaneous, peritoneal and epidural emphysema was reported. The patient was admitted to our hospital because of dyspnea. Chest and abdominal X-ray films revealed mediastinal emphysema with peribronchial air sheath, subcutaneous emphysema in the neck and chest, and peritoneal emphysema. CT-scan revealed severe mediastinal, subcutaneous and epidural emphysema. These findings disappeared about 10 days after recovery from the attack. Diagnostic methods and the pathogenesis of air leak were also discussed.

Adolescent↗
PubMed2001

[Subcutaneous cervico-thoracic emphysema and pneumo-mediastinum following a tracheostomy].

Reporting the case of a man, 70-year-old, suffering a chronic obstructive lung disease of moderate degree linked to important Reinke's oedema, who underwent a tracheotomy, being troubled the immediate postoperative period with subcutaneous emphysema and pneumomediastinitis, complications resolved favourably in a ten days term, and the patient could be decannulated.

Aged↗
PubMedDate not supplied

[Complications in laparoscopic cholecystectomy].

INTRODUCTION: For more than a century classical cholecystectomy has been a method of choice in surgical management of gallbladder diseases. At the end of eighties and at the beginning of nineties of this century, laparoscopic cholecystectomy has been introduced gradually taking the place of classical. Numerous studies deal with complications associated with this surgical procedure. COMPLICATIONS RELATED TO INSERTION OF VERESS NEEDLE: During insertion of Veress needle, injuries of the frontal abdominal wall may occur (9). Insertion of the needle into the peritoneal cavity may cause: injury of the omentum with consequential hemorrhage; intestinal and mesenteric injuries as well as injuries of urinary bladder and great blood vessels of retroperitoneum. Initial insufflation of CO2 through the needle, if it is inadequately placed, may cause subacute emphysema, intraperitoneal adhesion formation, mediastinal emphysema and pneumothorax (8-10). COMPLICATIONS RELATED TO TROCAR INSERTION--TROCAR INJURIES: Apart from injuries associated with insertion of Veress needle, insertion of trocar may cause injuries of the liver, spleen and falciform ligament (4). Trocar injuries are more severe (8,9). BILE DUCTS INJURIES: Bile ducts injuries are divided into mild (injuries of a smaller bile duct, incomplete ductus cysticus occlusion or partial that is lateral injury of greater ducts) and severe (injuries of duct choledochus or hepatic ducts) (1). Bile ducts injuries are extremely severe complications with high morbidity, long-term hospitalization and may be life threatening (11,12). INTRAOPERATIVE BLEEDING: Intensive and uncontrolled intraoperative bleeding, especially within the operative field, both arterial (from arterial cyst) and venous (gallbladder, vena porte) requires conversion. POSTOPERATIVE HEMORRHAGE: Postoperative hemorrhage usually occurs in cases of cystic artery damage, prolonged hemorrhage from the gallbladder, parenchymal liver injuries and as well as in open cholecystectomy it is an indication for reoperation (8,9). OTHER COMPLICATIONS: Other complications, thermic and mechanic diaphragmatic injuries and infections of incisional injuries and herniations at the place of trocar insertion. OUR EXPERIENCES: In the period June 1995-November 1997, 500 patients underwent laparoscopic cholecystectomy (401 female--80.2% and 99 male--19.8%) aging from 16-78 years of age, average age 46 years. 16 (3.2%) mild complications were recorded (reoperation was necessary in one case): 1) subcutaneous emphysema in 3 patients (0.6%) which gradually disappeared up to 36 hours after surgery; 2) Retzin's space emphysema in 1 patient (0.2%) causing dysuria for 3 days; 3) bilirea--bile excretion through subhepatic drain in 2 patients (0.4%)--from the second to seventh postoperative day (excretion did not exceed 500 ml a day) and it spontaneously stopped; 4) inflammatory hematoma of the falciform ligament (0.02%); 5) in 8 patients (1.6%) postoperative infection of infraxifoid wound was registered; 6) in 1 patient (0.2%) segmental bile duct injury occurred. Out of 500 laparoscopic cholecystectomies conversion was necessary in 19 cases (3.8%). CONCLUSION: In spite of numerous advantages and better comfort for patients, this method may have complications, whereas incidence of bile ducts injuries seems to be higher than in the classical procedure. The more laparoscopic cholecystectomies are performed, the more bile ducts injuries occur. Out of 500 laparoscopic cholecystectomies performed at the Surgery Department of the hospital in Senta, 3.2% of mild complications were registered with 1 case needing reoperation, while in 1 case (0.2%) it was probably type A bile duct injury.

Adolescent↗
PubMed1999

Single-stage laryngotracheal reconstruction: the Great Ormond Street experience and guidelines for patient selection.

OBJECTIVES: To review all patients undergoing single-stage laryngotracheal reconstruction and to determine guidelines to predict successful outcomes and prevent the necessity of tracheotomy following laryngotracheal reconstruction. DESIGN: Chart review. SETTING: Tertiary care children's hospital. PATIENTS: A retrospective chart review was performed at our institution involving all patients who underwent single-stage laryngotracheal reconstruction from 1993 through 1996. A total of 28 patients were reviewed. RESULTS: Based on this chart review, a statistically higher incidence of extubation complications (P = .045), ie, bleeding, reintubation, or subcutaneous emphysema, occurred in children who weighed less than 4 kg. Although not statistically significant (P>.99), the relative risks of failure, defined as tracheotomy dependent or significant airway compromise following single-stage laryngotracheal reconstruction, were 3.43 if the child's weight was less than 4 kg at the time of surgery and 2.31 if the gestational age was less than 30 weeks at the time of surgery. Length of time for intubation did not appear to have any effect on outcome. CONCLUSIONS: Patients' gestational age and weight at the time of surgery appear to have the most impact on successful outcome. Children weighing more than 4 kg and those with gestational age of greater than 30 weeks appear to have a greater chance at successful extubation and eventual patent airway. Duration of intubation following single-stage laryngotracheal reconstruction does not appear to affect outcome.

Body Weight↗
PubMed2000

Appropriateness of routine postoperative chest radiography after tracheotomy.

OBJECTIVE: To determine the appropriateness of postoperative chest radiography after adult tracheotomy. DESIGN: Retrospective case series. SETTING: Tertiary care academic medical center. PATIENTS: The records of 379 consecutive adult patients who underwent tracheotomy by the Otolaryngology-Head and Neck Surgery Service from January 1992 to December 1996 were available for review and met inclusion criteria. All patients underwent postoperative chest radiography. MAIN OUTCOME MEASURES: Frequency of postoperative tracheotomy-associated complications, most significantly pneumothorax. RESULTS: The patients had no pneumothorax on postoperative chest films. Minor complications, which were found in 7.1% of the patients, included small bleeds, wound infection, and subcutaneous emphysema. Tracheostomy-associated death occurred in 2 patients (0.5%). CONCLUSIONS: Routine postoperative chest radiography is unnecessary after adult tracheotomy. Chest radiography may be indicated by clinically suspicious signs or symptoms.

Adolescent↗