scholarly journals Spontaneous Pneumomediastinum: A Possible Severe Condition in SARS-CoV-2 Pneumonia

2021 ◽  
Vol 10 (01) ◽  
pp. e55-e58
Author(s):  
Geoffrey Jacqmin ◽  
Manuel Pirotte ◽  
Carlo Caravaggio ◽  
Philippe Devaux
Keyword(s):  
Mechanical Ventilation ◽  
Severe Acute Respiratory Syndrome ◽  
Rare Condition ◽  
Case Description ◽  
Severe Condition ◽  
Potential Predictor ◽  
Spontaneous Pneumomediastinum ◽  
Free Air

Abstract Background Spontaneous pneumomediastinum (SP) is the presence of free air into extra-alveolar tissues within the mediastinum, without notion of trauma. This rare condition may occur as a complication of an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Higher rates of mechanical ventilation are reported in coronavirus disease 2019 (COVID-19) patients with pneumomediastinum. Case Description We report two cases of COVID-19 infected patients suffering from mild and severe SP and their outcome. Discussion The objective of this report is to review the literature about this condition. We discuss about the pathological pathways underlying this complication and how it reflects the severity of COVID-19 pneumonia. Conclusion Currently, it remains unclear if SP in SARS-CoV-2 pneumonia is a potential predictor of disease worsening, for it does not seem to be related with a higher rate of mortality.

scholarly journals Spontaneous Pneumomediastinum from Running Sprints

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Joseph W. Turban
Keyword(s):  
Physical Activity ◽  
Lung Cancer ◽  
Asthma Exacerbation ◽  
Rare Condition ◽  
Intrathoracic Pressure ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum ◽  
Free Air ◽  
Life Threatening ◽  
Intense Physical Activity

Spontaneous pneumomediastinum (SPM) is a fairly rare condition, caused by increased intrathoracic pressure, leading to free air in the mediastinal structures. Underlying lung conditions are associated with increased incidence of SPM, including asthma, interstitial lung disease, pneumonia, bullous lung, and radiation therapy for lung cancer. It is often preceded by Valsalva maneuvers, vomiting, coughing, asthma exacerbation, sneezing, childbirth, or intense physical activity. A case of SPM is presented in a 15-year-old male, who complained of throat pain and dyspnea while running sprints at football practice. Workup revealed SPM, and he was subsequently admitted and treated conservatively. His symptoms resolved in 2 days and he was discharged and suffered no further recurrences. In contrast to secondary pneumomediastinum, SPM is usually a benign condition although life-threatening conditions can rarely arise. Differentiating between these two conditions has important prognostic indications. There is a paucity of prospectively collected data regarding SPM, and considerable variation in recommendations concerning the extent of workup.

scholarly journals Pediatric inflammatory multisystem syndrome associated with COVID-19: A report of 10 cases in a Peruvian hospital

Medwave ◽  
2021 ◽  
Vol 21 (02) ◽  
pp. e8142-e8142
Author(s):  
Consuelo Luna-Muñoz ◽  
Giuliana Reyes-Florian ◽  
Martin Seminario-Aliaga ◽  
Angie Stapleton-Herbozo ◽  
Lucy E. Correa-López ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Latin America ◽  
Severe Acute Respiratory Syndrome ◽  
Antibiotic Therapy ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Rare Condition ◽  
Immunoglobulin M ◽  
Serological Tests ◽  
Control And Prevention

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 is a potentially severe and rare condition that still needs a better understanding to guide its management. Reports worldwide, and especially in Latin America, are still scarce. This report presents ten cases of pediatric inflammatory multisystem syndrome temporally associated with COVID-19 in children between 2 and 12 years old treated in a Peruvian hospital, diagnosed using the Centers for Disease Control and Prevention criteria. Severe acute respiratory syndrome coronavirus 2 was detected through serological tests (immunoglobulin M or G). Most had gastrointestinal symptoms. Therapeutics consisted mainly of intravenous immunoglobulin, corticosteroids, ivermectin, hydroxychloroquine, digoxin, and antibiotic therapy. Three patients underwent mechanical ventilation; no mortality occurred in this case series. In conclusion, the manifestations presented here are similar to those reported in the literature. A timely diagnosis is necessary for proper management.

scholarly journals An Unusual Case of Spontaneous Pneumomediastinum

2020 ◽  
Vol 9 (1) ◽  
pp. 61-63
Author(s):  
Bidesh Bista ◽  
Ram Hari Ghimire ◽  
Deevya Raj Mishra
Keyword(s):  
Interstitial Lung Disease ◽  
Drug Users ◽  
Unusual Case ◽  
Illicit Drug ◽  
Rare Condition ◽  
Intrathoracic Pressure ◽  
Sudden Increase ◽  
Spontaneous Pneumomediastinum ◽  
Free Air ◽  
Precipitating Factor

Spontaneous pneumomediastinum is rare condition with free air in the mediastinum. There are some controversies to consider spontaneous pneumomediastinum in patients with predisposing factors like asthma, interstitial lung disease, illicit drug users and irritant inhalations. It generally occurs due to sudden increase in intrathoracic pressure causing rupture of alveoli and movement of air to the mediastinum. Here we present a case of a 20 years old male patient with few bouts of cough as precipitating factor and development of spontaneous pneumomediastinum and subcutaneous emphysema.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

2021 ◽  
Vol 10 (7) ◽  
pp. 1346
Author(s):  
Talida Georgiana Cut ◽  
Cristina Tudoran ◽  
Voichita Elena Lazureanu ◽  
Adelina Raluca Marinescu ◽  
Raluca Dumache ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Diffuse Alveolar Damage ◽  
Demographic Data ◽  
Pathophysiological Mechanism ◽  
Spontaneous Pneumomediastinum ◽  
Intensive Care Stay ◽  
Laboratory Investigations ◽  
Male Patients ◽  
Pulmonary Pathology

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

scholarly journals Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takeshi Ueda ◽  
Tetsuya Tanaka ◽  
Takashi Yokoyama ◽  
Tomomi Sadamitsu ◽  
Suzuka Harada ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Abdominal Cavity ◽  
Vital Signs ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Case Presentation ◽  
Free Air ◽  
Spontaneous Pneumoperitoneum ◽  
Upper Abdominal ◽  
Emergent Laparotomy

Abstract Background Pneumoperitoneum commonly occurs as a result of a viscus perforation and usually presents with peritoneal signs requiring emergent laparotomy. Spontaneous pneumoperitoneum is a rare condition characterized by intraperitoneal gas with no clear etiology. Case presentation We herein report a case in which conservative treatment was achieved for an 83-year-old male patient with spontaneous pneumoperitoneum that probably occurred due to duodenal diverticulosis. He had stable vital signs and slight epigastric discomfort without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy showed duodenal diverticulosis but no perforation of the upper gastrointestinal tract. He was diagnosed with spontaneous pneumoperitoneum, and conservative treatment was selected. His medical course was uneventful, and pneumoperitoneum disappeared after 6 months. Conclusion In the management of spontaneous pneumoperitoneum, recognition of this rare condition and an accurate diagnosis based on symptoms and clinical imaging might contribute to reducing the performance of unnecessary laparotomy. However, in uncertain cases with peritoneal signs, spontaneous pneumoperitoneum is difficult to differentiate from free air resulting from gastrointestinal perforation and emergency exploratory laparotomy should be considered for these patients.

scholarly journals Spontaneous pneumomediastinum COVID-19: Impact of mechanical ventilation

2021 ◽  
Vol 10 ◽  
pp. 1
Author(s):  
Rita Oze Koudouhonon ◽  
Suzanne Rita Aubin Igombe ◽  
Biziman Wilson ◽  
Hounayda Rita Aubin Igombe ◽  
Rachida Latib ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Pneumomediastinum

scholarly journals An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre

2015 ◽  
Vol 7 (2) ◽  
pp. 93-96 ◽  
Author(s):  
CB Pratibha ◽  
Deepthi Satish ◽  
Suraj Gopal
Keyword(s):  
Foreign Body ◽  
Subcutaneous Emphysema ◽  
Rare Condition ◽  
Interesting Case ◽  
Valsalva Manoeuvre ◽  
Laryngeal Edema ◽  
Airway Compromise ◽  
Air Leak ◽  
Spontaneous Pneumomediastinum ◽  
Laryngeal Involvement

ABSTRACT Aim To discuss a case of spontaneous pneumomediastinum with pneumothorax with subcutaneous emphysema presenting with stridor due to laryngeal edema with relevant review of literature. Background Spontaneous pneumomediastinum is a rare condition that has been described in healthy individuals following Valsalva manoeuvre, excessive and prolonged cough or emesis. Laryngeal involvement in these cases has not been reported so far. Case description We present an interesting case of spontaneous pneumomediastinum with pneumothorax with pneumopericardium and cervicofacial emphysema with suspected ingestion of foreign body. In view of stridor due to laryngeal edema tracheostomy was done. No obvious cause for the air leak was found on further investigations. The foreign body sensation could have led to oral provocative manoeuvres by the patient causing increased intra-alveolar pressures and air leak. Conclusion Spontaneous pneumomediastinum with cervicofacial emphysema with pneumopericardium with laryngeal involvement is very rare. Tracheostomy is essential in case of airway compromise. A thorough evaluation for the underlying condition is essential to prevent further air leak. Clinical significance In a case of spontaneous pneumomediastinum with airway compromise due to involvement of the larynx, tracheostomy is essential to secure the airway and could also help in resolution of emphysema. How to cite this article Pratibha CB, Satish D, Gopal S, Balasubramanya AM. An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre. Int J Otorhinolaryngol Clin 2015;7(2):93-96.

scholarly journals Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome

2004 ◽  
Vol 23 (6) ◽  
pp. 802-804 ◽  
Author(s):  
C.M. Chu ◽  
Y.Y. Leung ◽  
J.Y.H. Hui ◽  
I.F.N. Hung ◽  
V.L. Chan ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Spontaneous Pneumomediastinum

scholarly journals SUN-693 What Else Should Be Done in Patients with Uncontrolled Type 2 Diabetes and Severe Insulin Allergy?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ghada Elshimy ◽  
Ricardo Rafael Correa ◽  
Pawarid Techathaveewat ◽  
Karyne Lima Vinales ◽  
Sherman Mitchell Harman
Keyword(s):  
Type 2 Diabetes ◽  
Allergic Reaction ◽  
Insulin Pump ◽  
Case Reports ◽  
Skin Testing ◽  
Rare Condition ◽  
Inpatient Setting ◽  
Severe Condition ◽  
Insulin Allergy

Abstract Introduction: Insulin allergy in patients with diabetes mellitus is a very rare condition. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We present a case of a patient that was unable to tolerate the insulin desensitization process, however; he was successfully treated with antidiabetics’ medications following the AACE guidelines for the management of type 2 diabetes (T2DM).Case description:31 years old obese Caucasian male with a BMI of 35, a history of T2DM and insulin allergy who was admitted to the hospital with hyperglycemia and osteomyelitis of the right foot. Endocrinology was consulted for the management of diabetes. Laboratory results showed hemoglobin A1C 11.1%, C peptide level 2.79 with blood glucose 283 mg/dl with negative insulin specific IgG level and elevated Ig E levels. The patient was actually diagnosed with T2DM in 2001, then started on metformin, glyburide initially. Given uncontrolled diabetes he was started on insulin in 2007 however, he developed an allergic reaction to different types of insulin (including anaphylactic reaction) so he was referred to allergy and immunology for further testing and possible desensitization. He had an allergy to human, bovine and porcine insulin. Exclusion of other causes of allergy including latex, protamine, and zinc was performed by the immunologist. Trial of insulin desensitization (using NPH and regular Insulin) failed. He also developed an allergic reaction to different medications including sulfonylurea, SGLT2 inhibitors, DDP4 inhibitors, and alpha-glucosidase inhibitors. During the inpatient setting in 2019, we assessed the patient and considered different options available; bromocriptine versus amylin products versus fish insulin versus IGF1 (as of last resort). Other options were another desensitization process in the ICU setting with transitioning to an insulin pump, however, the patient refused that option. We started the patient on bromocriptine mesylate(cyclocet) with pioglitazone and the A1C improved in the next 3 months from 11.1%-->9.8%. The patient is still following up with us and plans for desensitization once the osteomyelitis of the foot is controlled. Discussion and conclusion: Insulin allergy is a rare but severe condition that calls for immediate work-up. It can be managed well in close cooperation between the endocrinologist and the immunologist. Our patient developed IgE-mediated symptoms occurring immediately after insulin injection and confirmed by intradermal skin testing. Specific immunotherapy has been reported in case reports in the literature and should be considered for these patients Following AACE guidelines for the management of T2DM with the addition of bromocriptine mesylate until desensitization was a beneficial option for our patient.

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