Pneumomediastinum, pneumorrhachis and subcutaneous emphysema associated with viral infections: Report of three cases

Emiralioğlu, Nagehan; Özcan, Hatice Nursun; Oğuz, Berna; Yalçın, Ebru; Özçeli̇k, Uğur; Ki̇per, Nural

doi:10.1111/ped.12785

Cited by 19 publications

(18 citation statements)

References 10 publications

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“…Interstitial air can then dissect into the mediastinum, pleural cavity and subcutaneous tissues. Similar pathological progressions have been previously observed in a variety of viral pneumonias [ 32 , 33 ]. Impaired oxygenation as a result of alveolar rupture and PIE, whether on a macroscopic or microscopic level, may also play a role in the profound hypoxia common with COVID-19 lung disease through impairment of ventilation and pulmonary blood flow.…”

Section: Discussionsupporting

confidence: 86%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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Purpose We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.

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Section: Discussionsupporting

confidence: 86%

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

et al. 2020

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“…There are very few reports of association of pneumomediastinum and pneumorrhachis with no thoracic injury in the published literature. 3 Our patient had no risk factors, but we determined air extending from cervical to lumbar spinal canal by computed tomography. Besides pneumomediastinum and pneumorrhachis, extensive air was detected in the skull base, the orbita, abdomen, retroperitoneum, scrotum and femoral head.…”

Section: Discussionmentioning

confidence: 90%

“…Subcutaneous emphysema, pneumothorax and pneumomediastinum generally occur in consequence of esophageal or bronchial ruptures due to trauma, iatrogenic factors, infections, coughing and severe vomiting. [1][2][3] Pneumorrhachis is characterized by the presence of ectopic air in the spinal canal. It can be observed in the cases of trauma, epidural anesthesia, epidural abscess, lumbar puncture and pneumomediastinum.…”

Section: Introductionmentioning

confidence: 99%

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A Surprising Outcome of a Patient with Psychosis: Progressive Emphysema Associated with Pneumorrhachis

Polat¹,

Akça²,

Tuygun³

et al. 2019

cayd

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Air can be detected in various anatomical regions during the course of several diseases. This accumulation of air is often seen as pneumothorax and subcutaneous emphysema. Rarely extraordinary regions such as skull base and spinal region can be involved. In the majority of the patients, it is caused by trauma, iatrogenic factors and Valsalva maneuver. Supportive treatment is generally sufficient. A 14-year-old boy with psychosis who developed extensive air in the scull base, the neck, the orbita, mediastinum, abdomen, retroperitoneum, spinal canal, scrotum and head of the femur was presented. In the course of psychiatric disorders, in the case of excessive shouting and self-harm as a result of squeezing the throat, beside subcutaneous emphysema, air existing in the various anatomical regions of the body should be kept in mind.

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“…The findings are clinically significant because most previous reports involved young adults. We reviewed the relevant literature regarding cases involving children aged <15 years and retrieved 25 articles reporting 32 cases [3], [4], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]. In total, 22 boys and 10 girls aged between 1 and 15 years (mean age: 9 years) were identified.…”

Section: Discussionmentioning

confidence: 99%

Pneumorrhachis in children: A report of two cases and review of the literature

Yaginuma

Watanabe

Saitō

et al. 2019

Radiology Case Reports

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Pneumorrhachis refers to the clinical presentation of air within the spinal canal, and it is rarely associated with pneumomediastinum, particularly in young children. Pneumorrhachis associated with pneumomediastinum is generally asymptomatic. Here we report 2 unusual cases involving very young children with pneumorrhachis secondary to pneumomediastinum and present a review of the relevant literature. Case 1 involved a 4-year-old girl who presented with wheezing, violent coughing, and dyspnea associated with bronchiolitis. Case 2 involved a 3-year-old boy who presented with wheezing, violent coughing, and dyspnea associated with interstitial pneumonia possibly caused by graft-versus-host disease with human herpesvirus 6 infection after allogeneic hematopoietic stem cell transplantation. In both cases, pneumorrhachis improved with oxygen inhalation therapy and treatment of the underlying disease. Pneumorrhachis is rarely associated with neurological problems; however, decompressive laminectomy may be indicated to relieve the air block. Because pneumorrhachis is rare in children and neurological sequelae may be difficult to identify, close clinical, and radiographic observations are necessary. Plain radiography is not sufficient, and computed tomography should be performed to rule out intraspinal air.

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Pneumomediastinum, pneumorrhachis and subcutaneous emphysema associated with viral infections: Report of three cases

Cited by 19 publications

References 10 publications

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

Spontaneous subcutaneous emphysema and pneumomediastinum in non-intubated patients with COVID-19

A Surprising Outcome of a Patient with Psychosis: Progressive Emphysema Associated with Pneumorrhachis

Pneumorrhachis in children: A report of two cases and review of the literature

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