Computed tomography-guided tube thoracostomy for massive subcutaneous emphysema following lung resection: a case report

Pneumoparotitis is a rare cause of parotid gland swelling. We report a case of self-induced pneumoparotitis that resulted in subcutaneous emphysema and pneumomediastinum after an open biopsy of the parotid gland. We suggest a new method for diagnosing this condition. This is done by insufflation of the cheeks with contrast in the oral cavity. A reflux of air and contrast is subsequently demonstrated by a computed tomography scan of the area.

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Pneumocephalus and pneumorachis after blunt chest trauma without spinal fractures: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2208-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Etienne Allard ◽

Jean Selim ◽

Benoit Veber

Keyword(s):

Computed Tomography ◽

Intensive Care Unit ◽

Intensive Care ◽

Case Report ◽

Blunt Trauma ◽

Subcutaneous Emphysema ◽

Spinal Canal ◽

Skull Fractures ◽

Computed Tomography Scan ◽

Tomography Scan

Abstract Background Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. Case description We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. Conclusions This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.

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Challenging chest drainage: a case report

Revista Colombiana de Cirugía ◽

10.30944/20117582.711 ◽

2021 ◽

Vol 36 (3) ◽

pp. 540-544

Author(s):

Bruno Jose

Keyword(s):

Case Report ◽

Subcutaneous Emphysema ◽

Anterior Chest Wall ◽

Tube Thoracostomy ◽

Initial Assessment ◽

Blunt Dissection ◽

Bilateral Pneumothorax ◽

Thoracic Drainage ◽

The Right ◽

Light Pole

Introduction. Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography. Case report. A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department. Discussion. There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart. Conclusion. We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful.

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Case report: Postpartum pneumomediastinum and subcutaneous emphysema

Obstetric Medicine ◽

10.1177/1753495x18757162 ◽

2018 ◽

Vol 12 (3) ◽

pp. 143-145

Author(s):

AD Jakes ◽

K Kunde ◽

A Banerjee

Keyword(s):

Computed Tomography ◽

Case Report ◽

Subcutaneous Emphysema ◽

Oxygen Therapy ◽

Rare Complication ◽

Supplemental Oxygen ◽

Second Stage ◽

Second Stage Of Labour ◽

Nasal Flow ◽

Repeat Imaging

Postpartum pneumomediastinum is a rare complication of labour and delivery, where air leaks into the mediastinum following rupture of marginal alveoli. It follows prolonged and forceful Valsalva manoeuvres that increase intra-thoracic pressure. Subcutaneous emphysema may also develop. A chest radiograph can confirm the diagnosis, however a computed tomography thorax maybe required. Treatment is conservative as it is usually self-limiting. We present a case of postpartum pneumomediastinum following a delay in the second stage of labour and subsequent instrumental delivery. She developed chest pain and dyspnea 40 min post-delivery, and subcutaneous emphysema was palpable. Supplementary nasal flow oxygen was administered for 24 h prior to discharge. There is sparse evidence or guidance as to the management of postpartum pneumomediastinum, but consensus appears to be supplemental oxygen for 24 h. More data are needed on the type and duration of oxygen therapy, need for repeat imaging and management of subsequent pregnancies.

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Pulmonary barotrauma during hookah diving: a case report

Undersea and Hyperbaric Medicine ◽

10.22462/03.07.2020.8 ◽

2020 ◽

pp. 471-475

Author(s):

Şefika Körpinar ◽

◽

Uğur Gönlügür ◽

Oğuz Kapicibaşi ◽

Tanseli Gönlügür ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Subcutaneous Emphysema ◽

Definitive Diagnosis ◽

Pulmonary Barotrauma ◽

Normobaric Oxygen ◽

Rapana Venosa ◽

Thoracic Computed Tomography ◽

One Year

When commercial sea harvesters have dive accidents, it is sometimes difficult to obtain an accurate dive history and make a definitive diagnosis. We report a sea harvest diver who dived to collect sea snails (Rapana venosa) by using a hookah dive system. He experienced mediastinal and subcutaneous emphysema due to interruption of breathing airflow. Thoracic computed tomography performed one year prior to the accident revealed paramediastinal subpleural blebs on both lung apices. Emphysema was resolved by administering normobaric oxygen.

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Transient Prealbumin- Associated Hyperthyroxinemia in TSH-Producing Pituitary Adenoma

Nuklearmedizin ◽

10.1055/s-0038-1629511 ◽

1990 ◽

Vol 29 (01) ◽

pp. 40-43 ◽

Cited By ~ 3

Author(s):

W. Langsteger ◽

P. Költringer ◽

P. Wakonig ◽

B. Eber ◽

M. Mokry ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Pituitary Adenoma ◽

Thyroid Hormones ◽

Protein Binding ◽

Alpha Subunit ◽

Normal Range ◽

Thyroxine Binding Globulin ◽

Free Thyroid Hormones ◽

Transmission Computed Tomography

This case report describes a 38-year-old male who was hospitalized for further clarification of clinically mild hyperthyroidism. His increased total hormone levels, the elevated free thyroid hormones and the elevated basal TSH with blunted response to TRH strongly suggested a pituitary adenoma with inappropriate TSH incretion. Transmission computed tomography showed an intrasellar expansion, 16 mm in diameter. The neoplastic TSH production was confirmed by an elevated alpha-subunit and a raised molar alpha-sub/ATSH ratio. However, T4 distribution on prealbumin (PA, TTR), albumin (A) and thyroxine binding globulin (TBG) showed a clearly increased binding to PA (39%), indicating additional prealbumin-associated hyperthyroxinemia. The absolute values of PA, A and TBG were within the normal range. After removal of the TSH-producing adenoma, basal TSH, the free thyroid hormones and T4 binding to prealbumin returned to normal. Therefore, the prealbumin-associated hyperthyroxinemia had to be interpreted as a transitory phenomenon related to secondary hyperthyroidism (T4 shift from thyroxine binding globulin to prealbumin) rather than a genetically conditioned anomaly of protein binding.

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