Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review

Abstract

Background:Spontaneous pneumomediastinum (SPM) is an uncommon disorder. It is rarely reported in paediatric patients and may be accompanied by subcutaneous emphysema. It is usually benign and self-limiting, with only supportive therapy being needed, but severe cases may require invasive measures. Asthma exacerbations have classically been described as a cause of SPM. However, detailed descriptions in asthmatic children are scarce. We aimed at improving the current understanding of the features of SPM and subcutaneous emphysema, and outcomes, by means of a case report and a systematic review.Methods:For the systematic review a literature search was performed in PubMed to identify reported cases of SPM in asthmatic children.Results:The case a 10-year-old asthmatic girl with SPM is reported. The patient received an inhaled corticosteroid and long-acting beta2 agonist, in addition to sublingual immunotherapy (SLIT) with eventual control of asthma symptoms. Review: A total of 114 published cases were found since 1995, most of them in teenagers; no sex differences were observed. Clinical presentation was associated with an asthma exacerbation in a number of cases. Other presenting features were chest pain, dyspnoea, cough, and particularly acute swelling of the face, neck, and upper chest. Subcutaneous emphysema was present in most patients. Overall, three cases of pneumothorax and two cases of pneumorrhachis were reported. Therapy was mainly based on supportive care, rest, oxygen therapy, analgesics, steroids, and bronchodilators. All patients recovered spontaneously, in spite of a small initial increase in SPM in a few cases.Conclusions:Early identification of patients at risk of SPM would avoid the high number of under-diagnosed cases. Patients should be treated not only with supportive therapy but also with measures to achieve control of the underlying cause (such as poorly controlled asthma).

Pneumomediastinum and pneumopericardium in an adolescent with asthma attacks. Case report

“…(6) Two incidence peaks have been reported in the pediatric population: in children under seven years of age, probably secondary to lower respiratory tract infections, and in adolescents, due to asthma attacks and upper respiratory tract infections. (7) The increase in intrathoracic pressure is the main predisposing factor: the rupture of the alveoli, secondary to a difference in pressure gradients between the alveoli and the mediastinum, moves the air from the place with the highest pressure gradient (intra-alveolar space) to the mediastinal structures with the lowest pressure gradient. (8) The dissection to release the free air is not only limited to the mediastinum, as this communicates with the mandibular space, the retropharyngeal space and the vascular beds within the neck.…”

Spontaneous pneumomediastinum and subcutaneous emphysema in a child with unknown aetiology

“…Spontaneous pneumomediastinum in H1N1 infection4 describes a case presenting with spontaneous pneumomediastinum after an H1N1 infection. Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review5 describes a 10-year-old girl with asthma presenting with subcutaneous emphysema and spontaneous pneumomediastinum and literature review of various cases across the world. Spontaneous pneumomediastinum in the paediatric patient6: a total of 129 patients were included.…”

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

“…If tension pneumothorax develops, the outcome will be fatal. 9,10 Our patient was mechanically ventilated in pediatric intensive care unit for five days. At the end of first week, there was a significant improvement in general condition of patient.…”