Retropharyngeal emphysema: An unusual aetiology—A case report and literature review

Abstract

Introduction: Retropharyngeal emphysema is a potentially life threatening condition which may require urgent diagnosis and intervention. It has been documented to occur following trauma to the aerodigestive tract and is usually accompanied by subcutaneous emphysema of the cervical region. This condition may be complicated by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is quite common in little children and in this environment; a cultural practice is for mothers or other caregivers to attempt to remove these foreign bodies by forcing their finger(s) down the oropharynx and Hypopharynx of these young children. This usually results in injuries to these anatomical sites. Retropharyngeal emphysema complicating this practice is rarely reported. Case presentation: We present the case of a 4-year-old Nigerian boy who presented with stridor and severe dyspnoea following repeated attempts at removal of a purportedly ingested foreign body by his mother. Examination revealed oedema of the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal walls. Oxygen therapy was commenced and preparations for urgent upper airway intervention made. Soft tissue neck X-ray revealed retropharyngeal and subcutaneous emphysema with upper airway compromise. Conservative treatment with high dose steroids and antibiotics led to a gradual resolution of the condition. Conclusion: This is a rarely reported complication of this relatively common socio-cultural "foreign body removal method". Public awareness is required to stop this potentially life threatening practice.

Spontaneous cervical emphysema: a challenge in establishing a plausible etiology

“…Cervical emphysema is usually seen in association with penetrating trauma, infections from gas forming organisms, or cases in which a breach in the integrity of the upper aerodigestive tract has occurred [1,2]. In cases where these are not clinically evident, the term spontaneous cervical emphysema is used.…”

“…Other causes include pulmonary conditions such as bronchiolitis, pneumonia and asthma or rupture of pulmonary bulla [1,3,4]. Surgically induced spontaneous emphysema has also been reported in cases of tooth extraction and gastrointestinal surgery in which the primary operated site is not within the cervical region [2,5]. Dekel et al reported that the primary complaints of subcutaneous emphysema were neck swelling which may be associated with pain and also obstructive symptoms depending on the extent of the disease as in this case [5].…”

“…This is then confirmed with imaging either plain radiograph of the cervical region or as in our case with a computer tomography scan. Management of such cases will depend greatly on the underlying disease process and degree of airway compromise [2,5]. This however usually involves surgical release of the emphysema and the advice against acts that may increase intrathoracic pressure including straining and coughing postoperatively so as to prevent recurrence.…”

“…It may occur as a complication of surgery within the anatomical regions of the neck, a breach to the integrity of the upper aero digestive tract, infection with a gas-forming organism or from direct externa trauma [1]. Spontaneous cervical emphysema occurs in the absence of previous disorders or initiating factors and often poses a challenge in establishing an etiology at presentation [2] . We report a 23-year-old lady who presented with extensive subcutaneous emphysema in which a clear etiology was not evident during the initial presentation.…”

Retropharyngeal air column: a rare complication of tracheostomy

“…The presentation may vary depending on the cause of RAC, amount or site where most air accumulates. As the air dissects through various fascial planes, the patient may present with severe sore throat, odynophagia, dysphagia, dysphonia, dyspnoea, generalised neck pain, and neck swelling (13,15) . The onset can be from hours up to days (14) .…”