scholarly journals A case of spontaneous pneumomediastinum in a patient with severe SARS-CoV-2 and a review of the literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Duong T Hua ◽  
Farah Shah ◽  
Cherlyn Perez-Corral
Keyword(s):  
Subcutaneous Emphysema ◽  
Lung Diseases ◽  
Illicit Drugs ◽  
Positive Pressure Ventilation ◽  
Rare Complication ◽  
Positive Pressure ◽  
Chest Imaging ◽  
Shortness Of Breath ◽  
Spontaneous Pneumomediastinum ◽  
Hypoxic Respiratory Failure

Spontaneous pneumomediastinum is defined as having an etiology that is not related to surgery, trauma, or mechanical ventilation. Precipitating causes of spontaneous pneumomediastinum include coughing, exercise, vomiting, infection, underlying lung diseases such as asthma, and illicit drugs. Symptoms include chest pain, shortness of breath, and dysphagia. A 54-year-old man presented with 2 weeks of shortness of breath, cough, and fever. He was admitted for severe SARS-CoV-2 pneumonia and acute hypoxic respiratory failure requiring non-rebreather mask. Chest imaging on admission showed bilateral peripheral consolidations and pneumomediastinum with subcutaneous emphysema. No precipitating event was identified. He did not require initiation of positive pressure ventilation throughout his admission. On hospital day 7, chest imaging showed resolution of pneumomediastinum and subcutaneous emphysema, and he was successfully discharged on oxygen therapy. Spontaneous pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 infection. Spontaneous pneumomediastinum is typically benign and self-limiting, requiring only supportive treatment.

scholarly journals Subcutaneous emphysema and pneumomediastinum in patients with COVID-19 disease; case series from a tertiary care hospital in Pakistan

2021 ◽  
Vol 149 ◽  
Author(s):  
S. M. Sethi ◽  
A. S. Ahmed ◽  
S. Hanif ◽  
M. Aqeel ◽  
A. B. S. Zubairi
Keyword(s):  
Hospital Stay ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Pressure ◽  
Care Hospital ◽  
Spontaneous Pneumomediastinum ◽  
Disease Case

Abstract Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23–75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5–10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8−25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.

scholarly journals Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review

2020 ◽  
Vol 13 (12) ◽  
pp. e239489
Author(s):  
Tarig Sami Elhakim ◽  
Haleem S Abdul ◽  
Carlos Pelaez Romero ◽  
Yoandy Rodriguez-Fuentes
Keyword(s):  
Literature Review ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Stable Condition ◽  
Positive Pressure ◽  
Unusual Complication ◽  
Pathophysiological Mechanism ◽  
Air Leak ◽  
Non Invasive ◽  
Spontaneous Pneumomediastinum

Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.

scholarly journals Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Vikisha Hazariwala ◽  
Hind Hadid ◽  
Denise Kirsch ◽  
Cecilia Big
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Laboratory Data ◽  
Positive Pressure ◽  
Case Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Important Complication ◽  
Underlying Pathophysiology

Abstract Background Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. Case presentation We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. Conclusions Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.

Management of an unusual presentation of foreign body aspiration

1992 ◽  
Vol 106 (8) ◽  
pp. 751-752 ◽  
Author(s):  
Hassan H. Ramadan ◽  
Nicolas Bu-Saba ◽  
Anis Baraka ◽  
Salman Mroueh
Keyword(s):  
Foreign Body ◽  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Foreign Body Aspiration ◽  
Positive Pressure ◽  
Review Of The Literature ◽  
X Ray ◽  
Post Surgery ◽  
Chest X Ray

AbstractForeign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.

scholarly journals Trimming the need for invasive ventilation: pragmatic critical care during the COVID-19 pandemic

2020 ◽  
Vol 13 (9) ◽  
pp. e237597
Author(s):  
Connor P Oates ◽  
Sarah A Goldman ◽  
Gennaro Giustino ◽  
Martin E Goldman
Keyword(s):  
Critical Care ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Medical Professionals ◽  
Religious Leaders ◽  
Invasive Ventilation ◽  
Facial Hair ◽  
Non Invasive ◽  
Hypoxic Respiratory Failure ◽  
Religious Reasons

COVID-19 has challenged all medical professionals to optimise non-invasive positive pressure ventilation (NIV) as a means of limiting intubation. We present a case of a middle-aged man with a voluminous beard for religious reasons who developed progressive hypoxic respiratory failure secondary to COVID-19 infection which became refractory to NIV. After gaining permission to trim the patient’s facial hair by engaging with the patient, his family and religious leaders, his mask fit objectively improved, his hypoxaemia markedly improved and an unnecessary intubation was avoided. Trimming of facial hair should be considered in all patients on NIV who might have any limitations with mask fit and seal that would hamper ventilation, including patients who have facial hair for religious reasons.

scholarly journals Hamman’s syndrome in diabetic ketoacidosis

2017 ◽  
Vol 2017 ◽  
Author(s):  
Alexandra Rose Pain ◽  
Josh Pomroy ◽  
Andrea Benjamin
Keyword(s):  
Differential Diagnosis ◽  
Diabetic Ketoacidosis ◽  
Chest Radiograph ◽  
Subcutaneous Emphysema ◽  
Rare Complication ◽  
Water Soluble ◽  
List Type ◽  
Shortness Of Breath ◽  
Boerhaave’S Syndrome ◽  
Boerhaave's Syndrome

Summary Hamman’s syndrome (spontaneous subcutaneous emphysema and pneumomediastinum) is a rare complication of diabetic ketoacidosis (DKA), with a multifactorial etiology. Awareness of this syndrome is important: it is likely underdiagnosed as the main symptom of shortness of breath is often attributed to Kussmaul’s breathing and the findings on chest radiograph can be subtle and easily missed. It is also important to be aware of and consider Boerhaave’s syndrome as a differential diagnosis, a more serious condition with a 40% mortality rate when diagnosis is delayed. We present a case of pneumomediastinum, pneumopericardium, epidural emphysema and subcutaneous emphysema complicating DKA in an eighteen-year-old patient. We hope that increasing awareness of Hamman’s syndrome, and how to distinguish it from Boerhaave’s syndrome, will lead to better recognition and management of these syndromes in patients with diabetic ketoacidosis. Learning points: Hamman’s syndrome (spontaneous subcutaneous emphysema and pneumomediastinum) is a rare complication of DKA. Presentation may be with chest or neck pain and shortness of breath, and signs are subcutaneous emphysema and Hamman’s sign – a precordial crunching or popping sound during systole. Boerhaave’s syndrome should be considered as a differential diagnosis, especially in cases with severe vomiting. The diagnosis of pneumomediastinum is made on chest radiograph, but a CT thorax with water-soluble oral contrast looking for contrast leak may be required if there is high clinical suspicion of Boerrhave’s syndrome. Hamman’s syndrome has an excellent prognosis, self-resolving with the correction of the ketoacidosis in all published cases in the literature.

scholarly journals Non-Cardiogenic Pulmonary Oedema Following the Use of Gadolinium-Based Contrast Medium: A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 181-185
Author(s):  
Chilan Nguyen ◽  
Tho Pham
Keyword(s):  
Pulmonary Oedema ◽  
Positive Pressure Ventilation ◽  
Rare Complication ◽  
Positive Pressure ◽  
Cardiogenic Pulmonary Oedema ◽  
Contrast Administration ◽  
Prompt Treatment ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Life Threatening Complication

AbstractNon-cardiogenic pulmonary oedema can be life threatening and requires prompt treatment. While gadolinium-based contrast is generally considered safe with a low risk of severe side effects, non-cardiogenic pulmonary oedema has become increasingly recognised as a rare, but possibly life-threatening complication. We present a case of a usually well, young 23-year-old female who developed non-cardiogenic pulmonary oedema with a moderate oxygenation impairment and no mucosal or cutaneous features of anaphylaxis following the administration of gadolinium-based contrast. She did not respond to treatment of anaphylaxis but made a rapid recovery following the commencement of positive pressure ventilation. Our case highlights the importance of recognising the rare complication of non-cardiogenic pulmonary oedema following gadolinium-based contrast administration in order to promptly implement the appropriate treatment.

A rare complication of diabetic ketoacidosis: spontaneous pneumomediastinum with subcutaneous emphysema

2019 ◽  
Author(s):  
Daniel Yusef ◽  
Henna Khattak ◽  
Leonie Perera ◽  
Saravanakumar Paramalingam ◽  
Shankar Kanumakala
Keyword(s):  
Diabetic Ketoacidosis ◽  
Subcutaneous Emphysema ◽  
Rare Complication ◽  
Spontaneous Pneumomediastinum

scholarly journals Cervicofacial Surgical Emphysema following Tonsillectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Samir Yelnoorkar ◽  
Wolfgang Issing
Keyword(s):  
Subcutaneous Emphysema ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
X Ray ◽  
Swallowing Difficulties ◽  
Considerable Length ◽  
Surgical Emphysema ◽  
The Right

We report the case of a patient who developed cervicofacial subcutaneous emphysema following a routine tonsillectomy. An 18-year-old male with swallowing difficulties underwent a tonsillectomy and developed swelling of the right side of his neck and face 36 hours after surgery. A neck X-ray revealed subcutaneous emphysema. Unlike similar previously published cases, there were no postoperative issues of coughing, straining, or use of positive pressure ventilation. The complication also occurred after a considerable length of time. Further complications may include pneumothorax and pneumomediastinum and these should be excluded.

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