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Adlar F, Anthony W. Spontaneous Pneumothorax as a Complication in Concomitant Diabetic Ketoacidosis and Pulmonary Tuberculosis: A Case Report. CASE REPORTS IN ACUTE MEDICINE 2021. [DOI: 10.1159/000513324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) can occur as a complication of several underlying diseases such as pulmonary tuberculosis (TB) or, rarely, diabetic ketoacidosis (DKA). As diabetes mellitus (DM) is significantly prevalent in tuberculosis patients, it is possible to have both TB and DKA concurrently. However, there has not been any documentation of SSP as a complication in concomitant DKA and pulmonary TB. In this report, we described a 30-year-old female who presented to the emergency department with a chief complaint of shortness of breath that had intensified since a day before. She was diagnosed with pulmonary TB 1 week before and had started on her anti-tuberculosis drugs regimen. Prior history of DM was not known. Physical examination showed a slight decrease in consciousness, tachycardia, tachypnea, Kussmaul breathing, decreased lung sounds in the right hemithorax and hyperresonant on percussion. Laboratory results showed leukocytosis and hyperglycemia, ketones were positive on urinalysis and arterial blood gas analysis indicated metabolic acidosis. Chest X-ray revealed pneumothorax in the right hemithorax. She was diagnosed with pneumothorax of the right hemithorax, DKA, sepsis and pulmonary TB. Treatment involved prompt placement of chest tube drainage, fluid rehydration, intravenous insulin, antibiotic, sodium bicarbonate and anti-tuberculosis drugs. Her condition improved after 9 days of uneventful hospitalization. We discussed how concomitant presence of both DKA and pulmonary TB can increase the likelihood of developing secondary spontaneous pneumothorax.
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Winterton J, Biart S. Spontaneous pneumomediastinum and pneumopericardium in a young healthy adult with plans for air travel. Clin Case Rep 2020; 8:3075-3078. [PMID: 33363883 PMCID: PMC7752392 DOI: 10.1002/ccr3.3339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/09/2022] Open
Abstract
Although rare, pneumomediastinum and pneumopericardium should be considered in patients presenting with sudden onset post-tussive chest discomfort.
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Affiliation(s)
| | - Simon Biart
- Acute Medical UnitArrowe Park HospitalWirralUK
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Zhang W, Chen J, Wu X, Chen L, Wei J, Xue M, Liang Q. Analysing the Clinical Features of Pneumomediastinum Associated with Diabetic Ketoacidosis in 79 Cases. Diabetes Metab Syndr Obes 2020; 13:405-412. [PMID: 32110073 PMCID: PMC7034958 DOI: 10.2147/dmso.s230799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyse the clinical features of pneumomediastinum associated with DKA (diabetic ketoacidosis) to improve clinicians' understanding of the disease. METHODS A total of 78 patients with pneumomediastinum associated with DKA were identified in the literature search, and one patient treated in our hospital was included. The clinical features of the 79 patients were retrospectively analysed, and the pathogenesis, clinical symptoms, diagnostic methods, treatment strategies and prognoses were explored. RESULTS All cases were confirmed by chest CT (computed tomography), and Kussmaul respiration, severe vomiting, chest pain were common symptoms. The main treatment principle was to correct acidosis and treat the primary disease. The majority of patients recovered within 1-2 weeks, and only 2 patients died. CONCLUSION Pneumomediastinum associated with DKA is a rare disease, and it has a benign course when an early diagnosis is made and aetiological treatment is administered.
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Affiliation(s)
- Weidong Zhang
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
- Correspondence: Weidong Zhang Room 1, Weiwu Road, Zhengzhou City, Henan Province450003, People’s Republic of China Email
| | - Jingfang Chen
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
| | - Xiaoming Wu
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
| | - Luyu Chen
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
| | - Jinxing Wei
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
| | - Mingqiang Xue
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
| | - Qingzheng Liang
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, Henan Province450003, People’s Republic of China
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James RE, Bhanu C, Hapuarachi S, Leyva Caraballo E. Facial swelling and dysphonia during labour: a case of Hamman's syndrome. BMJ Case Rep 2019; 12:12/6/e227489. [PMID: 31248891 DOI: 10.1136/bcr-2018-227489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a previously fit and well 30-year-old primiparous woman who developed Hamman's syndrome during the second stage of labour. This is an unusual and peculiar condition, characterised by spontaneous pneumomediastinum and subcutaneous emphysema. The rarity of the condition means it can easily be misdiagnosed. Its exact aetiology is unknown, but it is believed that extreme Valsalva manoeuvre during prolonged or difficult labours may contribute to its development. Chest X-ray is the first investigation of choice in this presentation, followed by CT scanning. Fortunately, it is usually a benign condition that can be managed conservatively and resolved quickly, with no long-term effects and low risk of recurrence in future pregnancies. We are pleased to say that this case does not differ in this respect. It is, however, important to rule other more serious pathologies that present in a similar way, for example, Boerhaave syndrome, pneumothorax or pulmonary embolism.
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Affiliation(s)
- Rhian Elin James
- Obstetrics and Gynaecology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
| | - Cini Bhanu
- Department of Primary Care and Population Health, University College London Research, London, UK
| | - Sharleen Hapuarachi
- Obstetrics and Gynaecology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
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Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography. World J Radiol 2014; 6:850-854. [PMID: 25431639 PMCID: PMC4241491 DOI: 10.4329/wjr.v6.i11.850] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/16/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM) is described as free air or gas located within the mediastinum that is not associated with any noticeable cause such as chest trauma. SPM has been associated with many conditions and triggers, including bronchial asthma, diabetic ketoacidosis, forceful straining during exercise, inhalation of drugs, as well as other activities associated with the Valsalva maneuver. The Macklin effect appears on thoracic computed tomography (CT) as linear collections of air contiguous to the bronchovascular sheaths. With the recent availability of multidetector-row CT, the Macklin effect has been seen in the clinical setting more frequently than expected. The aim of this review article is to describe the CT imaging spectrum of the Macklin effect in patients with SPM, focusing on the common appearance of the Macklin effect, pneumorrhachis, and persistent SPM with pneumatocele.
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Pneumomediastinum Complicating Diabetic Ketoacidosis and Boerhaave's Syndrome. Case Rep Med 2013; 2013:598720. [PMID: 24348573 PMCID: PMC3856144 DOI: 10.1155/2013/598720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/22/2013] [Indexed: 11/18/2022] Open
Abstract
An 18-year-old man presented with altered mental status. He was found to have diabetic ketoacidosis. Chest X-ray showed pneumomediastinum. After intubation for air-way protection, an oral-gastric tube was placed. A chest computed tomography scan showed the tip of the oral-gastric tube to be in the right hemithorax. The patient underwent a thoracotomy and was managed in the intensive care unit. Both diabetic ketoacidosis and Boerhaave's syndrome should be considered as possible causes of pneumomediastinum in a patient with similar presentation. Boerhaave's syndrome should be ruled out prior to the insertion of an oral-gastric tube to avoid further morbidities.
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Abstract
Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.
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Diagnosis and treatment of patients with spontaneous pneumomediastinum. Respir Investig 2013; 52:36-40. [PMID: 24388369 DOI: 10.1016/j.resinv.2013.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/10/2013] [Accepted: 06/03/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although many patients complaining of chest pain visit the emergency department, very few are diagnosed with spontaneous pneumomediastinum (SPM). We present the management of 20 patients with SPM. METHODS We retrospectively analyzed the clinical features, past history, chest X-rays (CXRs), 64-slice helical computed tomography (CT) images, and clinical course of 20 patients with SPM (19 men and 1 woman) who visited the emergency department of the Tokyo Metropolitan Bokutoh Hospital between 2005 and 2010. RESULTS SPM predominantly resulted from physical exertion during such activities as sports and weight lifting (8 patients). The most common complaint was chest pain (15 patients), followed by dysphagia (10 patients), and dyspnea (8 patients). Subcutaneous emphysema was detected in 9 patients. The mean body mass index of the patients was 20.8±1.4kg/m(2). Although CXR findings of pneumomediastinum were absent in 5 patients, CT showed findings of the Macklin effect in all patients-interstitial gas was observed in the perihilar area in all patients and in the peripheral lung area in 9 patients (45%). Ten patients were hospitalized. The others received ambulatory care in the form of analgesics without antibiotics. All patients fully recovered without complications. CONCLUSIONS Our results showed that 64-slice helical CT is more reliable than CXRs for diagnosing SPM. Moreover, some patients with SPM can be treated without hospitalization, thus decreasing medical expenses for these patients.
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Ojima H, Fukai Y, Soda M, Kuwano H. Asymptomatic spontaneous cervical and mediastinal emphysema. BMJ Case Rep 2012; 2012:bcr-2012-006248. [PMID: 22761236 DOI: 10.1136/bcr-2012-006248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report our experience with four patients presenting with spontaneous pneumomediastinum (SPM) within a 3-month period. The patients (three male and one female, aged 15-17 years) were hospitalised with SPM. All patients were kept under observation, successfully treated and followed up for several years, with no recurrences reported. Two patients had histories of asthma, while the other two developed SPM during sporting activities. SPM carries the possibility of being latent. For symptoms such as chest pain without evidence of pneumothorax in young people, it is necessary to always consider SPM and make the diagnosis accordingly.
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Affiliation(s)
- Hitoshi Ojima
- Department of Gastrointestinal Surgery, Gunma Prefectural Cancer Center, Ota, Gunma, Japan.
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Abstract
OBJECTIVE To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. PATIENTS AND METHODS We conducted a retrospective review of 62 consecutive adult patients (age >or=18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years). RESULTS Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients [63%]), cough (28 [45%]), and dyspnea (27 [44%]). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). CONCLUSION Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients.
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Affiliation(s)
- Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Mondello B, Pavia R, Ruggeri P, Barone M, Barresi P, Monaco M. Spontaneous pneumomediastinum: experience in 18 adult patients. Lung 2007; 185:9-14. [PMID: 17310299 DOI: 10.1007/s00408-006-0002-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2006] [Indexed: 12/26/2022]
Abstract
Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum, developing in the absence of traumatic, iatrogenic, or preceding pulmonary pathologies (emphysema, chronic bronchitis, and lung cancer). The aim of this study was to review our experiences with SPM, underlining its symptomatology, diagnosis, treatment, and followup, and defining a reasonable course of assessment and management. A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in our institution between 1998 and 2005. Eighteen patients (10 males) were identified (average age = 25 +/- 4.8 years). Acute onset of chest pain was the predominant symptom at presentation. All patients developed clinically evident subcutaneous emphysema and underwent chest computerized tomography. Fiber bronchoscopy and echocardiogram were used selectively (8 patients). The average hospital stay was 6 (+/-1.4) days. Sixteen patients were conservatively treated, and only two patients were treated with thoracic drainage due to a related pneumothorax. The disease followed a benign evolution in all patients and, as of today, no relapse has been reported. SPM is an uncommon pathology with a usually benign course. The authors discuss SPM. A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment.
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Affiliation(s)
- Baldassare Mondello
- Unit of Thoracic Surgery, Department of Cardiovascular and Thoracic Sciences, Azienda Ospedaliera Universitaria G. Martino, Messina, Italy
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Reddymasu S, Borhan-Manesh F, Jordan PA. Spontaneous pneumomediastinum due to achalasia: a case report. South Med J 2006; 99:892-3. [PMID: 16929889 DOI: 10.1097/01.smj.0000220884.80266.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous pneumomediastinum (SPM) is a rare and benign clinical entity characterized by free air around mediastinal structures. Precipitating factors include violent cough, asthma, inhalational drugs, labor and exercise. We report a case of SPM due to achalasia which to the best of our knowledge, has never been reported. In achalasia, Valsalva maneuver might accompany severe vomiting. This causes alveolar rupture due to elevated intrabronchial and intra-alveolar pressure. Air tracks along the mediastinal spaces cause SPM. In our patient, there was no evidence of esophageal perforation. Tension pneumomediastinum and pneumothorax are complications of SPM.
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Affiliation(s)
- Savio Reddymasu
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
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Pooyan P, Puruckherr M, Summers JA, Byrd RP, Roy TM. Pneumomediastinum, pneumopericardium, and epidural pneumatosis in DKA. J Diabetes Complications 2004; 18:242-7. [PMID: 15207845 DOI: 10.1016/s1056-8727(03)00059-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Revised: 05/05/2003] [Accepted: 05/07/2003] [Indexed: 02/08/2023]
Abstract
Pneumomediastinum (PM) is an uncommon condition characterized by the presence of air in the mediastinum. It is associated with alveolar rupture that allows air to traverse along the bronchovascular bundle into the mediastinum. A review of the world medical literature identified 50 additional cases of PM and pneumopericardium (PC) associated with diabetic ketoacidosis (DKA). We report the occurrence of PM, PC, as well as epidural pneumatosis occurring simultaneously in a patient with DKA. Epidural pneumatosis in association with this metabolic derangement has not been previously described.
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Affiliation(s)
- Payam Pooyan
- Veterans Affairs Medical Center 111-B, PO Box 4000, Mountain Home, TN 37684-4000, USA
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Gerazounis M, Athanassiadi K, Kalantzi N, Moustardas M. Spontaneous pneumomediastinum: a rare benign entity. J Thorac Cardiovasc Surg 2003; 126:774-6. [PMID: 14502153 DOI: 10.1016/s0022-5223(03)00124-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Spontaneous pneumomediastinum usually occurs in young people without an apparent precipitating factor or disease. Thoracic surgeons are involved in the diagnosis and management of this entity because of the potentially life-threatening conditions that either must be treated as an emergency or excluded, such as esophageal perforation or necrotizing mediastinitis. We present our modest experience in treating spontaneous pneumomediastinum. MATERIALS Between 1988 and 1998 we treated 22 cases of spontaneous pneumomediastinum in 18 male patients and 4 female patients, ranging in age between 12 and 32 years. All traumatic cases were excluded. Retrosternal chest pain was the main symptom the patients presented. In only 11 cases was subcutaneous emphysema present. Chest radiography was diagnostic in all our cases. Computed tomographic scan, when performed, confirmed the diagnosis. An esophagogram was essential to exclude an esophageal rupture. Last, a cardiologic examination especially focusing on pericarditis excluded cardiac disease. RESULTS Conservative treatment consisted of bed rest, oxygen therapy, and analgesics, which led to rapid resolution of the spontaneous pneumomediastinum. The mean hospital stay ranged between 3 and 10 days. In a follow-up of 3 to 12 years only 1 recurrence was observed. CONCLUSION Spontaneous pneumomediastinum is usually an undiagnosed benign entity that responds very well to conservative treatment. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults.
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Affiliation(s)
- G Albaugh
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Cooper Hospital/University Medical Center, Camden, New Jersey, USA.
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Patel A, Kesler B, Wise RA. Persistent pneumomediastinum in interstitial fibrosis associated with rheumatoid arthritis: treatment with high-concentration oxygen. Chest 2000; 117:1809-13. [PMID: 10858424 DOI: 10.1378/chest.117.6.1809] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We present a case of persistent spontaneous pneumomediastinum precipitated by an upper respiratory infection in a patient with interstitial fibrosis associated with rheumatoid arthritis who was receiving chronic corticosteroid treatment. The persistent nature of the mediastinal emphysema over 2 months eventually required treatment with high concentrations of inhaled oxygen that resulted in rapid resolution of the pneumomediastinum without recurrence over 6 months of follow-up. This case, along with others in the medical literature, emphasizes the need for early use of high-concentration inhaled oxygen in the treatment of pneumomediastinum in high-risk patients, such as those with connective tissue disorders.
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Affiliation(s)
- A Patel
- Johns Hopkins University, School of Medicine at the Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, Baltimore, MD 21224, USA
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Abstract
Spontaneous pneumomediastinum is a rare complication of diabetic ketoacidosis. We report two patients with this complication who presented to a Sydney hospital within one week. Although both patients were young backpackers, staying at the same hostel, we believe this was coincidental.
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