Pneumomediastinum and pneumorrhachis: a lot of air about nothing?

Abstract

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.

Traumatic air myelogram

“…There is no fascia between the posterior mediastinal space and the dural space; therefore, air generated by pneumothorax or pneumomediastinum can enter the nerve roots through the neural foramen due to pressure as a result of the macklin effect. 4 Another possible pathway for pneumorachis is the embolization of air into the mediastinum veins and vertebral vein plexus from the air entrapped in the mediastinum. 3 Another mechanism is the migration of air within the subcutaneous emphysema and a pleural hernia into the spinal canal.…”

Adult Male with Neck Pain

“… 1 , 2 Conditions that produce elevated intrathoracic pressure, such as coughing, sneezing or vomiting, can lead to the entrapment of air in the paraspinal soft tissues and epidural space via the neural foramina. 3 The majority of cases appear to involve young males. 1 , 4 The association between pneumorrhachis and subcutaneous emphysema due to barotrauma is well described.…”