IntroductionWe present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube.Case presentationA 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with no motor deficits. On his spinal CT a fracture on multiple ribs leading to right sided hemothorax was observed with air in the T6-T8 spinal canal. A chest tube was placed and as he did not have any neurological deficits surgical intervention to the pneumorrhachis was not considered. On the next day's a follow-up CT the air in the spinal canal was reduced and on the 5th day resolved completely.ConclusionTraumatic pneumorrhachis is a rare phenomenon and is not fully understood how the air from the posterior mediastinal wall can spread to the epidural or subarachnoid space. One hypothesis for subarachnoid air is that the high pressure air from a pneumothorax or pneumomediastinum pushes in a one-valve mechanism through the fascial layers of the posterior mediastinum through the neural foramina into the spinal canal. In our case, after the insertion of the chest tube the air in the subarachnoid space resolved and the patient's tingling sensation on his legs disappeared. We believe that the negative pressure of the chest tube did a somehow reverse effect of the air flow back from the spinal canal into the chest tube which has not been reported in the literature before.
Background Glioblastomas are the most common and highly malignant primary brain tumors in adults with a median survival of 15 months even with appropriate treatment. Extracranial metastases are extremely rare due to the poor prognosis not allowing sufficient time to spread. We report an extremely rare case of extracranial metastasis of supra-tentorial glioblastoma involving the skin, subcutaneous and muscular layers, periauricular region and parotid gland, and review the literature. A total of 13 glioblastoma parotid gland metastases cases have been hitherto described. Main body of the abstract A 42-year-old man underwent surgery for right temporal glioblastoma and received 60 Gy/30 fractions radiotherapy together with temozolomide at 75 mg/m2. Seven months later, the tumor relapsed and the patient underwent a second surgery while chemotherapy continued. Fifteen months later, he complained of swelling in the right neck region. Fine needle aspiration and tru-cut biopsy revealed a high-grade malignant tumor infiltration within the parotid gland. Despite salvage chemotherapy and adjuvant radiotherapy, in his follow-up after 6 months neck swelling increased. The patient declined any treatment modality and continues his life 39 months after the primary diagnosis of intracranial glioblastoma. Short conclusion Due to the recurrence rate of intracranial glioblastoma and its malignant nature; close imaging follow-up is highly crucial. The increase in reported cases of its extracranial metastases is generally due to the modern diagnostic tools and prolonged survival attributed to the improvement in treatment modalities where now radical surgery with adjuvant radiotherapy and chemotherapy is standard protocol. Patients with glioblastomas presenting with swelling in the cervical region should be investigated to rule out parotid gland metastasis.
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