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

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.

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.

Spontaneous pneumomediastinum: ten years of our experience in diagnosis and outcome

Open Medicine ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. 642-647
Author(s):  
Sanja Hromis ◽  
Biljana Zvezdin ◽  
Ivan Kopitovic ◽  
Senka Milutinov ◽  
Violeta Kolarov ◽  
...  
Keyword(s):  
Chest Pain ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Sudden Onset ◽  
Recurrent Event ◽  
First Episode ◽  
Close Monitoring ◽  
Tertiary Care Centre ◽  
Benign Condition ◽  
Spontaneous Pneumomediastinum

AbstractSpontaneous pneumomediastinum (SPM) is a rare clinical condition that may be mild but also dramatic with sudden onset of chest pain and dyspnea accompanied by swelling and subcutaneous crepitations. The objective of this study was to analyze the clinical presentation and outcome of SPM in a specialized pulmonary tertiary care centre over a 10 years year period. In subsequent followup, we received information related to recurrence episodes of SPM by patients or their GPs physicians. Eighteen patients, 15 (83%) men, mean age 24 years (SD ±7.86) were diagnosed with SPM. Predominant symptoms were chest pain and cough (n=11) then dyspnea (n=9). Asthma was the most common predisposing condition (n=12). Pneumomediastinum was present on chest radiograph in 17 cases (94%), and in one case it was detected only by computed tomography. The mean length of hospital stay was 7 days (SD ±4.4 days). All our patients recovered and there were no complications. Recurrent event occurred in one asthma patient, 2 years after the first episode. Although, SPM is usually a self-limiting and benign condition, close monitoring is necessary. Recurrence is rare, but possible, with no evidence that routine monitoring of those patients is needed.

scholarly journals Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years

2017 ◽  
Vol 43 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Patrícia Dionísio ◽  
Luís Martins ◽  
Susana Moreira ◽  
Alda Manique ◽  
Rita Macedo ◽  
...  
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
Tobacco Consumption ◽  
Sudden Increase ◽  
Precipitating Factors ◽  
Intense Exercise ◽  
Predisposing Factor ◽  
X Ray ◽  
Spontaneous Pneumomediastinum ◽  
Chest X Ray

ABSTRACT Objective: To characterize clinically all of the patients with spontaneous pneumomediastinum (SPM) admitted to an adult pulmonology ward in Lisbon, Portugal. Methods: This was a retrospective descriptive study of all adult patients (≥ 18 years of age) diagnosed with SPM between January of 2004 and September of 2015. Results: At least one predisposing factor was identified in most (88.9%) of the 18 patients who presented with SPM during the study period. With regard to precipitating factors, bouts of cough were present in 50.0% of the patients. Other precipitating factors included a sudden increase in tobacco consumption, inhaled drug use, occupational inhalation of varnish fumes, intense exercise, and vomiting. The most common complaints were dyspnea (in 83.3%) and chest pain (in 77.8%). Other complaints included cough, neck pain, dysphagia, and odynophagia. Subcutaneous emphysema was found in most of the patients. The diagnosis of SPM was based on chest X-ray findings in 61.1% of the patients. Conclusions: Although SPM is a rare condition, it should be considered in the differential diagnosis of chest pain and dyspnea. It can develop without a triggering event or conclusive findings on a chest X-ray, which is usually sufficient for diagnosis.

Spontaneous pneumomediastinum: A report of two cases at a District General Hospital

2021 ◽  
pp. 1753495X2110192
Author(s):  
Nathanael Yong ◽  
Oladimeji Olowu
Keyword(s):  
Chest Pain ◽  
Rare Condition ◽  
District General Hospital ◽  
Valsalva Manoeuvre ◽  
Second Stage ◽  
Spontaneous Pneumomediastinum ◽  
Management Algorithm ◽  
Second Stage Of Labour ◽  
Management Approaches ◽  
Limiting Condition

Spontaneous pneumomediastinum is a rare condition thought to be caused by excessive Valsalva manoeuvre during the second stage of labour. Women with pneumomediastinum typically presents with chest pain or tightness, dyspnoea, and a tearing sensation around the neck. It is commonly diagnosed with a chest radiograph but further imaging may be necessary to exclude more sinister conditions with similar clinical features. We describe two cases of pneumomediastinum and the different management approaches with different multi-disciplinary input. It is often a self-limiting condition. We propose a management algorithm for women suspected to have pneumomediastinum during the intrapartum and postpartum period.

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.

DOZ047.79: Bronchoscopic treatment of plastic bronchitis in children

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Y Erdas ◽  
N Valiyev ◽  
K K Cerit ◽  
Y Gokdemir ◽  
G Kiyan
Keyword(s):  
Respiratory Distress ◽  
Rare Condition ◽  
Airway Disease ◽  
Underlying Disease ◽  
Bronchial Tree ◽  
X Rays ◽  
Plastic Bronchitis ◽  
Left Hemithorax ◽  
X Ray ◽  
Chest X Ray

Abstract Purpose Plastic bronchitis or cast bronchitis is a rare condition characterized by the formation of large gelatinous or rigid airway casts. Classification of plastic bronchitis is done by disease association and cast histology. This rare condition can cause airway obstruction and there is no standardized treatment. Here are presented two cases with plastic bronchitis treated by bronchoscopic removal of casts in our clinic. Patients Case 1: A 9-year-old boy presented with wheezing, cough, and respiratory distress. He expectorated the cast spontaneously and the cast was misdiagnosed as germinative membrane of a hydatid cyst at the previous center. Total collapse of the left hemithorax was seen on chest X-ray. Any underlying disease was not detected. The plastic-like solid structure was detected and easily extracted from the bronchial tree. Pathology results of the casts were eosinophilic mucoid casts. The patient experienced three bronchoscopic removals and had no recurrence thereafter for two years. Case 2: A 7-year-old girl presented with persistent cough and respiratory distress. The patient was referred to our center with the diagnosis of foreign body aspiration. Total collapse of the right middle and lower segment and partial collapse of the upper segment were seen on chest X-ray. Previously, she was diagnosed with reactive airway disease. The plastic-like semisolid structure was detected during bronchoscopy its extraction from the bronchial tree was not easy but was possible. Pathology results were eosinophilic mucoid and fibrinotic casts. This patient still needs bronchoscopy for cast removal after 12 bronchoscopic removals but her symptoms and bronchoscopy findings have regressed with time. Conclusion Bronchoscopic extraction of casts provides fast improvement of patients’ symptoms and postoperative chest X-rays, but recurrence of cast formation is common. Nevertheless, it is the mostly chosen therapy in the literature. Further researches in this area are required.

Acute haemorrhagic oedema of infancy: a condition that is not always benign

2020 ◽  
Vol 13 (11) ◽  
pp. e236059
Author(s):  
Ugo Cucinotta ◽  
Francesca Mazza ◽  
Giovanni Battista Pajno ◽  
Romina Gallizzi
Keyword(s):  
Clinical Outcome ◽  
Steroid Therapy ◽  
Rare Condition ◽  
Henoch Schonlein Purpura ◽  
Benign Condition ◽  
Atypical Case ◽  
Systemic Involvement ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Acute haemorrhagic oedema of infancy (AHOI) is a rare condition and an unusual diagnosis for the paediatrician, as approximately 300 cases have been reported in literature so far. Although it was considered for years a less serious variant of Henoch-Schönlein purpura, nowadays it is thought to be a different entity, with his own characteristics and clinical outcome. In literature it is described as a benign condition, self-limiting and without any systemic involvement in most of the cases. We present an atypical case of AHOI with a severe presentation and which needed an aggressive and prolonged steroid therapy.

scholarly journals Spontaneous pneumomediastinum following pneumonia in a 23-year-old male patient

2016 ◽  
Vol 83 (1-2) ◽  
Author(s):  
Yusuf Kayar ◽  
Nüket Bayram Kayar ◽  
Tuncay Şahutoğlu ◽  
Venkatanarayana Gangarapu
Keyword(s):  
Chest Pain ◽  
Male Patient ◽  
Outpatient Clinic ◽  
Oral Intake ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Spontaneous Pneumomediastinum ◽  
Arterial Blood ◽  
Interstitial Air ◽  
Precipitating Factor

<p>Spontaneous pneumomediastinum (SPM) is defined as the presence of interstitial air in the mediastinum without any apparent precipitating factor. We present a case of 23 year old male patient, who has been referred to our outpatient clinic with the complaints of sudden chest pain, dyspnea followed by pneumonia and was diagnosed as SPM. The patient was treated with ampicillin sulbactam (4 gr/day) and methylprednisolon (20 mg/day) for 4 days. and oral intake was stopped during treatment. Post treatment, it was observed that the crepitations were disappeared thoroughly and vesicular sounds were heard by oscultation. The control values of arterial blood gas was as following: pH:7,39 pO<sub>2</sub>:95 mmHg, pCO<sub>2</sub>:37 mmHg, SaO2: %97. In the 5th day his oral intake was started and he was discharged. </p>

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