Mediastinal and Subcutaneous Emphysema in Labor

Rt, Brandfass; Dm, Martinez

doi:10.1097/00007611-197612000-00011

Cited by 15 publications

(7 citation statements)

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“…It occurs in situations where there is a sudden increase in intraalveolar pressure such as severe coughing, straining and vomiting and has been associated with acute asthma (Kirsh & Orvald, 1970), violent exercise (Morgan & Henderson, 1981), diabetic ketoacidosis (Girard et al, 1971), marihuana smoking (Miller & Spiekerman, 1972) and childbirth (Bradfass & Martinez, 1976). We report a patient who developed a spontaneous pneumomediastinum in association with anorexia nervosa.…”

Section: Introductionmentioning

confidence: 92%

Spontaneous pneumomediastinum: a complication of anorexia nervosa?

Fergusson

Shaw

Turnbull

1985

Postgraduate Medical Journal

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Section: Introductionmentioning

confidence: 92%

Spontaneous pneumomediastinum: a complication of anorexia nervosa?

Fergusson

Shaw

Turnbull

1985

Postgraduate Medical Journal

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“…The condition is usually self-limiting and recovery generally takes place in 3–14 days. 11 Only four cases of maternal deaths are reported, all before 1908. 3 The patient should be reassured about the good prognosis and spontaneous resolution.…”

Section: Discussionmentioning

confidence: 99%

Postpartum spontaneous pneumomediastinum and subcutaneous emphysema: Hamman's syndrome

Kuruba

Hla

2011

Obstet Med

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Summary: This is a case report of a spontaneous pneumomediastinum and surgical emphysema in a 32-year-old woman presenting a few hours after forceps vaginal delivery with symptoms of chest tightness, shortness of breath and swelling in the neck, which resolved with conservative management. It is a rare but potentially dangerous complication of labour, which can be accurately diagnosed with clinical features and chest X-ray. The treatment is conservative as it is usually self-limiting and recurrence in subsequent pregnancies is extremely rare.Keywords: high-risk pregnancy, thoracic medicine, pneumomediastinum CASE REPORTA 32-year-old fit and well Caucasian woman with an uneventful pregnancy presented in spontaneous labour at 40 weeks. This was her second pregnancy and the previous was a miscarriage at eight weeks. She was a non-smoker and her body mass index was 23. The progress in the first stage was good and lasted 10 hours. She had an epidural for analgesia and after one hour of passive descent started pushing. The baby weighing 4.2 kg was delivered by forceps due to failure to progress after 1 and a 1/2 hours of pushing.Twelve hours after delivery, she reported swelling in the neck, chest tightness and shortness of breath. Her vital signs were stable and oxygen saturation on air was 98%. On examination, there was subcutaneous crepitus in the neck and chest. Chest auscultation revealed bilateral decreased air entry. Chest X-ray was performed which showed pneumomediastinum and minimal pneumothorax (Figure 1). She was reviewed by the medical team and a diagnosis of Hamman's syndrome was made. She was managed conservatively and the symptoms slowly settled over the next two days. Subcutaneous emphysema continued to resolve and repeat chest X-ray after 72 hours revealed resolving pneumomediastinum. She was discharged home with no other postpartum problems. The six-week postnatal check showed complete resolution of subcutaneous emphysema.

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“…The escape of air into mediastinal tissues referred to as pneumomediastinum is a serious condition most commonly attributed to ruptured pulmonary blebs. Although Macklin first reported it as caused by increased intra‐alveolar pressure due to screaming, coughing, defecation, or emesis (1), it has also been associated with DKA (4,5), marijuana use (6), and childbirth (7). Zegal and Miller described self‐induced vomiting which may lead to esophageal rupture and a particularly dangerous form of pneumomediastinum, since mediastinitis is associated.…”

Section: Discussionmentioning

confidence: 99%

Ehlers–Danlos Syndrome and Anorexia Nervosa: A Dangerous Combination?

Miles¹,

Robinson

M.D.

2007

Pediatric Dermatology

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A 16-year-old boy with anorexia nervosa and Ehlers–Danlos syndrome presented with spontaneous pneumomediastinum and bradycardia.Although prior occurrences of pneumomediastinum and visceral perforations have been reported in adolescents with isolated anorexia nervosa or Ehlers–Danlos syndrome, to our knowledge this is the first instance to be noted in a patient with both conditions.We explore several possibilities regarding the etiology of his mediastinal air, but ultimately conclude that it was the existence of Ehlers–Danlos syndrome in the presence of anorexia nervosa that led to the development of this dangerous condition.

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Mediastinal and Subcutaneous Emphysema in Labor

Cited by 15 publications

References 0 publications

Spontaneous pneumomediastinum: a complication of anorexia nervosa?

Spontaneous pneumomediastinum: a complication of anorexia nervosa?

Postpartum spontaneous pneumomediastinum and subcutaneous emphysema: Hamman's syndrome

Ehlers–Danlos Syndrome and Anorexia Nervosa: A Dangerous Combination?

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