[Subcutaneous emphysema--mediastinal emphysema, pneumothorax, complicating tracheotomy or foreign bodies in the airway].
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Child, Preschool↗
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Mediastinal emphysema.
Mediastinal emphysema may occur due to migration of air from the lungs, from the esophagus or tracheobronchial tree and from the abdomen. Of especial interest is the mechanism starting with the rupture of the perivascular alveoli due to a rapid decrease in intrathoracic pressure from any cause, the development of pulmonary interstitial emphysema and migration of the air into the mediastinum. In one case the patient had severe interstitial emphysema of the left lung, mediastinal emphysema and subcutaneous emphysema without pneumothorax and rapid improvement followed tracheotomy. In another case the patient had interstitial emphysema of the left lung that did not progress to mediastinal emphysema and subcutaneous emphysema. Pneumothorax was not present. Recovery was more rapid than in the first patient.
Abdominal Cavity↗
[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients].
A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. Next day she was transnasally intubated for respiratory management, but no mechanical ventilation was required. While she was undergoing the CT scanning 5 days after intubation, respiratory arrest and cyanosis developed all of a sudden, and her face and neck became swollen. The chest x-ray revealed a marked subcutaneous emphysema, mediastinal emphysema and bilateral pneumothorax. CT at that time showed a diffuse low density area in the right hemisphere, and a marked midline shift returned. She did not regain consciousness and died 12 days after the incident. At autopsy an ulcer was observed in the wall of the trachea, where the tip or the cuff of the transnasal tracheal tube was supposed to be present. No perforation, however, was there. Case 2: A 75-year-old woman was admitted to our hospital because of SAH. In hospital course she was also transnasally intubated and required no mechanical ventilation. When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.
Adult↗
Sarcoidosis and mediastinal emphysema.
Mediastinal emphysema developed in a 13-year-old boy with diffuse interstitial pulmonary disease, later proved to be sarcoid. No previous report was found.
Adolescent↗
[Miliary tuberculosis with bullous pulmonary emphysema; terminal acute mediastinal emphysema].
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Child↗
Spontaneous mediastinal emphysema.
OBJECTIVE: Spontaneous mediastinal emphysema is uncommon. Its cause has not been determined precisely, but the entity is usually associated with suddenly raised alveolar pressure. METHODS: Between 1980 and 2001, 114 patients with mediastinal emphysema of various causes were hospitalized in the Wolfson Medical Center. In 22 of these patients (19.3%) the emphysema occurred without an obvious preceding event and was classified as spontaneous. The commonest symptoms and signs were chest pain, dyspnea and subcutaneous emphysema. All patients were kept under observation. Contrast esophagogram was performed in two patients who vomited. Pleural drains were inserted in six patients who had concomitant pneumothorax. RESULTS: All patients recovered and were followed for at least one year. There were no complications and no recurrences. CONCLUSIONS: Spontaneous mediastinal emphysema is usually a benign condition, which can be treated expectantly. The patients should be observed for 24 h. Recurrences are rare.
Adolescent↗
Traumatic mediastinal emphysema.
The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.
Accidents, Traffic↗
[Subcutaneous and mediastinal emphysema related to facial injuries].
Mediastinal emphysema following facial trauma in the absence of neck, chest or abdominal injury is a rare entity. Mediastinal emphysema associated with fractures of the facial bones or odontological surgery has only been reviewed previously in case reports. This article reviews the etiological and pathogenetic mechanisms of subcutaneous facial/cervical emphysema and mediastinal emphysema associated with fractures of the facial bones. Complications and risk factors in treating fractures of the facial bones when mediastinal emphysema is present are discussed with emphasis on anaesthesiological complications.
Emphysema↗
Mediastinal emphysema simulating acute pericarditis.
A case of extensive subcutaneous emphysema, retropneumoperitoneum and mediastinal emphysema is described. The mediastinal emphysema was associated with signs and symptoms of pericardial tamponade, and previously undocumented ECG changes, consistent with acute pericarditis, were noted.
Acute Disease↗
A recurrent case of spontaneous mediastinal emphysema.
The first case of spontaneous mediastinal emphysema was reported by Hamman et al. in 1939. It is a rare condition that primarily occurs in young adults. In many instances, spontaneous mediastinal emphysema is caused by yelling, shouting or active exercise, but the cause is often unknown. It is rare for cases of spontaneous mediastinal emphysema to recur. Recently, we experienced a recurrent case of spontaneous mediastinal emphysema in a patient with a duodenal ulcer. Vomiting appeared to be the cause of the recurrence in our patient. Of the 58 patients with spontaneous mediastinal emphysema who have been reported in Japan so far, recurrences were documented only in our patient and two others.
Adult↗
A case of spontaneous cervical and mediastinal emphysema.
Subcutaneous cervical and mediastinal emphysema usually can occurs as a result of surgery or trauma. Spontaneous cervical subcutaneous emphysema and pneumomediastinum, occurring in the absence of previous disorders or provocating factors, is very rare. The following case report of spontaneous cervical and mediastinal emphysema is assumed to be the first of its kind in Korea. The patient has been followed up for three years without recurrence or sequelae.
Adolescent↗
Spontaneous cervical and mediastinal emphysema in asthma.
Patients with mediastinal emphysema and free air in the cervical region often present to an emergency medicine department, where an otolaryngologist-head and neck surgeon may be consulted for a surgical opinion. These occasions underscore the necessity that the disease be thoroughly understood and that conservative management be executed. Two patients with asthma, a 16-year-old boy and a 20-year-old man, were found on roentgenograms to have retropharyngeal free air and mediastinal emphysema. They were treated conservatively, and both recovered rapidly.
Adolescent↗
Recurrent pneumothoraces and mediastinal emphysema in systemic lupus erythematosus.
Neither pneumothorax or mediastinal emphysema are well recognized pulmonary manifestations of systemic lupus erythematosus (SLE). We describe a 41-year-old woman with severe lupus pneumonitis complicated by recurrent pneumothoraces and mediastinal emphysema. Other features of SLE were minimal. She died of progressive respiratory failure. Autopsy revealed innumerable blebs in both lungs responsible for the pneumothoraces and mediastinal emphysema. Both pneumothoraces and mediastinal emphysema occurred during a course of corticosteroid therapy. The course of her illness was unaffected by treatments that included high dose corticosteroids, immunosuppressives and plasmapheresis. Better medical treatment for these lupus complications should be sought in addition to surgery.
Adrenal Cortex Hormones↗
[Cervical-mediastinal emphysema of abdominal origin].
Cervical mediastinic emphysema usually does not demand emergency procedures: nevertheless its ethiology must be promptly assessed though his achievement may prove less than easy owing the vague clinical presentation and to the limits imposed by regional topography. Among the possible etiologic factors one should take into account the rare abdominal source too. Indeed the cervical region is connected to the retroperitoneal space through a virtual "visceral space" via the thoracic cavity and some diaphragmatic break-throughs variable in size. The communication allows, in some pathologic conditions, the unopposed circulation of air and fluids. Our interest in the topic is due to the occurrence of a cervical mediastinic emphysema in a patient suffering from a colonic perforation.
Adult↗
[Mediastinal emphysema after thoracotomy (author's transl)].
A mediastinal emphysema was seen via x-ray film in 35 of 40 patients after opening of the mediastinum by longitudinal sternotomy. After about a week it was found in approximately every second patient; after 14 days it had been fully absorbed by all patients. Mediastinal emphysema could occur in conjunction with a cutaneous emphysema, and pneumothorax, respectively. Occasionally a pneumopericardium is seen even in the recumbent patient. Safe diagnosis of mediastinal emphysema is possible in the anterior lower mediastinum projected on to the cardiac silhouette if the x-ray film is taken obliquely.
Humans↗
[Six patients in whom exacerbation of asthma was complicated by mediastinal emphysema].
We encountered 6 patients with bronchial asthma complicated by mediastinal emphysema. Their average age was 21 years. All were atopic and had histories of asthma in childhood. In 5 of the 6, mediastinal emphysema developed when the patients had upper respiratory infections. In 3, the mediastinal emphysema worsened. After insertion of subcutaneous drains to decrease intramediastinal pressure, the conditions of those 3 patients improved remarkably. The conditions of the other 3 improved after medication only. During the period of this study, 1.24% of all patients treated at Hiroshima Asa Citizen's Hospital for exacerbations of asthma had mediastinal emphysema.
Adolescent↗
[Recent acquisitions in the radiology of mediastinal emphysema].
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Emphysema↗
Comparative study of mediastinal emphysema as determined by etiology.
OBJECTIVE: To evaluate the difference in the clinical features of mediastinal emphysema as classified into three groups based on etiology; patients in whom it was spontaneous with unknown etiology (A group), those in whom it was secondary to bronchial asthma (B group), and those in whom it was secondary with other respiratory diseases (C group). PATIENTS: Forty-three cases (45 episodes) with mediastinal emphysema treated at Kawasaki Medical School Kawasaki Hospital between April 1985 and March 2000 (A group: 17 cases, B group: 17 cases, C group: 9 cases). RESULTS: The average ages of the A and B groups were of little significance. Most of the patients in the A group were males with a thin body. Three patients in the A group had episodes of pneumothorax or mediastinal emphysema in their past history. Five patients in the A group had Hamman's sign on physical examination. In all of the patients in the C group, mediastinal emphysema was accompanied by subcutaneous emphysema, whereas only eight patients in the A group had subcutaneous emphysema. The prognosis was good for A and B groups because the mediastinal emphysema disappeared within 10 days, but was poor in the C group because its disappearance was very late compared with that in the other two groups and skin incision was required in three patients in the C group due to severe subcutaneous emphysema. CONCLUSIONS We suggest that the existance and kind of underlying diseases significantly affect the method of treatment and the prognosis.
Adult↗