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

Abstract

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.

Pneumorrhachis: An uncommon radiological entity

“… 3 Yaginuma et al presented two cases of PR associated with pneumomediastinum in young patients. 2 Their literature search of children less than 15 years documented 25 articles reporting 32 cases, in which PR associated with pneumomediastinum occurred in all cases. 2 …”

“… 1 It is rarely associated with pneumomediastinum, particularly in young children. 2 The common causes listed include epidural trauma from spinal fracture, epidural instrumentation for lumbar puncture, epidural anaesthesia or ‘spontaneous pneumomediastinum’. 1 Case reports have described PR in the setting of direct trauma to the spine or skull and within the context of pneumomediastinum, pneumopericadium and pneumoperitoneum.…”

Rare Case of Spontaneous Pneumorrhachis in a Young Male with COVID-19

“…The internal type needs more attention, as it is associated with major spinal trauma. 1 3 In the direct route of intraspinal entry, air may entrap due to a one-way air valve mechanism, and dissects indirectly between the paraspinal soft tissues into the epidural space of the spinal canal via the neural foramina and along the vascular and nerve root sheaths, thereby producing PR.…”

“…PR associated with spontaneous pneumomediastinum is generally asymptomatic. 3 Tsuji et al report instances of occurrence of PR associated with asthma and violent coughing. 4 The route of entry into the spinal canal is through the neural foramen from the posterior mediastinum due to the absence of a barrier between the posterior mediastinum and epidural space.…”

Long non-coding RNA NKILA weakens TNF-α-induced inflammation of MRC-5 cells by miR-21 up-regulation

“…Pneumonia is a common respiratory disease in paediatrics [1]. Bacteria, viruses and mycoplasma are common pathogens that cause infantile pneumonia (IP) [2].…”