Rapid disappearance of pneumorrhachis after chest tube placement

Abstract

IntroductionWe present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube.Case presentationA 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with no motor deficits. On his spinal CT a fracture on multiple ribs leading to right sided hemothorax was observed with air in the T6-T8 spinal canal. A chest tube was placed and as he did not have any neurological deficits surgical intervention to the pneumorrhachis was not considered. On the next day's a follow-up CT the air in the spinal canal was reduced and on the 5th day resolved completely.ConclusionTraumatic pneumorrhachis is a rare phenomenon and is not fully understood how the air from the posterior mediastinal wall can spread to the epidural or subarachnoid space. One hypothesis for subarachnoid air is that the high pressure air from a pneumothorax or pneumomediastinum pushes in a one-valve mechanism through the fascial layers of the posterior mediastinum through the neural foramina into the spinal canal. In our case, after the insertion of the chest tube the air in the subarachnoid space resolved and the patient's tingling sensation on his legs disappeared. We believe that the negative pressure of the chest tube did a somehow reverse effect of the air flow back from the spinal canal into the chest tube which has not been reported in the literature before.

Pneumorrhachis and pneumocephalus resulting from pneumothorax: illustrative case

“…1,10 Management of pneumorrhachis is mostly conservative with bed rest and treatment of any underlying cause. 1,10,17 Meningitis should also be suspected as a complication of PR. However, as shown by the systematic review conducted by Osunronbi et al, 1 there is not enough evidence supporting prophylactic antibiotic treatment as a means of preventing meningitis.…”

Traumatic epidural pneumorrhachis: a case report

“…Three cases have been reported with complete resolution of PRS on follow-up CT scan after 4 to 14 days. [5][6][7] The PRS is usually asymptomatic and an accidental finding on CT images while evaluating other severe or life-threatening torso injuries. Although CT is the gold standard for diagnosis, it is difficult to differentiate epidural and subarachnoid PRS.…”

“…1 In subarachnoid PRS, timely consultation with a neurosurgeon for decompression of nerve root injuries, tension pneumocephalus and exploratory surgery by a chest surgeon to detect severe thoracic trauma is vital. Impressively, Avci et al 5 reported a case of complete resolution of subarachnoid PRS on the fifth day of admission with recovery of neurological deficit after chest tube insertion. They concluded that the negative pressure of the chest drain to withdraw the air supported the hypothesis of a one-way valve mechanism in which high pressure air travels through fascial layers but is unable to return.…”