Spontaneous Pneumomediastinum from Running Sprints

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.

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An Unusual Case of Spontaneous Pneumomediastinum

Journal of Nobel Medical College ◽

10.3126/jonmc.v9i1.29544 ◽

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.

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Spontaneous pneumomediastinum – a rare cause of chest pain and dyspnoe in children

Journal of Medical Science ◽

10.20883/medical.e570 ◽

2021 ◽

pp. e570

Author(s):

Marcin Mikoś ◽

Katarzyna Jończyk-Potoczna ◽

Paulina Sobkowiak ◽

Anna Bręborowicz ◽

Edyta Nagła ◽

...

Keyword(s):

Chest Pain ◽

Respiratory Insufficiency ◽

Genetic Material ◽

Severe Pneumonia ◽

Rare Condition ◽

Bronchial Tree ◽

Human Bocavirus ◽

Esophageal Rupture ◽

Benign Condition ◽

Spontaneous Pneumomediastinum

Introduction. Spontaneous pneumomediastinum is a very rare condition in children. Nevertheless it should be considered in the differential diagnosis in patients who present with chest pain and dyspnoe.Aim. The aim of our study was to describe clinical presentation, management and outcomes of the paediatric patients with spontaneous pneumomediastinumMaterial and Methods. This was a retrospective analysis of the charts of all the patients who were admitted to the Department of Pneumonology, Paediatric Allergy and Clinical Immunology in a ten year period from 01.01.2011 till 31.12.2020 in whom spontaneous pneumomediastinum was diagnosed.Results. There were 11 children (7 females) with spontaneous pneumomediastinum. The median age of the children was 11 years (range 3 to 17.5 years). Most of the children presented to the hospital with chest pain, three children complained of the neck swelling and four children developed dyspnoe. Three children with the primary spontaneous pneumomediastinum had a history of physical exercise prior to the onset of symptoms. The secondary spontaneous pneumomediastinum occurred in two children with asthma and 4 children with pneumonia. Genetic material of human Bocavirus was identified in 3 cases. In 81.8% of children pneumomediastinum was accompanied by subcutaneous emphysema and in one case, in a child with severe pneumonia and respiratory insufficiency caused by Bocavirus with pneumorrhachis. In 10 children computed tomography was performed, bronchoscopy in 4 and esophagoscopy in two children. There was no evidence of esophageal rupture or bronchial tree rupture in any of our patients. Three children with pneumonia and pneumomediastinum developed respiratory insufficiency, two of these were treated with mechanical ventilation and one with High Flow Nasal Cannula oxygen therapy. All the children received oxygen. In one child surgical procedure was performed and the drain was inserted into mediastinal space in order to decompress it. Outcome was favourable in all children. Mean time to recovery was 10.6 ± 1.2 days. There was no recurrence of symptoms in any of our patients.Conclusions. Spontaneous pneumomediastinum in most cases is a benign condition, sporadically however it may progress rapidly, leading to respiratory insufficiency and warrant invasive management.

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Hamman’s Syndrome: A Rare Cause of Chest Pain in a Postpartum Patient

Case Reports in Pulmonology ◽

10.1155/2015/201051 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Daniyeh Khurram ◽

Brijesh Patel ◽

M. Waseem Farra

Keyword(s):

Subcutaneous Emphysema ◽

Valsalva Maneuver ◽

Diagnostic Technique ◽

Rare Condition ◽

Benign Condition ◽

X Ray ◽

Life Threatening ◽

Subcutaneous Tissues ◽

Chest X Ray ◽

Tissue Diffusion

Hamman’s syndrome is a rare condition represented by spontaneous pneumomediastinum and subcutaneous emphysema. Excessive Valsalva maneuver during vaginal delivery and excessive retching, coughing, and straining are frequently reported causes. The incidence of Hamman’s syndrome is believed to be 1 in 100,000 deliveries. The pathophysiology of this condition is rupture of alveoli and seepage of air through bronchovascular connective tissue. Diffusion of air to subcutaneous tissues results in subcutaneous emphysema. In most cases, it is a benign condition and resolves spontaneously. In life-threatening cases, a cardiac tamponade can ensue. Chest X-ray is a useful early diagnostic technique. We report a case of a twenty-four-year-old female who was diagnosed with Hamman’s syndrome after prolonged, exhaustive labor.

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Hemophagocytic syndrome triggered by intense physical activity and viral infection in a young adult female with three heterozygous mutations in Munc-18-2

Vojnosanitetski pregled ◽

10.2298/vsp150701224m ◽

2017 ◽

Vol 74 (5) ◽

pp. 494-497

Author(s):

Olivera Markovic ◽

Dragana Janic ◽

Milorad Pavlovic ◽

Ljiljana Tukic ◽

Srdja Jankovic ◽

...

Keyword(s):

Physical Activity ◽

Viral Infection ◽

Protein Function ◽

Hemophagocytic Lymphohistiocytosis ◽

Diagnostic Procedures ◽

Acceptor Side ◽

Complete Clinical Remission ◽

Life Threatening ◽

Strenuous Physical Activity ◽

Intense Physical Activity

Introduction. Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially life-threatening, hyperinflammatory syndrome caused by severe hypercytokinemia due to a highly stimulated, but ineffective immune response. Case report. We reported a 19-year-old woman presenting with fever, muscle and joint pain and sore throat. After diagnostic procedures we made the diagnosis of hemophagocytic lymphohistiocytosis (7 of 8 HLH-2004 diagnostic criteria) caused by Ebstein-Barr viral infection and trigerred by the intense physical activity. Genetic analysis showed three different sequence changes in Munc-18-2, two splice acceptor side mutations/changes affecting exon 10 (c.795?4 C > T) and exon 15 (c.1247?10 C > T) and a missense mutation c.1375 C > T; p.Arg 459 Trp. All mutations were in heterozygous state and their significance in pathogensis of HLH is not clear. After treatment with corticosteroids and cyclosporin A complete clinical remission was achieved. Conclusion. The presented case history suggests the possibility that mutations of undetermined clinical significance in a gene associated with primary HLH may underlie some cases of secondary HLH, probably by causing a partial, rather than total or subtotal, impairment of encoded protein function. Our case also suggests that strenuous physical activity (in apparent synergy with viral infection) can trigger HLH.

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Pulmonary Hyalinizing Granuloma Mimicking Primary Lung Cancer: An Unusual Case Involving a Pulmonary Tumor

Case Reports in Pulmonology ◽

10.1155/2020/3268608 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Hideki Marushima ◽

Hiroki Sakai ◽

Reimi Yoneyama ◽

Hiroyuki Kimura ◽

Tomoyuki Miyazawa ◽

...

Keyword(s):

Lung Cancer ◽

Unusual Case ◽

Solitary Pulmonary Nodule ◽

Tumor Resection ◽

Primary Lung Cancer ◽

Rare Condition ◽

Histopathological Analysis ◽

Radiographic Findings ◽

Benign Condition ◽

Uncommon Location

Pulmonary hyalinizing granuloma is a very rare benign condition. This study describes a case involving pulmonary hyalinizing granuloma in a 76-year-old man who presented with a solitary pulmonary nodule, determined through chest radiography and computed tomography, that mimicked primary lung cancer. To establish a definitive diagnosis, tumor resection was performed with histopathological analysis indicating pulmonary hyalinizing granuloma. Radiographic findings in previously reported cases showed that most patients had well-defined margins and usually bilateral, multiple lesions. In our case; however, the solitary ill-defined tumor mimicking lung cancer is an uncommon location for this rare condition.

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Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Case Reports in Emergency Medicine ◽

10.1155/2014/275490 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ozlem Bilir ◽

Ozcan Yavasi ◽

Gokhan Ersunan ◽

Kamil Kayayurt ◽

Baris Giakoup

Keyword(s):

Chest Wall ◽

Subcutaneous Emphysema ◽

Specific Treatment ◽

Pediatric Intensive Care ◽

Anterior Chest Wall ◽

Benign Condition ◽

Spontaneous Pneumomediastinum ◽

Life Threatening ◽

Lateral Chest ◽

Physical Findings

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

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

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0041-1735478 ◽

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.

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Spontaneous Pneumomediastinum with a Rare Presentation

Case Reports in Emergency Medicine ◽

10.1155/2014/451407 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Ehsan Bolvardi ◽

Elham Pishbin ◽

Mohsen Ebrahimi ◽

Azadeh Mahmoudi Gharaee ◽

Farhad Bagherian

Keyword(s):

Subcutaneous Emphysema ◽

Vital Signs ◽

Physical Exertion ◽

Rare Presentation ◽

Benign Condition ◽

Spontaneous Pneumomediastinum ◽

Free Air ◽

Close Observation ◽

Chest Examination ◽

History Of

Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia.

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