Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Abstract

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication

“…The etiology in the younger population is thought to be air leak due to elevated intrathoracic pressure during forceful Valsalva maneuver (coughing, emesis, straining) [7]. Spontaneous pneumomediastinum in children is typically managed conservatively [7,8]. Our patient, with her associated pneumopericardium, bilateral severe pneumothoraces requiring thoracotomy tubes, and cervical subcutaneous emphysema makes this case particularly unusual.…”

“…There have been rare cases of traumatic or spontaneous pneumomediastinum reported in the pediatric population [7,8]. There is a bimodal incidence with peaks at less than age 4 years and over age 15 years.…”

“…There is a bimodal incidence with peaks at less than age 4 years and over age 15 years. The etiology in the younger population is thought to be air leak due to elevated intrathoracic pressure during forceful Valsalva maneuver (coughing, emesis, straining) [7]. Spontaneous pneumomediastinum in children is typically managed conservatively [7,8].…”

Pneumopericardium as a consequence of air embolism

“…Pneumopericardium is defined as a collection of air or gas in the pericardial cavity and was described by Bricheteau in 1844 [1]. Although a relatively rare condition, cases have been reported in the literature [1,2].…”

“…Although a relatively rare condition, cases have been reported in the literature [1,2]. Pneumopericardium has been reported to result from blunt and penetrating chest trauma, as a complication of invasive iatrogenic procedures, from abnormal pathological communications such as fistulas from the pericardium to the adjacent structures containing air from different causes, from barotrauma, and from pericardial infections [3,4].…”