Spontaneous pneumomediastinum, pneumopericardium and epidural pneumatosis: insights on clinical management

Allen, Casey J.; Teisch, Laura F.; Ståhl, Kenneth

doi:10.3109/17482941.2015.1005103

Cited by 11 publications

(14 citation statements)

References 26 publications

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“…Este puede ser primario o secundario, si hay o no una causa clara desencadenante [2,4,6,7,9,10]. La incidencia del síndrome de Hamman ha sido reportada en una de cada 44.000 visitas al servicio de urgencias [11,12], con una relación hombre mujer 8:1 que incluso puede llegar hasta 14:3 [7,12,13].…”

Section: Discussionunclassified

“…En la literatura sobre el tema se han descrito factores desencadenantes comunes para la presentación de un neumomediastino espontáneo, como las maniobras de Valsalva, crisis asmáticas (21 %), episodios eméticos (36 %), tos (7 %), esfuerzo al realizar la deposición, durante la realización de pruebas de función pulmonar y la inhalación de sustancias de abuso como cocaína o consumo de anfetaminas [2,7,11,17,18].…”

Section: Discussionunclassified

“…Una vez el aire alcanza el mediastino, se puede desplazar a lo largo de los planos tisulares alcanzando el cuello, la cara, el abdomen e, incluso, las extremidades [2,4,11]. Cuando el aire se acumula en el espacio pericárdico parietal anterior y recubre la pared torácica, produce el clásico signo de Hamman.…”

Section: Fisiopatologíaunclassified

“…El neumomediastino se define como la presencia de aire libre en el mediastino [1], que puede ser dividida en dos grupos: el primero, el neumomediastino con una causa clara desencadenante como producto de traumatismos, infecciones intratorácicas por bacterias productoras de gas o ruptura esofágica secundaria a episodios eméticos o exploraciones endoscópicas (neumomediastino secundario) [2,3]. El segundo, neumomediastino espontáneo o síndrome de Hamman, en el cual no existe una causa obvia por la que se ocasione la presencia de aire intersticial en el mediastino, no existe una relación con patologías traumáticas, cirugías u otros procedimientos médicos, ni antecedente de ventilación mecánica asociada (neumomediastino primario) [2,3,4,5,6,7,8]. El diagnóstico se basa en la sospecha clínica, dado que su presentación puede orientar hacia otros diagnósticos más comunes relacionados con patologías cardiopulmonares o digestivas.…”

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Neumomediastino espontáneo: revisión de tema

Duarte

Arenas

2017

UNIV.MED.

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a RESUMENEl neumomediastino espontáneo se define como la presencia de aire en el mediastino sin que tenga relación con patología traumática, procedimientos quirúrgicos o ventilación mecánica. Se considera una patología benigna y de rara presentación con una sintomatología que puede orientar a otros diagnósticos relacionados con patologías cardiovasculares, digestivas o respiratorias. Con una baja incidencia, la literatura reporta la presencia de un caso por cada 14.000 consultas al servicio de urgencias. Es más frecuente en adultos jóvenes, de sexo masculino, que manifiestan dolor torácico y disnea con otros hallazgos físicos relacionados que hacen sospechar el diagnóstico como la evidencia de enfisema subcutáneo. El artículo presenta una revisión de tema sobre neumomediastino espontáneo, patología poco frecuente, pero de importancia clínica en el diagnóstico diferencial del dolor torácico. Palabras clave neumomediastino espontáneo; mediastino.ABSTRACT Spontaneous pneumomediastinum is defined as the presence of air in the mediastinum that's not directly related to a traumatic pathology, surgical procedures or mechanical ventilation. It is considered a benign pathology which rarely occurs with symptoms that can lead to other diagnosis related to cardiovascular, gastrointestinal or respiratory pathologies. It also has a low incidence according to literature, with reports of only one case for every 14,000 patients that visit emergency care services, having a higher incidence on young male adults that manifest thoracic pain and dyspnea, with additional related physical findings similar to a subcutaneous emphysema. This is a revision concerning spontaneous pneumomediastinum, a low incidence pathology with a clinical importance in the differential diagnosis of thoracic pain.

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Neumomediastino espontáneo: revisión de tema

Duarte

Arenas

2017

UNIV.MED.

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“…In the MEDLINE, we found patients with tracheobronchial rupture and PM secondary to smoking free-base cocaine [12], but no cases concerning the relationship between tracheobronchial laceration and sexual activity. We found only one case report describing concomitant air in the epidural space, mediastinum and pericardium after illicit drug use and engagement in sexual activity [13], and one case report with concomitant PM and sexual intercourse [14]. The presenting symptoms and signs evidenced in our patient, such as retrosternal chest pain increasing with breath and thorax movements, bilateral tenderness on acupressure of sternum-chondral joints, subcutaneous emphysema involving the neck and shortness of breath with normal vital signs, are typical of PM [15].…”

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Pneumomediastinum in a smoking free-base cocaine abuser during sexual intercourse

Gioia¹

2017

Radiol Diagn Imaging

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Case: 21-year-old man.Chief complaint: Retrosternal chest pain.Clinical history: There were no pathologies in family history. He did not take any medications. He was smoking 10 cigarettes daily. He was a habitual cocaine user. The patient had a blood pressure of 120/80 mmHg, a resting heart rate of 73 beats/minute, a respiratory rate of 16 breaths/minute, an oxygen saturation of 98%, and no temperature. The main symptom was an initial sharp retrosternal chest pain starting 5 hours before in the course of free-base cocaine smoking. Dyspnea and retrosternal pain were increasing with breath and chest movements. The pain was intensifying 2 hours earlier during sexual intercourse with a female partner. Then, the retrosternal pain was constant as regards intensity and localization. Subcutaneous emphysema of the neck was palpable on physical examination. Inspiratory effort and elicited rib pain was evident on chest examination. Cardiopulmonary auscultation and electrocardiography were normal.Laboratory findings: Blood tests were normal; urine drug analysis was positive for cocaine. Image findingsChest X-ray (CXR) revealed clear lung fields, pneumomediastinum (PM) and emphysema in the soft tissues between the muscles of the neck ( Figure 1a). Pulmonary computed tomography (CT) without contrast showed pneumomediastinum (PM), i.e. air dissecting tissue planes extending in the soft tissues of the neck, including the muscles, the nerves, the right rear second back rib and the ipsilateral front first and second anterior rib, all the mediastinal recesses (also anterior) and the bilateral peribronchial and paraesophageal spaces until the diaphragmatic hiatus. CT also showed a solution of continuity of the right postero-lateral portion of the trachea with adjacent minimum hypo-dense material (Figures 2a, 3a, 4a). In emergency department, the application of human fibrin glue by means of bronchoscopy was used to seal the tracheal lesion. CXR showed complete resolution of the PM and subcutaneous emphysema after 12 days (Figure 1b). Chest CT without contrast also revealed complete resolution at 15 days ( Figures 2b, 3b, 4b). DiscussionPM was consequent to tracheal rupture due to Valsalva maneuver during both smoking free-base cocaine use and sexual activity. PM consequent to barotrauma is a possible finding in patients with cocaineinduced pulmonary disease [1]. Barotrauma is a complication related to cocaine inhalation [2] or crack smoking [3]. It is the consequence of an increased airway and intrathoracic pressure due to intentional production of Valsalva maneuvers and episodes of coughing after smoking, in an attempt to absorb the maximal amount of drug. The rupture of alveoli into the interstitium and the mediastinum frequently produces PM after over-distension against a closed glottis. Our case report is particular as regards the etiology of PM, i.e. tracheobronchial tree laceration consequent to Valsalva maneuvers and tracheobronchial wall fragility due to the direct toxicity of the cocaine on the lung tissue after repeated i...

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