Concurrent Spontaneous Pneumomediastinum and Pneumorrhachis

Heckman, Alexander; Mohseni, Michael; Villanueva, Armando; Cowart, Jennifer B.; Graham, Charles R.

doi:10.1016/j.jemermed.2018.02.036

Cited by 9 publications

(8 citation statements)

References 11 publications

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“… 88 Serial neurological examinations are recommended, while serial imaging for pneumorachis is not required unless there is a concern for cord compression. 89 The development of neurological symptoms warrants surgical decompression; otherwise, the management is conservative. 4 Treatment of the inciting etiology, such as bronchodilators and oxygen supplementation for asthma exacerbation, abscess drainage, chest tube for pneumothorax, etc.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumorachis – A Case-Based Review

Venkataramanan¹,

George²,

Sahu³

2021

JAA

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Pneumorachis is characterized by the presence of free air in the spinal canal. It is referred by different names in literature such as epidural emphysema, intraspinal air, intraspinal pneumoc(o)ele, spinal epidural and subarachnoid pneumatosis, spinal and epidural emphysema, aerorachia, pneumosaccus, air myelogram, etc. Pneumorachis can be broadly classified as traumatic, iatrogenic, or spontaneous. In this case-based review, we present a case of spontaneous pneumorachis secondary to asthma exacerbation. This is followed by a systematic review of all cases of spontaneous pneumorachis identified in PubMed. The aim of this review is to understand the pathophysiology, common causes and the management of spontaneous pneumorachis.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumorachis – A Case-Based Review

Venkataramanan¹,

George²,

Sahu³

2021

JAA

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“…[3,6,11,13] Rarely, PNR can be a complication of spontaneous pneumomediastinum due to repeated, sustained Valsalva maneuver resulting in barotrauma. [6,13] In addition, there exists two cases in the literature in which the patients had none of the aforementioned underlying risk factors; the cause for each was determined to be erosion in the annulus fibrosis with vacuum disc phenomenon. [5,8] Notably, in PNR, while air is most commonly located in the posterior spinal canal because of decreased resistance compared to the anterior epidural space which houses a denser vascular network, this patient demonstrated air in the anterior portion of the canal, proximal to the disc space.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] e natural course of spontaneous PNR is spontaneous reabsorption through the bloodstream. [6] High-concentration oxygen therapy can speed up this process. Follow-up imaging is not indicated.…”

Section: Discussionmentioning

confidence: 99%

Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Houston

Musch

Tayag

2021

Surgical Neurology International

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Background: Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam. Case Description: Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3. Conclusion: Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.

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“…Increases in intra-alveolar pressure and alveolar rupture can lead to movement of air into the perivascular interstitium, leading to pneumomediastinum and air tracking in the retropharyngeal space. Continued air dissection from the retropharyngeal space through the neural foramina can subsequently lead to pneumorrhachis [3,4]. In many cases, pneumorrhachis is a self-limiting condition and…”

Section: Discussionmentioning

confidence: 99%

“…a conservative treatment approach is appropriate in patients that are stable from a neurological and cardiopulmonary standpoint [3]. Nevertheless, given the volatile nature of this clinical entity, prompt recognition, urgent evaluation by a specialist, close monitoring and appropriate management can lead to improved patient outcomes.…”

Section: Disclosure Statementmentioning

confidence: 99%

Epidural pneumorrhachis in COVID-19: a rare clinical entity

Rao

Lakra

Chittal

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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Pneumorrhachis is an extremely rare clinical entity, involving air entrapment within the spinal canal. We present a unique case of epidural pneumorrhachis accompanying pneumomediastinum and pneumopericardium, in the setting of COVID-19 infection in a 62-year-old woman. Diagnostic testing was remarkable for elevated inflammatory markers, along with mild transaminitis and hyponatremia. CT scan of the chest revealed extensive patchy groundglass opacities, with no evidence of pulmonary embolism. Intravenous antibiotics and steroids were initiated for management of advanced multifocal bilateral COVID-19 pneumonia. Her hospital course was complicated by rapidly worsening hypoxia accompanied by worsening inflammatory markers. Repeat chest CT showed worsening multifocal opacities, extensive pneumomediastinum, pneumopericardium, and subcutaneous emphysema extending into the lower neck soft tissues, posterior mediastinum, and supraclavicular regions. Neck CT confirmed diffuse subcutaneous emphysema from the mediastinum extending into the retropharyngeal space, neck, and anterior chest wall. Right-sided epidural air in the spinal canal spanning C6-T1 was also noted. She was evaluated by neurosurgery, continued on antibiotics for the epidural air, and transferred to the ICU for frequent monitoring of respiratory and neurological status, which remained stable. Although pneumorrhachis is an extremely rare clinical manifestation, prompt recognition can lead to appropriate early interventions and improved patient outcomes.

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Concurrent Spontaneous Pneumomediastinum and Pneumorrhachis

Cited by 9 publications

References 11 publications

Spontaneous Pneumorachis – A Case-Based Review

Spontaneous Pneumorachis – A Case-Based Review

Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Epidural pneumorrhachis in COVID-19: a rare clinical entity

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