Pneumomediastinum: An unusual complication of bronchial asthma in a young man

doi:10.1016/S0300-2977(98)00012-6

The Netherlands Journal of Medicine

Volume 52, Issue 4, April 1998, Pages 150-154

The Netherlands Jour...

https://doi.org/10.1016/S0300-2977(98)00012-6 Get rights and content

Abstract

We report a patient with bronchial asthma who presented with pneumomediastinum, pneumopericardium, pneumoretroperitoneum, pneumorrhachis and extensive subcutaneous emphysema, after a period of coughing. Pathogenesis, diagnostic procedures and treatment of pneumomediastinum and its complications are discussed.

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Cited by (23)

Imaging of Asthma
2016, Immunology and Allergy Clinics of North America
Citation Excerpt :
Acute complications of asthma include spontaneous pneumothorax, pneumomediastinum, subcutaneous emphysema, mucus plugging with or without atelectasis, and pneumonia.44 Although rare, pneumopericardium, pneumoperitoneum, and pneumorhachis have been reported.44,45 Spontaneous pneumomediastinum as triggered by bronchial asthma has an interesting mechanism, as described by Macklin and colleagues.46
Spontaneous Tracheal Rupture: A Case Report
2014, Journal of Emergency Medicine
Citation Excerpt :
In our case, it was extensive, tracking from the eyelids down to the lower extremities. Among the reported cases in the literature, the majority presented with subcutaneous emphysema, pneumothorax, and pneumomediastinum (2,5,7−12). Additionally, findings can include tension pneumothorax, tension pneumomediastinum, respiratory extremis, and persistent air leak despite chest tube placement (11).
Upper-airway disruption is a rare but potentially life-threatening phenomenon. It can occur spontaneously, be due to trauma, or be iatrogenically induced. Even more rare are such events reported in the pediatric population.
This article discusses the presentation, diagnostic difficulties, and management of spontaneous tracheal rupture in a child.
A 3-year-old boy was brought by emergency medical services to our emergency department with a presumptive diagnosis of anaphylaxis. With progressive swelling and respiratory distress, the patient quickly deteriorated. He received i.v. epinephrine, chest compressions, and bag-valve mask ventilation. He was intubated without difficulty and with no noted airway edema. Concomitant bilateral needle thoracostomies were performed and subsequent bilateral tube thoracostomies were placed. Immediately after intubation and chest tube placements, the patient's oxygen saturations and heart rate improved. Bronchoscopy failed to demonstrate any evident pathology. However, computed tomography scan revealed a defect in the posterior wall of the trachea proximal to the termination of the endotracheal tube. Cardiothoracic surgery was consulted and performed a primary repair of the tracheal defect. The patient was extubated soon after surgery, and he was discharged home neurologically intact.
The initial presentation of spontaneous tracheal rupture can be misleading and difficult to diagnose. After resuscitation, stabilization, and diagnosis, both surgical repair and nonoperative management have been reported as successful treatment measures for tracheal disruption.
Epidural emphysema complicating bronchial asthma
2012, Revue de Pneumologie Clinique
L’emphysème épidural est une complication rare de l’asthme bronchique, de découverte fortuite à la tomodensitométrie thoracique. Nous rapportons l’observation d’un homme de 21 ans, qui suite à une crise d’asthme sévère, a développé un emphysème sous-cutané et médiastinal. La tomodensitométrie thoracique a confirmé le diagnostic d’emphysème médiastinal et a révélé la présence d’un emphysème épidural. L’examen neurologique ne montrait aucun signe neurodéficitaire. L’évolution est marquée par la régression spontanée au bout de dix jours. L’emphysème épidural est une complication rare au cours des crises d’asthme. La bénignité de cette complication ne doit pas imposer sa recherche systématique par tomodensitométrie thoracique.
Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10 days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.
Air within the spinal canal in spontaneous pneumomediastinum
2010, Chest
Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with air within the spinal canal. We describe a further case in a 14-year-old girl and suggest a classification system based on a detailed review of the previous literature. Forty-eight patients with spontaneous pneumomediastinum and intraspinal air accumulation (36 men and 12 women, age range 4–72 years, median age 18 years) were grouped into those with underlying lung disease (n = 13), those with other underlying etiologic factors (n = 22), and those arising spontaneously (n = 13). Neurologic symptoms or signs were noted in one case. The remaining cases were successfully managed conservatively. In spontaneous pneumomediastinum, accumulation of air within the spinal canal is self-limiting and benign. The same management is advised in spontaneous pneumomediastinum with and without intraspinal air accumulation.
Asthma: An Imaging Update
2009, Radiologic Clinics of North America
Citation Excerpt :
Radiologic imaging is important in identifying complications of asthma. Acute complications of asthma may include pneumothorax, pneumomediastinum (Fig. 10) (and rarely pneumopericardium, pneumoperitoneum, pneumoretroperitoneum, pneumorrhachis, and even subdural emphysema),50–52 mucus impaction with or without atelectasis, and pneumonia. Chronic complications of asthma include allergic bronchopulmonary aspergillosis (discussed elsewhere in this issue), eosinophilic pneumonia, and Churg-Strauss vasculitis.
Tracheal Rupture in an Adolescent Female Presenting with Chest Pain and Subcutaneous Emphysema at the Emergency Department: A Case Report
2021, Journal of Pediatric Emergency and Intensive Care Medicine(Turkey)

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Brief reportPneumomediastinum: An unusual complication of bronchial asthma in a young man

Abstract

J Emerg Med

Chest

Eur J Radiol

Pneumomediastinum: old signs and new signs

Am J Roentgenol

Pneumomediastinum and subcutaneous emphysema following vaginal delivery

Brief report
Pneumomediastinum: An unusual complication of bronchial asthma in a young man