Analysis of gas in vacuum lumbar disc

Ford, Lee T.; Gilula, Louis A.; Murphy, William A.; Gado, Mokhtar H.

doi:10.2214/ajr.128.6.1056

Cited by 148 publications

(89 citation statements)

References 9 publications

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“…The presence of air into the joints, named as "vacuum phenomenon" is defined as a radiolucent collection representing gas that appears at sites of negative pressure [2]; the gas comes out of solution because of the reduced pressure. This phenomenon can be a normal finding on radiographs of various joints.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Gas not Related to Infection

Barquiel¹

2017

J Musculoskelet Disord Treat

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The presence of gas in joints or soft tissues is usually indicative of infectious pathology or degenerative diseases [1]. However, the presence of gas inside the medullary canal in the diaphysis of long bones is an uncommon condition, and it is often associated with fractures or previous surgeries.We present the case of a 29-year-old man who suffered an open supraintercondylar femur fracture, treated with debridement, surgical scrub with saline solution, and stabilization by external fixator, and in a second stage with a definitive osteosynthesis, which after being washed with pressure gun presented abundant intramedullary gas non-related to infectious pathology but possibly related to a pulsatile jet lavage during surgery. CASE REPORTture; 2: articular simple, metaphyseal multifragmentary) supraintercondylar fracture of the right femur with Gustilo-Anderson type IIIA ( Figure 1A), and an AO34-C1 (3: femur; 4: patella; C: complete articular; 1: transverse) non-displaced fracture of the right patella. Extensive wound cleaning was immediately performed at the emergency department, with manual irrigation using saline solution, as well as debridement of the most superficial contaminant material and temporary approximation of the wound edges. According to our hospital open fracture protocol, intravenous antibiotherapy was initiated with cefuroxime 1 g every 8 hours for 3 days and gentamicine 240 mg every 24 h for 3 days.He was taken to the operation room where we conducted first an antegrade intramedullary nailing of the left femur with a Synthes Expert femoral nail, using a traction table. Secondly, on the right femur, we performed a resection of the wound edges according to Friederich, a debridement of the contaminating deep tissue and the fracture focus, manual wound cleaning with saline irrigation, and temporary fixation of the supracondylar fracture with an external fixator (Hoffman II, Synthes). Given the fact that the patella fracture was non-displaced, there were no more surgical procedures.Subsequently, a CT scan of the right knee was performed in order to complete the preoperative studies so we could make a good surgical planning ( Figure 1B), which did not show any intraosseous air bubbles. After CaseThe patient is a 29-year-old man with no history of interest, who was taken to our hospital on November 2015 approximately one hour after suffering a high energy traffic accident. He was a motorbike rider hit by a car riding at high speed. He was received at the emergency department where advanced life support measures were applied. After the stabilization of the patient, the body-CT showed contusive focus in both pulmonary bases, discarding other internal emerging lesions.In the radiological series, we identified an AO32-B2 (3: femur; 2: diaphyseal; B: with a wedge fragment; 2: bending wedge) fracture of the left femur, an open AO33-C2 (3: femur; 3: distal; C: complete articular frac-

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Section: Discussionmentioning

confidence: 99%

Intramedullary Gas not Related to Infection

Barquiel¹

2017

J Musculoskelet Disord Treat

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“…It is usually found incidentally on CT or magnetic resonance imaging [11][12][13][14]. The differential diagnosis of intraspinal air is wide and can be due to degeneration, inflammation, malignancy and infection [15].…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum and pneumorrhachis: a lot of air about nothing?

Aujayeb

Worthy

2012

Breathe

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A never-smoking 22-year-old male with no past medical history presented to the emergency department with sudden onset of sharp central chest pain and right-sided neck discomfort. There was no history of trauma or bronchitis. There was no history of air travel, allergen exposure or illicit drug use. He had consumed alcohol the night before presentation but had not vomited.Clinically, he had right-sided subcutaneous emphysema but no signs of pneumothorax. His pulse was 82 beats per min, blood pressure was 134/76 mmHg and oxygen saturation was 98% on air. His blood tests revealed no abnormality. His blood alcohol level was not measured.HERMES syllabus link: module B.13.3 Task 1Interpret the chest radiograph ( fig. 1) Statement of interestNone declared.

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“…Of the clinical scenarios, the most common is probably due to rupture of the vacuum disc. The presence of gas within an intervertebral disc is common and occurs in 2.0-3.2% of the standard population but may be seen in up to 20.8% in elderly populations [9]. Presence of gas within an intervertebral disc can expand or contract based on position of the patient and, rarely, can lead to pressure on neural elements [3,10,11].…”

Section: Discussionmentioning

confidence: 99%

Extracranial epidural emphysema: pathway, aetiology, diagnosis and management

Cloran¹,

Bui-Mansfield²

2011

BJR

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ABSTRACT. Extracranial epidural emphysema is an uncommon phenomenon that refers to the presence of gas within the epidural space. As an isolated finding, it is typically benign, but it can be a secondary sign of more ominous disease processes, such as pneumothorax, pneumoperitoneum and epidural abscess. Although the phenomenon has been cited in case reports, a comprehensive review of this topic is lacking in the radiology literature. The authors' aim is to report our experience with extracranial epidural emphysema, illustrating the spectrum of its clinical presentation. We also review the aetiology, pathophysiology, diagnosis and management of extracranial epidural emphysema. Pneumorrhachis (also known as aerorachia) is a term that has been used to describe air within the spinal canal. It can be separated into two distinct entities, epidural and intradural. In general, the presence of intradural intraspinal air has been associated with significant morbidity, while the presence of epidural air is typically more benign [1]. Epidural air within the spinal canal is best descriptively termed extracranial epidural emphysema and has been described sporadically in case reports. The purpose of this pictorial review is to present a diversity of clinical scenarios that can give rise to extracranial epidural emphysema and to discuss its pathophysiology, diagnosis and management. Methods and materialsA comprehensive literature search was conducted on the MEDLINE database using PubMed. Keywords including pneumorrhachis, pneumosaccus, aerorachia, intraspinal pneumocele, pneumomyelogram, epidural emphysema and epidural pneumatosis were used in the literature search. In addition to a review of the literature, four cases of extracranial epidural emphysema collected at our institution are also reported. They illustrate the common pathways of extracranial epidural emphysema.All the clinical records were reviewed for demographic data, symptoms and duration of symptoms. The study did not require approval from the institution's Investigation Review Board. However, the Brooke Army Medical Center Department of Clinical Investigation reviewed and approved the manuscript for publication. Results Case 1A 59-year-old male complained of left flank pain. He had a non-contrast CT of the abdomen and pelvis that showed a left ureterovesical junction stone. The examination also revealed severe degenerative disc disease at L4-5 and L5-S1 disc spaces with vacuum disc phenomenon and extracranial epidural emphysema behind the L5 vertebral body (Figure 1a,b). Case 2A 20-year-old male presented with diabetic ketoacidosis and crepitus in the neck and upper chest. He had palpable crepitus over his jaw and a friction rub on cardiac examination. A CT scan of the chest showed severe pneumomediastinum tracking from the mediastinum into the soft tissues of the neck, anterior and posterior chest wall with pneumopericardium and extracranial epidural emphysema (Figure 2a,b). Case 3A 49-year-old male with Crohn's disease presented with abdominal pain and distensi...

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Analysis of gas in vacuum lumbar disc

Cited by 148 publications

References 9 publications

Intramedullary Gas not Related to Infection

Intramedullary Gas not Related to Infection

Pneumomediastinum and pneumorrhachis: a lot of air about nothing?

Extracranial epidural emphysema: pathway, aetiology, diagnosis and management

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