Spontaneous epidural emphysema and pneumomediastinum

Dosios, T.; Fytas, Anastasia; Zarifis, G.

doi:10.1016/s1010-7940(00)00454-1

Cited by 14 publications

(9 citation statements)

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“…Free air surrounding the dura mater spinalis is an uncommon phenomenon that was primarily reported by Gordon et al [ 30 ] in 1977 and described under various terms such as intraspinal pneumocele [ 28 , 38 , 50 ] or pneumocoele [ 78 ], spinal epidural and subarachnoid pneumatosis [ 4 – 6 , 9 , 18 , 19 , 32 – 34 , 41 , 47 , 61 , 74 ], spinal and epidural emphysema [ 4 , 11 , 23 , 27 , 28 , 33 , 59 , 65 , 69 , 70 , 72 , 77 ], aerorachia [ 18 , 22 , 28 , 34 ], pneumosaccus [ 9 , 28 , 62 ], air myelogram [ 2 , 30 , 76 ], pneumomyelogram [ 2 , 3 , 12 , 17 , 20 , 28 , 30 , 76 ] or pneumomyelography [ 26 ]. The term PR itself was first coined 10 years later by Newbold and co-workers [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen cases are found in the literature describing PR caused by violent coughing due to bronchial asthma or acute bronchitis [ 11 , 14 , 23 , 24 , 40 , 55 , 56 , 58 , 59 , 70 , 72 ], single cases of PR after cardiopulmonary resuscitation [ 58 ], airway obstruction due to foreign body aspiration [ 69 ] and two cases each of PR after physical exertion [ 19 , 77 ] and inhalational drug abuse of 3,4-methylenedioxymethamphetamine (“Ecstasy”) [ 6 ] or marijuana [ 34 ]. Furthermore, three cases of PR because of prolonged and forceful emesis with diabetic ketoacidosis were documented [ 5 , 47 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

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Pathogenesis, diagnosis and management of pneumorrhachis

et al. 2006

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Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pathogenesis, diagnosis and management of pneumorrhachis

et al. 2006

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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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“…Air has also been noted in the epidural space secondary to degenerative disc disease and epidural abscess. Pneumorrhachis can also be complicated by marijuana smoking [5], mechanical artificial ventilation and chest tube placement [6], it can be spontaneous [7,8] or can also develop after strenuous exercise [9]. Finally pneumorrhachis can develop secondary to a subarachnoid pleural fistula [10].…”

Section: Discussionmentioning

confidence: 99%

“…Thus any cause of pneumomediastinum may also result in pneumorrhachis [4,8] as in asthma, a complication of intubation or ventilation, retching or coughing and even vigorous exercise [9] Pathogenesis of Pneumorrhachis Macintosh and Mushin [12] demonstrated that the epidural space is not a closed cavity but is continuous with the paravertebral space via the intervertebral foramina. On inspiration the thoracic walls expand and the resultant negative pressure within the cage is transmitted via the paravertebral space to the epidural space.…”

Section: Discussionmentioning

confidence: 99%