Fascial relationship of the thymus: Radiologic-pathologic correlation in neonatal pneumomediastinum

Quattromani, Frank; Foley, Latombya; Bowen, AʼDelbert; Weisman, Leonard; Hernández, J. Gordillo

doi:10.2214/ajr.137.6.1209

Cited by 20 publications

(9 citation statements)

References 1 publication

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“…The reported incidence of pneumomedia stinum is 425 per 10,000 live births. 15 has reported multiloculated multiseptated pneumomediastinum that is similar to our case. They ex plained the reason of tendency to loculate and multiple in ternal septa as follows.…”

Section: Discussionsupporting

confidence: 89%

“…The air dissects within the interlobular and con nective tissue septa of the thymic capsule, giving rise to a multiseptated cystic appearance. 15 One study has suggested that a surgical approach of pneu momediastinum is necessary in case of progressive cardiopulmonary distress and failure of supportive treat ments. 16 However, pneumomediastinum is generally self limited.…”

Section: Discussionmentioning

confidence: 99%

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Multiseptated Cystic Pneumomediastinum in a Term Newborn: Cystic and Bubbly Lesion on Chest X-ray

Kang

Seo

2016

Perinatology

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In general, pneumomediastinum occurs in newborns with underlying lung problems, particularly when a ventilator is needed. Spontaneous pneumomediastinum without preceding assisted ven tilation, and presenting as a huge cystic mass in a term newborn infant has rarely been reported. This case baby was delivered vaginally at term and developed respiratory distress after birth. The finding of artery blood gas analysis shows severe respiratory acidosis. Initial chest Xrays obtained on admission revealed the presence of a large quantity of air in the mediastinum and pneumo thorax. On the third day of admission, the baby showed no respiratory symptoms and signs. How ever, the cystic and bubbly lesion on the mediastinum remained in chest Xrays. A chest com puted tomography (CT) was performed to determine the origin of the cystic lesion. The CT revealed multiseptated cystic pneumomediastinum on the anterior mediastinum and over the anterior region of both lungs. We report a term neonate with spontaneous multiseptated cystic pneumomediastinum suspected as congenital mediastinal cystic mass.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Multiseptated Cystic Pneumomediastinum in a Term Newborn: Cystic and Bubbly Lesion on Chest X-ray

Kang

Seo

2016

Perinatology

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“…The mediastinum is limited by a fascial band which conceals the thymus and merges with fibrous pericardium. The air dissects within the interlobular and connective tissue septa of the thymic capsule, giving rise to a multiseptated cystic appearance (1,5). The histopathological description of a cystic pneumomediastinum describes fibrovascular and fibrofatty connective tissue lacking in epithelium, similar to our case (2).…”

Section: Diagnosis: Multiseptated Cystic Pneumomediastinumsupporting

confidence: 73%

“…The location within the mediastinum was suggestive of pneumomediastinum. Quattromani et al and Hyun et al reported similar cases of multiloculated multiseptated pneumomediastinum (1,5). The mediastinum is limited by a fascial band which conceals the thymus and merges with fibrous pericardium.…”

Section: Diagnosis: Multiseptated Cystic Pneumomediastinummentioning

confidence: 95%

Lucent thoracic lesion in a newborn with respiratory distress

Mah

Azman

Shah

2019

Paediatrics &Amp; Child Health

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CASEA full-term baby girl weighing 3 kg was born to a 34-year-old mother via caesarean section. There was no significant antenatal history. Her APGAR scores were 8 at the first minute and 10 at the fifth minute.At 15 minutes after birth, she showed signs of respiratory distress. Bubble continuous positive airway pressure was commenced. Despite high ventilation settings, she remained in respiratory distress and was intubated. A chest radiograph revealed a large, lucent, bubbly lesion occupying the anterosuperior mediastinum (Figure 1).The child was transferred to a tertiary referral centre at 29 hours of life. Clinically, she had a hyperinflated chest and was tachypnoeic. She was pink and normotensive. The lungs were normal on auscultation.A computed tomography (CT) scan revealed a multiseptated, air-filled, cystic structure in the anterosuperior mediastinum, involving and causing mass effect to the thymus, the rest of the mediastinal structures as well as the lungs (Figure 2). Her oxygen saturation remained poor. An echocardiogram showed mild pulmonary arterial hypertension.Intraoperatively, there was a large lobulated cystic structure in the anterior mediastinum, surrounding the thymic tissue, predominantly in the left hemithorax. A total of 40 mL of air was aspirated and 80% of the thymic gland was resected. The histopathology report revealed benign thymic tissue with loose collagenous capsule and areas of cauterized tissue lacking an epithelial lining.Postoperatively, the child recovered well. Subsequent chest radiographs and thorax CT showed no recurrence of the lesion (Figure 3).

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“…[3] In literature few cases presented with multiloculatedmultiseptated pneumomediastinum resulting in a distinctive "bubbly" appearance on chest radiographs as seen in our patient. [4,5] This "bubbly" appearance can be explained by findings of Quattromani et al [6] Authors observed that thymic fascia was also continuous with the fascia of the great vessels, trachea, fibrous pericardium, and pulmonary vessels at hilum. [6] When air dissects within fascia, the "bubbly" appearance occur.…”

Section: Discussionmentioning

confidence: 88%

Mass Effect of Pulmonary Sequestration: Multiloculated–Multiseptated Pneumomediastinum

Ünal¹,

Türkyılmaz²,

Derinkuyu³

et al. 2016

J Neonatal Surg

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Pulmonary sequestration (PS) and pneumomediastinum are two rare clinical diseases. Pneumomediastinum was generally observed in infants either with diseased lungs or who were performed assisted ventilation or resuscitation following birth. It was reported in patients with existing ectopic thoracic kidney and laryngeal cysts however, no coexisting congenital lung anomalies were reported. Here, we report the pneumomediastinum occurred due the extralobar PS because of the mass effect of the lesion.

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Fascial relationship of the thymus: Radiologic-pathologic correlation in neonatal pneumomediastinum

Cited by 20 publications

References 1 publication

Multiseptated Cystic Pneumomediastinum in a Term Newborn: Cystic and Bubbly Lesion on Chest X-ray

Multiseptated Cystic Pneumomediastinum in a Term Newborn: Cystic and Bubbly Lesion on Chest X-ray

Lucent thoracic lesion in a newborn with respiratory distress

Mass Effect of Pulmonary Sequestration: Multiloculated–Multiseptated Pneumomediastinum

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