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1
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Sari S, Wallendszus N, Struffert T. Neurologically Symptomatic Pneumorrhachis as the Primary Clinical Manifestation of Rectal Cancer. Clin Neuroradiol 2025:10.1007/s00062-025-01530-7. [PMID: 40423699 DOI: 10.1007/s00062-025-01530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Accepted: 05/08/2025] [Indexed: 05/28/2025]
Affiliation(s)
- Sabine Sari
- Institute of Neuroradiology, Justus Liebig-University Gießen, Klinikstraße 33, 35392, Gießen, Germany.
| | - Natascha Wallendszus
- Institute of Neurosurgery, Justus Liebig-University Gießen, Klinikstraße 33, 35392, Gießen, Germany
| | - Tobias Struffert
- Institute of Neuroradiology, Justus Liebig-University Gießen, Klinikstraße 33, 35392, Gießen, Germany
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2
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Magidenko SR, Huguet EE, Grosso FV. Nontraumatic Pneumorrhachis and Intraforaminal Gas, Presumed Intravascular, Is Occasionally Detected in Dogs Undergoing Computed Tomography Angiography Without Immediate Complications. Vet Radiol Ultrasound 2025; 66:e70037. [PMID: 40317562 DOI: 10.1111/vru.70037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 04/04/2025] [Accepted: 04/13/2025] [Indexed: 05/07/2025] Open
Abstract
Pneumorrhachis is a rare condition in human and veterinary medicine, defined as gas within the vertebral canal. Iatrogenic causes are the most common source of nontraumatic PR reported in humans. PR has been recognized in dogs undergoing routine CT. This study aims to identify the cause, prevalence, and distribution of PR and intraforaminal gas in dogs undergoing CT and identify any immediate post-CT complications. The medical records of dogs who underwent CT of the thorax, abdomen, and pelvis were retrospectively reviewed. Dogs were excluded if they presented with a history of trauma, neurologic deficits, recent surgery, or epidural injection. PR and intraforaminal gas were identified as present or absent and quantified subjectively. Patient positioning, intravenous catheter location, and complications in the 24 h following CT were recorded. 50/263 (19%) dogs with PR met the inclusion criteria. All dogs with PR had CT performed in sternal recumbency. Catheters were evenly distributed in laterality of placement, yet PR was predominantly right-sided (74%). The volume of gas identified was mild (87%) or moderate (13%). An increase in the amount of PR in postcontrast images was documented in 13 cases (20%). Intraforaminal gas was identified in 16.3% of dogs, and 88.4% had right-sided intraforaminal gas. No dogs developed neurologic deficits 24 h post-CT. The prevalence of PR and intraforaminal gas in this study was significantly higher than previously documented. Intravascular right-sided gas is proposed to be secondary to the ipsilateral location of the azygous vein and of no clinical significance.
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Affiliation(s)
- Steven R Magidenko
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - Elodie E Huguet
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
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3
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Ito Y, Mizumoto J. Esophageal perforation and epidural emphysema as complications of nasogastric tube placement. J Gen Fam Med 2025; 26:98-99. [PMID: 39776884 PMCID: PMC11702428 DOI: 10.1002/jgf2.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 10/02/2024] [Accepted: 10/14/2024] [Indexed: 01/11/2025] Open
Abstract
We present a 72-year-old man with end-stage renal disease and Hashimoto encephalopathy in whom a diagnosis of epidural emphysema because of esophageal perforation by a nasogastric tube placement. Although its imaging findings may be alarming to clinicians, close monitoring and conservative treatment are advisable.
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Affiliation(s)
- Yusuke Ito
- Department of Family PracticeAzusawa HospitalTokyoJapan
| | - Junki Mizumoto
- Department of Family PracticeEhime Seikyo HospitalMatsuyamaEhimeJapan
- Center for General Medicine Education, School of MedicineKeio UniversityTokyoJapan
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4
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Fu S, Liu L, Liu Y, Xu F. Pneumorachis mimicking lumbar disc herniation combined with lumbar spinal stenosis: A case report and literature review. Medicine (Baltimore) 2024; 103:e41012. [PMID: 39705443 PMCID: PMC11666139 DOI: 10.1097/md.0000000000041012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 11/23/2024] [Accepted: 12/02/2024] [Indexed: 12/22/2024] Open
Abstract
RATIONALE Pneumorachis is an uncommon lesion of the spinal canal, which is often asymptomatic. The pathogenesis and treatment strategies are uncertain because only a few cases have been reported. Some patients were treated with percutaneous aspiration or percutaneous endoscopic treatment, but poor pain release and symptom recurrence were observed. Some patients were treated with open surgery and completely cystectomy and had good clinical outcomes. This article reports a case of pneumorachis resembling lumbar disc herniation combined with lumbar spinal stenosis, in which the patient's compressive symptoms were completely alleviated through open surgery. PATIENT CONCERNS A-56-year-old patient has a 1-year history of radicular pain in the left leg. Magnetic resonance imaging prior to surgery showed a low-signal mass, like a sequestrated disc, in the epidural space at the level of L4 left recess and lumbar spinal stenosis of L4-5 level on both sides. There was a disc-like lesion located at the L4 recess. Computed tomography (CT) showed a homogeneous pneumorachis with a clear boundary. The patient underwent open surgery. Postoperative CT showed that the lumbar canal was decompressed, and this patient was free from pain. DIAGNOSES L4-5 lumbar canal stenosis, pneumorrhachis. INTERVENTIONS For treatment, the patient underwent open surgery to decompress the lumbar canal stenosis. OUTCOMES Postoperative CT demonstrated complete decompression of the L4-5 spinal canal, resulting in immediate relief of the patient's nerve root pain. At the 3-month follow-up after surgery, the patient remained pain-free. LESSONS For patients with suspected spinal pneumatosis, CT scans hold significant value to distinguish air and bones from soft-tissue lesions. Furthermore, in this case, we have demonstrated the effectiveness of open surgical treatment for spinal pneumatosis and achieved favorable prognostic outcomes.
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Affiliation(s)
- Songning Fu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Lu Liu
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, JIlin, China
| | - Yadong Liu
- Department of Spine Surgery, The First Hospital of Jilin University
| | - Feng Xu
- Department of Spine Surgery, The First Hospital of Jilin University
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5
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Kageyama H. Whole spinal pneumorrhachis following perforation of the rectum: A case report. Radiol Case Rep 2024; 19:4280-4282. [PMID: 39155936 PMCID: PMC11327514 DOI: 10.1016/j.radcr.2024.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/28/2024] [Indexed: 08/20/2024] Open
Abstract
Spinal pneumorrhachis is a relatively rare condition. Herein, we describe a case of whole spinal pneumorrhachis. A 68-year-old male, with a history of total proctocolectomy due to ulcerative colitis, had fever, diarrhea, and inflammatory reactions. Computed tomography (CT) revealed extensive epidural pneumorrhachis in the spinal canal from the cervical to sacral vertebrae. The patient was diagnosed with perforation of the rectal anastomosis and retroperitoneal abscess. Antibiotics were administered, and the abscess cavity was reduced on the follow-up CT. Pneumorrhachis in the spinal canal is often found only in the cervical, thoracic, or lumbar regions and is rarely found in the entire spinal canal. Spinal pneumorrhachis resulting from perforation of the colon or rectum has only been reported in 6 previous cases. To differentiate diseases that cause pneumorrhachis in the spinal canal, retroperitoneal abscess, and emphysema associated with perforation of the colon and rectum should be considered.
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Affiliation(s)
- Hiroshi Kageyama
- Department of Neurosurgery (Spinal surgery), Shin-Kuki General Hospital, Kamihayami 418-1, Kuki, Saitama, Japan
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6
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Lipinski AW, Smith MV, Wannamaker EJ, Timpone VM. Symptomatic Pneumorrhachis from Bronchial-Subarachnoid Fistula. Diagnostics (Basel) 2024; 14:2170. [PMID: 39410574 PMCID: PMC11482529 DOI: 10.3390/diagnostics14192170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 09/27/2024] [Accepted: 09/27/2024] [Indexed: 10/19/2024] Open
Abstract
Bronchial-subarachnoid fistulas are rare occurrences, which are not well defined in the literature. This uncommon clinical phenomenon may result in symptomatic pneumorrhachis and presents unique clinical challenges. This report details a case of a 53-year-old female whose treatment for recurrent chondrosarcoma of the thoracic spine included multiple surgeries and radiotherapy. Two weeks after her most recent debulking surgery, she experienced a rapid onset of unusual symptoms, including headache, back and neck spasms, bladder incontinence, and confusion. The source of her symptoms was found to be secondary to pneumorrhachis from a pre-existing bronchial-pleural fistula that had fistulized to the subarachnoid space discovered on computed tomography (CT) and confirmed intraoperatively. The patient was treated successfully with high-flow oxygen therapy and bed rest, followed by surgical correction of both a pleural air leak and a dural defect with muscular flaps. The patient was discharged home in stable condition and remained clinically free of recurrent bronchial-subarachnoid fistula six months after surgical repair. This case contributes to the existing literature by providing detailed clinical insights into the diagnosis and successful management of a bronchial-subarachnoid fistula leading to pneumorrhachis, thereby highlighting the importance of early recognition and intervention and underscoring the need for further research in this area.
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Affiliation(s)
- Alexander W. Lipinski
- Mayo Clinic Alix School of Medicine, Arizona Campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ 85259, USA
| | - Mathew V. Smith
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (M.V.S.); (E.J.W.); (V.M.T.)
| | - Eric J. Wannamaker
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (M.V.S.); (E.J.W.); (V.M.T.)
| | - Vincent M. Timpone
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (M.V.S.); (E.J.W.); (V.M.T.)
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7
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Ingram T, Kapoor I, Azzi Y, Evbuomwan MO, Okafor C. A Case of Pneumomediastinum and Pneumorrhachis in a Patient With Multiple Risk Factors. Cureus 2024; 16:e69536. [PMID: 39416521 PMCID: PMC11482537 DOI: 10.7759/cureus.69536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2024] [Indexed: 10/19/2024] Open
Abstract
Pneumomediastinum is the presence of gas (usually air) in the mediastinum, which is rare and typically benign. Pneumomediastinum is classified into primary and secondary based on etiology. Its pathophysiology is due to high intra-alveolar pressures causing alveolar rupture, which releases air that travels along bronchoalveolar sheaths into the mediastinum. Pneumomediastinum may also be concurrently seen with pneumorrhachis defined as air in the spinal canal, although this finding is rare. Here, we present the case of a 27-year-old male with a past medical history of polysubstance use and a one-week history of nausea, vomiting, and chest pain who presented with frostbite and was found to have pneumomediastinum and pneumorrhachis.
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Affiliation(s)
- Toyin Ingram
- Internal Medicine, Cape Fear Valley Health, Fayetteville, USA
| | - Ishani Kapoor
- Internal Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Yasmine Azzi
- Internal Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Moses O Evbuomwan
- Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Chika Okafor
- Internal Medicine, Cape Fear Valley Health, Fayetteville, USA
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8
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Khai NX, Tien TD, Dung HT, Thuan ND, Thong NH, Dung NT, Dung NV, Phuong NV, Minh NT. Epidural injection-related pneumorrhachis: A case report with cauda equina syndrome. Radiol Case Rep 2024; 19:2898-2903. [PMID: 38706812 PMCID: PMC11067536 DOI: 10.1016/j.radcr.2024.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Abstract
Pneumorrhachis (PR) is an uncommon condition characterized by the accumulation of air within the spinal canal. This finding may occur due to various causes, mostly after trauma and medical procedures. It can manifest with various features depending on the underlying cause, the location, and the extent of the air trapped. Clinically, the symptoms in affected patients can span a spectrum, ranging from being asymptomatic to manifesting as radiculopathies resulting from compression. The pneumorrhachis-related cauda equina syndrome is incredibly rare and typically appears as a large volume of air causing compression or irritation of the nerve roots in the lower spinal cord. In this report, we present a female patient whose cauda equina syndrome developed as a result of accidental extradural pneumorrhachis after epidural injection in the lumbar spine.
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Affiliation(s)
- Nguyen Xuan Khai
- Radiology Center, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Truong Dinh Tien
- Department of Pathology, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hoang Thi Dung
- Department of Neurology, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Duc Thuan
- Department of Neurology, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Huy Thong
- Department of Rheumatology, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Tien Dung
- Respiratory Center, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Viet Dung
- Department of Radiology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Viet Phuong
- Department of Infectious Disease, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Ngo Tuan Minh
- Radiology Center, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
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9
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Garcia-Cebrián MJ, Fontan-Atalaya IM, Garcia-Perez J, Fernandez-Torres B. Extensive extradural pneumorrhachis related to obstetric analgesia. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:491-495. [PMID: 37683975 DOI: 10.1016/j.redare.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/07/2023] [Indexed: 09/10/2023]
Abstract
Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia.We describe a very extensive extradural pneumorrachis (T9-S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symptomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described.
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Affiliation(s)
- M J Garcia-Cebrián
- Servicio de Anestesiología y Reanimación, Hospital Virgen Macarena, Seville, Spain
| | - I M Fontan-Atalaya
- Servicio de Obstetricia y Ginecología, Hospital Virgen Macarena, Seville, Spain
| | - J Garcia-Perez
- Servicio de Anestesiología y Reanimación, Hospital Virgen Macarena, Seville, Spain
| | - B Fernandez-Torres
- Servicio de Anestesiología y Reanimación, Hospital Virgen Macarena, Seville, Spain; Departamento de Cirugía, Facultad de Medicina, Universidad de Seville, Spain.
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10
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Kang KB, Kim YB, Shin YB, Cho SS, Lee ED. Progressive paraplegia after upper thoracic epidural block-related pneumorachis: A case report. Int J Surg Case Rep 2024; 119:109669. [PMID: 38718495 PMCID: PMC11091511 DOI: 10.1016/j.ijscr.2024.109669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE While the typical symptom associated with pneumorachis after an epidural block is radiculopathy in one or several corresponding segments, there has been a rare case report of significant complications such as cardiac arrest leading to death, or paraplegia. CASE PRESENTATION We present a case of an eighty-nine-year-old male patient who developed progressive paraplegia following an upper thoracic epidural block-associated pneumorachis. The procedure was performed at a different hospital using the loss of resistance (LOR) technique. Interestingly, the onset of paraplegia was delayed, occurring six hours after the procedure. Furthermore, there was a discrepancy between the clinical symptoms and the identified lesion in imaging studies. Despite the performance of an emergency laminectomy to remove the epidural gas, the paralysis continued to progress proximally. CLINICAL DISCUSSION Healthcare professionals should observe patients for an appropriate duration after the procedure to detect and manage any delayed symptoms. And it is crucial to recognize the potential for lesion extension beyond the symptomatic segment and perform thorough imaging examinations. CONCLUSION These findings emphasize the importance of exercising caution during the procedure, even when using a minimal amount of air with the LOR technique in the thoracic spine.
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Affiliation(s)
- Kyu-Bok Kang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - Youngbae B Kim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea.
| | - Young Bin Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - Sam Soon Cho
- Department of Anesthesia, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - Eun Dong Lee
- Department of Anesthesia, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
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11
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Balzano RF, Fascia G, Montatore M, Guglielmi G. Pneumorrhachis as a complication of a severe pressure ulcer: An unique case report. Radiol Case Rep 2024; 19:2302-2305. [PMID: 38559662 PMCID: PMC10978446 DOI: 10.1016/j.radcr.2024.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
Pneumorrhachis is a medical condition that refers to the presence of air within the spinal canal. Many circumstances, including trauma, infection, or medical procedures, might lead to this syndrome.In some cases, pneumorrhachis may not cause any symptoms and can resolve on its own. However, it can also be associated with more severe underlying conditions, such as spinal fractures, spinal infections, or underlying lung pathologies that lead to air escaping into the spinal canal. In this case we report an incidental finding of pneumorrhachis in a patient who came to our attention for suspected sepsis.
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Affiliation(s)
| | - Giacomo Fascia
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71122 Foggia, Italy
| | - Manuela Montatore
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71122 Foggia, Italy
| | - Giuseppe Guglielmi
- Radiology Unit, “Dimiccoli” Hospital, Viale Ippocrate 15, 70051, Barletta (BT), Italy
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71122 Foggia, Italy
- Radiology Unit, “IRCCS Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, FG, Italy
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12
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Anwar MS, Khan AA, Dua R, Nawaz FK, Khalid F, Du D. Hamman Syndrome with a Rare Feature of Pneumorrhachis - An Unusual Complication of Polysubstance abuse and e-vaping. Eur J Case Rep Intern Med 2024; 11:004473. [PMID: 38846659 PMCID: PMC11152237 DOI: 10.12890/2024_004473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/09/2024] Open
Abstract
Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status. Given the concerning physical examination, a computed tomography of the chest was undertaken, which showed pneumothorax, pneumomediastinum and pneumorrhachis. The patient was closely monitored in the intensive care unit and improved after symptomatic management. The symptoms of pneumorrhachis depend on the volume and location of air in intracranial and intraspinal space. Although asymptomatic in our case, it is crucial for clinicians to be aware that pneumorrhachis with Hamman syndrome can potentially cause neurological deficits and cardiopulmonary arrest in severe cases due to increased intraspinal and intracranial hypertension, emphasising the need for close monitoring. LEARNING POINTS Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.
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Affiliation(s)
| | - Anosh Aslam Khan
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Richa Dua
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Fatima Kausar Nawaz
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Farhan Khalid
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Doantrang Du
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, USA
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13
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Huang YE, Chuang CL, Wu SH, Chang YM, Kao PF. Pneumorrhachis With FDG Uptake Cervical Lesions on PET/CT of a Patient With Suspected Recurrent Hypopharyngeal Cancer. Clin Nucl Med 2024; 49:462-463. [PMID: 38466017 DOI: 10.1097/rlu.0000000000005164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT A 57-year-old man presented with odynophagia for 1 week was referred for FDG PET/CT scan to rule out recurrent hypopharyngeal cancer. The FDG PET/CT showed hypermetabolic lesions in hypopharyngeal area and adjacent cervical spine with pneumorrhachis, the presence of intraspinal air, on attenuation CT images, which might indicate a life-threatening infection. An emergency MRI confirmed the presence of cervical spondylodiscitis with an epidural abscess. The patient rapidly progressed to quadriplegia and difficulty voiding on the same day as the PET/CT scan, leading to emergent operation. The patient received antibiotics treatment and discharged 4 months later without evidence of cancer recurrence.
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14
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Abdillahi Mahamoud C, Benslima N, Bourial A, El Benna N, Rami A. Closed Thoracic Trauma as an Exceptional Cause of Pneumorrhachis: A Case Report. Cureus 2024; 16:e59437. [PMID: 38826888 PMCID: PMC11140438 DOI: 10.7759/cureus.59437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Pneumorrhachis, a rare clinical entity, refers to the presence of air in the spinal canal. Air can enter the spinal canal through various pathways, including the lungs and mediastinum (the space between the lungs), or directly from external sources due to trauma or infection. In rare cases, pneumorrhachis may result from repeated secondary Valsalva maneuvers, which is a complication of large-area pneumothorax. In this case report, we discuss a 36-year-old male patient who was involved in a high-intensity road accident. The injury assessment revealed significant findings including a large left pneumothorax, a right pneumothorax, multiple rib fractures, and the presence of pneumorrhachis. The entry of air into the spinal canal originated from the pleural space, likely through injuries to the parietal pleura. Rarely reported, closed thoracic trauma is an exceptional cause of pneumorrhachis. This unique mechanism of injury has been described in a limited number of publications addressing traumatic pneumorrhachis. The identification of pneumorrhachis in a traumatized patient should prompt further investigation to explore other potential injuries that may elucidate the formation of this intraspinal gas collection.
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Affiliation(s)
- Chirwa Abdillahi Mahamoud
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Radiology, Mohammed VI International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
| | - Najwa Benslima
- Radiology, Mohammed VI International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
| | - Abderrahim Bourial
- Otolaryngology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
| | - Naima El Benna
- Radiology, Centre Hospitalier Universitaire Ibn Rochd Hôpital 20 Août, Casablanca, MAR
| | - Amal Rami
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
- Radiology, Mohammed VI International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, MAR
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15
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Gupta A, Guha M, Bansal K. A rare case of spontaneous giant pneumorrachis presenting with cauda equina syndrome: a case report. Spinal Cord Ser Cases 2024; 10:18. [PMID: 38589363 PMCID: PMC11001869 DOI: 10.1038/s41394-024-00631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Pneumorrachis is presence of air in the epidural space. It could be the result of trauma, barotrauma, iatrogenic or spontaneous. The pneumorrachis per se is an underdiagnosed entity as most of the patients are asymptomatic or have subclinical symptoms. The spontaneous occurrence of pneumorrachis has been reported in literature but giant spontaneous occurrence causing cauda equina syndrome has not been reported so far. CASE PRESENTATION We report a case of 56-year-old male patient who came to our OPD on wheelchair with complains of difficulty in walking for 6 months with dribbling of urine for 2 months with on and off back pain. His perianal sensation was reduced with absent voluntary anal contraction. Imaging revealed giant air pockets in the spinal canal of L5-S1 extending upto L4-L5. It was managed surgically wherein laminectomy without fusion was done. The patient responded well to the treatment. DISCUSSION There are many causes of pneumorrachis described in literature. Most of the cases of pneumorrachis are asymptomatic and incidentally diagnosed. With the improvement in radio-diagnostic modalities, the diagnosis of pneumorrachis can be easily established. When symptomatic, they can be managed conservatively. Those presenting with neurological deficit may require surgical intervention or other invasive intervention.
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Affiliation(s)
- Anuj Gupta
- Spine Surgery, Max Super Speciality Hospital, Vaishali, New Delhi, India
| | - Mayukh Guha
- Fellow of National Board, Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India
| | - Kuldeep Bansal
- Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India.
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Pothiawala S, Civil I. Narrative review of traumatic pneumorrhachis. World J Crit Care Med 2023; 12:248-253. [PMID: 38188452 PMCID: PMC10768418 DOI: 10.5492/wjccm.v12.i5.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A comprehensive literature search was performed using the PubMed, Cochrane Library, Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023. A total of 34 resources were selected for inclusion in this narrative review. Traumatic PR can be classified anatomically into epidural and intradural types. In the epidural type, air is present peripherally in the spinal canal and the patients are usually asymptomatic. In contrast, in intradural PR, air is seen centrally in the spinal canal and patients present with neurological symptoms, and it is a marker of severe trauma. It is frequently associated with traumatic pneumocephalus, skull fractures or thoracic spine fracture. Computed tomography (CT) is considered to be the diagnostic modality of choice. Epidural PR is self-limited and patients are generally managed conservatively. Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak, with a need for surgical intervention. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. CT imaging of the entire spine must be performed to look for extension of air, as well as to identify concomitant skull, torso or spinal injuries Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.
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Affiliation(s)
- Sohil Pothiawala
- Trauma and Emergency Services, Auckland City Hospital, Auckland 1023, New Zealand
- Emergency Medicine, Woodlands Health, Singapore 768024, Singapore
| | - Ian Civil
- Trauma Services, Auckland City Hospital, Auckland 1023, New Zealand
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Patel MS, Patel NK, Alexopoulos G, Mercier P, Mattei TA. Traumatic pneumocephalus as a possible early sign of acute spinal cord injury: Case report. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100281. [PMID: 37942311 PMCID: PMC10628802 DOI: 10.1016/j.xnsj.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/21/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023]
Abstract
Background Traumatic pneumocephalus (TPC) following craniofacial injuries is common, but isolated TPC secondary to pneumorrhachis (PR) is the rare result of upward gas migration from the spinal canal. In the absence of craniofacial and grossly unstable spinal fractures, the etiology of TPC in polytrauma can be elusive and an underlying diagnosis of acute spinal cord injury (SCI) can be easily missed. We report the first polytrauma case where TPC was the most reliable early sign of SCI. Case Description A 34-year-old polytrauma female with imaging findings of TPC, which was later found to be secondary to an underlying SCI. As a focused exam could not be performed at admission, the TPC was first attributed to undiagnosed craniofacial injuries. Tertiary survey revealed the patient being paraplegic and MRI workup demonstrated an acute SCI at the T3-T4 level. PR was the most likely cause of TPC in the absence of other craniofacial injuries. Outcome The patient did not have a meaningful recovery given the extensive hemispheric infarcts, spinal cord injury, and respiratory failure. Conclusions Although uncommon, TPC may be an important radiographic sign suggesting the possibility of an underlying SCI in polytrauma patients. especially when focused neurologic assessment is limited at admission. Polytrauma patients with TPC and PR in the absence of coexisting craniofacial fractures require an urgent spine consultation by the ER physician, with possible early spine MRI workup. We suggest a diagnostic algorithm for the early identification of SCI in polytrauma patients presenting with TPC and propose considering 3 groups which may have different risks for SCI based on their clinical presentation and the presence of PR.
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Affiliation(s)
- Mayur S. Patel
- Department of Neurosurgery, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, United States
| | - Niel K. Patel
- Department of Neurosurgery, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, United States
| | - Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, United States
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, United States
| | - Tobias A. Mattei
- Department of Neurosurgery, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, United States
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Diaconescu R, Popovici D, Tarta C, Isaic A, Costachescu D, Totolici B. Pneumorrhachis Secondary to a Locally Advanced Rectal Cancer with Pre-Sacral Abscess-Case Report and Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2076. [PMID: 38138179 PMCID: PMC10744979 DOI: 10.3390/medicina59122076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
The occurrence of pneumorrhachis (PR), defined as the presence of air within the spinal canal, presents a complex clinical picture with diverse etiological factors. We report an exceedingly rare case of PR arising from locally advanced rectal cancer accompanied by a pre-sacral abscess. This report aims to enhance awareness and understanding of rare causes of PR within the medical community, particularly among surgeons engaged in emergency procedures. The patient survived the acute phase of the disease through multiple surgical interventions and admission to the intensive care unit, but succumbed to cardiovascular complications three weeks later. We also offer a brief review of the literature concerning PR originating from the colorectal lumen.
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Affiliation(s)
- Razvan Diaconescu
- Department of Oncology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (R.D.); (D.P.)
- Departments of General Surgery, Vasile Goldiş Western University of Arad, 310025 Arad, Romania;
| | - Dorel Popovici
- Department of Oncology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (R.D.); (D.P.)
| | - Cristi Tarta
- Department X, 2nd Surgical Clinic, Researching Future Chirurgie 2, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania;
| | - Alexandru Isaic
- Department X, 2nd Surgical Clinic, Researching Future Chirurgie 2, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania;
| | - Dan Costachescu
- Discipline of Radiology and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Bogdan Totolici
- Departments of General Surgery, Vasile Goldiş Western University of Arad, 310025 Arad, Romania;
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Yahanda AT, Connor MR, Desai R, Giles DA, Gupta VP, Ray WZ, Cadieux M. Cervical spinal cord compression from subdural hematoma caused by traumatic nerve root avulsion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23516. [PMID: 37956423 PMCID: PMC10651386 DOI: 10.3171/case23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Posttraumatic intradural hematomas of the cervical spine are rare findings that may yield significant neurological deficits if they compress the spinal cord. These compressive hematomas require prompt surgical evacuation. In certain instances, intradural hematomas may form from avulsion of cervical nerve roots. OBSERVATIONS The authors present the case of a 29-year-old male who presented with right upper-extremity weakness in the setting of polytrauma after a motor vehicle accident. He had no cervical fractures but subsequently developed right lower-extremity weakness. Magnetic resonance imaging (MRI) demonstrated a compressive hematoma of the cervical spine that was initially read as an epidural hematoma. However, intraoperatively, it was found to be a subdural hematoma, eccentric to the right, stemming from an avulsion of the right C6 nerve root. LESSONS Posttraumatic cervical subdural hematomas require rapid surgical evacuation if neurological deficits are present. The source of the hematoma may be an avulsed nerve root, and the associated deficits may be unilateral if the hematoma is eccentric to one side. Surgeons should be prepared for the possibility of an intradural hematoma even in instances in which MRI appears consistent with an epidural hematoma.
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20
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Sumitro K, Basir DN, Metussin A, Lim KC, Chong VH. Pneumorrhachis Secondary to Klebsiella pneumoniae Gas-Forming Paraspinal Abscess: A Case report and Review of Literature. Cureus 2023; 15:e45851. [PMID: 37881395 PMCID: PMC10594852 DOI: 10.7759/cureus.45851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
Pneumorrhachis is a rare entity, where air pockets are found in the spinal canal and the etiology can be categorized into traumatic and non-traumatic, the latter further categorized into spontaneous, iatrogenic, and associated with infections. Infective causes are often associated with gas-forming organisms and are associated with significant morbidity and mortality. Often the diagnosis is not suspected until imaging is done. We report the case of a 57-year-old man who presented with fever, backache, lower leg weakness, and dysuria. A computed tomography scan for evaluation of intra-abdominal sepsis incidentally showed pneumorrhachis affecting the thoracic and lumbar levels, gas-forming paraspinal abscess, prostate abscess, liver cirrhosis, and sigmoid colon carcinoma. Blood culture isolated Klebsiella pneumoniae. The patient recovered after six weeks of intravenous antibiotics followed later by sigmoid colectomy and chemotherapy. A literature review identified 63 cases of pneumorrhachis associated with infections and can be categorized into infections with spontaneous pneumorrhachis (predominantly respiratory tract infections), infections with pneumorrhachis (predominantly with emphysematous infections), and iatrogenic with infections and pneumorrhachis (predominantly postspinal interventions). Infections with pneumorrhachis occurred in older age groups and were associated with higher mortality compared to the other two categories.
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Affiliation(s)
- Kosasih Sumitro
- Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BRN
| | - Dewi Norwani Basir
- Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BRN
| | - Adli Metussin
- Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BRN
| | - Kian Chai Lim
- Department of Radiology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BRN
| | - Vui Heng Chong
- Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BRN
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Allena N, Javed N, Bojja S, Dileep A, Soliman M. "Beyond the Bladder: Exploring the Intricacies of Emphysematous Cystitis and Its Surprising Associations". Case Rep Crit Care 2023; 2023:5451554. [PMID: 37588033 PMCID: PMC10427224 DOI: 10.1155/2023/5451554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Emphysematous cystitis is defined by the presence of air within the bladder wall or lumen in imaging studies with increased incidence in elderly women and diabetics. It is a result of gas-forming organisms like Klebsiella and E. coli but can be caused by fungi such as Candida and Aspergillus as well with a wide spectrum of clinical presentations. In this article, we present a case of a 77-year-old female with diabetes mellitus who presented to the hospital with a chief complaint of left lower quadrant abdominal pain. Abdominal imaging revealed emphysematous cystitis, paraspinal abscess, and air in the thoracic and lumbar vertebrae. Laboratory results showed leukocytosis, lactic acidosis, and urinalysis significant for urinary tract infection but no positive urine or blood cultures. The patient was admitted to the intensive care unit for septic shock and was treated with mechanical ventilation, vasopressor support, and prompt antimicrobial therapy following which the requirement of vasopressors ceased on the third day of admission. The decision was then made by the family to pursue hospice care, following which mechanical ventilation was discontinued and the patient transferred to inpatient hospice. With this case report, we aim to add to the existing literature regarding the spread of intra-abdominal infections and go over a brief review of the currently available literature. From our review, we would like to conclude that the presence of pneumoracchis, especially in the setting of an intra-abdominal infection, is a poor prognostic marker, and timely diagnosis and treatment of potential causes are required to reduce mortality.
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Affiliation(s)
- Nishant Allena
- Division of Pulmonary Medicine and Critical Care, BronxCare Health System, New York, USA
| | - Nismat Javed
- Department of Internal Medicine, BronxCare Health System, New York, USA
| | - SriKaran Bojja
- Department of Internal Medicine, BronxCare Health System, New York, USA
| | - Arundhati Dileep
- Division of Pulmonary Medicine and Critical Care, BronxCare Health System, New York, USA
| | - Maryam Soliman
- Division of Pulmonary Medicine and Critical Care, BronxCare Health System, New York, USA
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22
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Stein M, Min A, Mohammed B, Mathur S, Ailon J. Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report. J Med Case Rep 2023; 17:150. [PMID: 37032335 PMCID: PMC10084606 DOI: 10.1186/s13256-023-03856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. CASE PRESENTATION This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. CONCLUSIONS Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.
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Affiliation(s)
- Maya Stein
- Department of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - Adam Min
- Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Basma Mohammed
- Department of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shobhit Mathur
- Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Ailon
- Department of Internal Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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23
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Rotsching NR, Mathias J, Gutierrez M, Ford N, Lamb J. Air All in the Wrong Places: A Case of Pneumorrhachis Secondary to Chronic Vomiting. Cureus 2023; 15:e37501. [PMID: 37187634 PMCID: PMC10181846 DOI: 10.7759/cureus.37501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Pneumorrhachis (PR) is a rare phenomenon in which air is present in the spinal canal. PR can be stratified into different categories based on etiology, with spontaneous PR being the least common. In this report, we describe the case of a 33-year-old male with a four-year history of emesis secondary to chronic gastroparesis who presented with pleuritic chest pain radiating to the neck. A CT scan of the chest showed pneumomediastinum, with air extending into the soft tissues of the neck and the spinal canal. A literature review found a trend between maneuvers that increase intrathoracic pressure, such as emesis or coughing, and the incidence of spontaneous pneumomediastinum, in which air may freely communicate with the epidural space of the spinal canal. Currently, there are no guidelines for the management of patients with PR. From our experience, conservative management of asymptomatic PR is an appropriate approach for these patients.
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Affiliation(s)
| | - Jay Mathias
- Internal Medicine, Wright State University, Dayton, USA
| | - Marc Gutierrez
- Internal Medicine, Wright State University, Dayton, USA
- Internal Medicine, Wright Patterson Air Force Base, Dayton, USA
| | - Nathaniel Ford
- Internal Medicine, Wright State University, Dayton, USA
- Internal Medicine, Wright Patterson Air Force Base, Dayton, USA
| | - James Lamb
- Internal Medicine, Wright State University, Dayton, USA
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24
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Zhuang Y, Zou JL, Huang YF, Hu DX, Shen X, Mao XY. Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema in a patient with pneumonia: A case report and literature review. Pediatr Pulmonol 2023; 58:1257-1265. [PMID: 36596604 DOI: 10.1002/ppul.26305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/24/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema caused by acute pneumonia are rarely observed in clinical practice. CASE PRESENTATION Herein, we report a case of a 12-year-old boy with spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema caused by a severe cough due to mycoplasma pneumonia. This patient neither received invasive or noninvasive ventilator treatment nor surgical treatment before the onset of the disease. After treatment, the patient recovered smoothly and was discharged from the hospital. LITERATURE REVIEW We reviewed all cases of spontaneous pneumorrhachis in children and adolescents between 1988 and 2022 in the PubMed database. Twenty-seven cases met our inclusion criteria, and the data on demographic information, triggers, comorbidities, symptoms, imaging findings, treatment, and prognosis were extracted and analyzed. CONCLUSION Although spontaneous pneumorrhachis is a rare condition, it has been reported in children. Computed tomography scanning is the gold standard for its detection. Spontaneous pneumorrhachis is typically a benign disease. This condition usually does not require any special treatment and should be monitored as common types of air leaks, such as pneumothorax and pneumomediastinum.
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Affiliation(s)
- Yuan Zhuang
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jia Lin Zou
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yu Fu Huang
- No.1 Orthopedics Hospital of CHENGDU, Chengdu, Sichuan, China.,Southwest Medical University, Luzhou, Sichuan, China
| | - Dong Xu Hu
- Southwest Medical University, Luzhou, Sichuan, China
| | - Xing Shen
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xiao Yan Mao
- Department of Pediatrics, Sichuan Clinical Research Center for Birth Defects, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Muacevic A, Adler JR, Habib Hussain Nasir Alabboudi Y, Abdulhadi HS, Younes Alobeid M. Pneumorrhachis Following Neck Penetrating Injury: A Case Report. Cureus 2022; 14:e31925. [PMID: 36580083 PMCID: PMC9793097 DOI: 10.7759/cureus.31925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
Abstract
The development of air in the spinal canal is an uncommon and usually asymptomatic event. Also known as pneumorrhachis (PNR), the main information about this phenomenon is based on a few case reports published previously. It is highly difficult to identify this entity clinically, and in most publications, PNR was incidentally identified during image procedures, mainly computed tomography (CT) scans. With the advancement of technology and the development of guidelines for the treatment of penetrating and neck injuries, the number of PNR diagnosis has increased. It is also a common agreement among the articles reviewed that the least common cause of PNR is traumatic events. This report presents a rare case of pneumorrhachis as a consequence of a penetrating neck injury. The studied patient was a 27-year-old female with multiple stab wounds on the left posterior side of the neck and left shoulder, thereby developing left-side body weakness as a consequence of the wound. The patient was immediately evaluated and managed by the emergency team, and as the patient was vitally stable, she was shifted to an urgent CT scan. CT scan showed subarachnoid air focus, multiple extradural air foci, and spinal cord injury on the cervical spine. This patient was treated conservatively, but her neurological symptoms persisted until discharge.
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26
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Ehret J, Powell TW, Lam P, Cluzet V. Emphysematous Cystitis Complicated by Pneumorrhachis. Cureus 2022; 14:e30401. [DOI: 10.7759/cureus.30401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
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Bichsel O, Hauck A, Oertel M. Air travel with pneumocephalus: a systematic review. Acta Neurochir (Wien) 2022; 164:2395-2400. [PMID: 35794427 PMCID: PMC9427915 DOI: 10.1007/s00701-022-05297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is that the intracranial volume could relevantly expand during flight and lead to elevated intracranial pressure. The aim of this systematic review was to identify and summarise models and case reports with confirmed pre-flight pneumocephalus. METHODS The terms (pneumocephalus OR intracranial air) AND (flying OR fly OR travel OR air transport OR aircraft) were used to search the database PubMed on 30 November 2021. This search returned 144 results. To be included, a paper needed to fulfil each of the following criteria: (i) peer-reviewed publication of case reports, surveys, simulations or laboratory experiments that focussed on air travel with pre-existing pneumocephalus; (ii) available in full text. RESULTS Thirteen studies met the inclusion criteria after title or abstract screening. We additionally identified five more articles when reviewing the references. A notion that repeatedly surfaced is that any air contained within the neurocranium increases in volume at higher altitude, much like any extracranial gas, potentially resulting in tension pneumocephalus or increased intracranial pressure. DISCUSSION Relatively conservative thresholds for patients flying with pneumocephalus are suggested based on models where the intracranial air equilibrates with cabin pressure, although intracranial air in a confined space would be surrounded by the intracranial pressure. There is a discrepancy between the models and case presentations in that we found no reports of permanent or transient decompensation secondary to a pre-existing pneumocephalus during air travel. Nevertheless, the quality of examination varies and clinicians might tend to refrain from reporting adverse events. We identified a persistent extracranial to intracranial fistulous process in multiple cases with newly diagnosed pneumocephalus after flight. Finally, we summarised management principles to avoid complications from pneumocephalus during air travel and argue that a patient-specific understanding of the pathophysiology and time course of the pneumocephalus are potentially more important than its volume.
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Affiliation(s)
- Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Clinical Neuroscience Centre, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Annalisa Hauck
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Markus Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Swarna SS, Jung J, Connor S, Belci M, Grahovac G. Iatrogenic post-surgical tension pneumosyrinx-a first reported case. Acta Neurochir (Wien) 2022; 164:2351-2355. [PMID: 35759148 PMCID: PMC9427891 DOI: 10.1007/s00701-022-05286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
We describe the first ever-reported occurrence of a post-operative tension pneumosyrinx occurring after a resection of an intradural intramedullary spinal tumour in a 40-year-old patient. Post-operatively, he developed sudden onset paraplegia and imaging revealed a tension pneumosyrinx which was subsequently surgically decompressed. He made a gradual neurological recovery. This is an extremely rare complication with potentially long-lasting deleterious effects on patients' neurological status if not recognized. We aim to bring this pathology to the attention of our neurosurgical colleagues and share our surgical approach and management to assist those who may encounter this pathology in the future.
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Affiliation(s)
- Shyam S Swarna
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Josephine Jung
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
| | - Steve Connor
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Maurizio Belci
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Gordon Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
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Leinert JL, Perez Ortiz A, Rafat N. Spontaneous Pneumomediastinum in Children with Viral Infections: Report of Three Cases Related to Rhinovirus or Respiratory Syncytial Virus Infection. CHILDREN 2022; 9:children9071040. [PMID: 35884024 PMCID: PMC9317719 DOI: 10.3390/children9071040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Background: Spontaneous pneumomediastinum (SP) is generally a benign condition which can have various etiologies. Data on SP related to respiratory viral infections in children are rare and there are currently no official guidelines or consistent treatment recommendations for these patients. Aim: To discuss treatment options considering the recommendations for SP with different etiologies. Methods: We report three cases of SP, which were related to rhinovirus or respiratory syncytial virus (RSV) infection. Results: All three patients presented with typical symptoms of a respiratory tract infection and required oxygen supplementation during the hospital stay. All children benefited from a conservative, supportive therapy, and bed rest, and could be discharged after seven days or less without remaining symptoms. Conclusion: Surveillance and monitoring might be reasonable to detect and treat potential complications in children with SP due to viral infections, as one child developed an increasing pneumothorax, which had to be treated with a thoracic drainage.
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Affiliation(s)
- Johanna L. Leinert
- University Children’s Hospital, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Department of Neonatology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Alba Perez Ortiz
- Department of Neonatology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Neysan Rafat
- Department of Neonatology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Correspondence:
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30
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Schmitz A, Town R, Siembida J, Wood KE. Case 3: Pneumo What? A Rare Finding in a Teenager with Chest Pain. Pediatr Rev 2022; 43:332-337. [PMID: 35641450 DOI: 10.1542/pir.2020-004697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anna Schmitz
- University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | | | | | - Kelly E Wood
- University of Iowa Stead Family Children's Hospital, Iowa City, IA
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Chickmagalur S, Davitt M, Lahoutiharahdashti A, Mitchell W, Arens R, Wallace MW, Sutyla RF, Plemmons G, Schmitz A, Town R, Siembida J, Wood KE. Respiratory Distress: Three Patient Cases. Pediatr Rev 2022; 43:322-337. [PMID: 35641452 DOI: 10.1542/pir.2020-003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As mentioned in the January 2022 Pediatrics in Review Commentary, we now present three patients who have a common chief complaint followed by 5 questions for CME credit. All three cases have discussions on presentation, the differential diagnosis, and management that collectively serve as a Review article. The common theme here is that all three patients have difficulty breathing. We hope you will enjoy this review format.
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Schömig F, Li Z, Becker L, Vu-Han TL, Pumberger M, Diekhoff T. Gas within the Intervertebral Disc Does Not Rule Out Spinal Infection-A Case Series of 135 Patients with Spontaneous Spondylodiscitis. Diagnostics (Basel) 2022; 12:1089. [PMID: 35626244 PMCID: PMC9139794 DOI: 10.3390/diagnostics12051089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Gas in the intervertebral disc is mainly associated with degenerative disc diseases and experts generally assume that it is unlikely in spinal infection. However, large-scale studies supporting this notion are lacking, which is why our study's aim was to analyze the prevalence of and factors associated with the occurrence of gas in patients with spontaneous spondylodiscitis. Patients presenting with spontaneous spondylodiscitis from 2006 to 2020 were included retrospectively. Exclusion criteria were previous interventions in the same spinal segment and missing imaging data. Clinical data were retrieved from electronic medical reports. Computed tomography (CT) scans were evaluated for the presence of intervertebral gas. Causative pathogens were identified from CT-guided biopsy, open biopsy, intraoperative tissue samples, and/or blood cultures. 135 patients with a mean age of 66.0 ± 13.7 years were included. In 93 patients (68.9%), a causative pathogen was found. Intervertebral gas was found in 31 patients (23.0%) in total and in 19 patients (20.4%) with positive microbiology. Patients with gas presented with significantly higher body temperatures (37.2 ± 1.1 vs. 36.8 ± 0.7 °C, p = 0.044) and CRP levels (134.2 ± 127.1 vs. 89.8 ± 97.3 mg/L, p = 0.040) on admission. As a considerable number of patients with spondylodiscitis showed intervertebral gas formation, the detection of intervertebral gas is not suited to ruling out spondylodiscitis but must be interpreted in the context of other imaging and clinical findings, especially in elderly patients.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; (Z.L.); (L.B.); (T.-L.V.-H.); (M.P.)
| | - Zhao Li
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; (Z.L.); (L.B.); (T.-L.V.-H.); (M.P.)
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; (Z.L.); (L.B.); (T.-L.V.-H.); (M.P.)
| | - Tu-Lan Vu-Han
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; (Z.L.); (L.B.); (T.-L.V.-H.); (M.P.)
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; (Z.L.); (L.B.); (T.-L.V.-H.); (M.P.)
| | - Torsten Diekhoff
- Department of Radiology, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany;
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Romano-Ribeiro C, Gaio-Lima C, Ferreira AP, Oliveira B, Dias-Vaz M, Camacho Ó. Abnormal motor blockade after epidural analgesia caused by pneumorrhachis and the role of hyperbaric oxygen treatment: a case report. Diving Hyperb Med 2022; 52:54-57. [PMID: 35313374 PMCID: PMC9177429 DOI: 10.28920/dhm52.1.54-57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/04/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pneumorrhachis is a rare clinical entity that is usually asymptomatic. Previous reports have associated such events with epidural insertion using a loss of resistance (LOR) to air technique. This report describes a case of symptomatic epidural pneumorrhachis following epidural anaesthesia using LOR to saline. CASE REPORT A 32-year-old American Society of Anesthesiologists (ASA) Classification II female patient was admitted for unplanned caesarean section. Epidural anaesthesia was performed at the L3-4 space using LOR to saline. The procedure, including delivery of the neonate, was uneventful. In the recovery room, a local anaesthetic infusion via an elastomeric pump (infusion 'balloon') was started. Two hours after initiation of the infusion the patient complained of motor blockade, so it was stopped. Two hours later she remained paraparetic, and a neurologist assessment was required. A computed tomography scan showed epidural pneumorrhachis at the L2-3 level. The patient was referred for emergent hyperbaric oxygen treatment (US Navy Treatment Table 5) and following one session the patient recovered completely. DISCUSSION Anaesthetists should be aware of this rare complication, which is easily overlooked. Hyperbaric oxygen treatment is a first line treatment for gas-associated lesions with neurological impairment. Timely referral is essential to prevent irreversible deficits.
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Affiliation(s)
- Carolina Romano-Ribeiro
- Anesthesiology Department: Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Clara Gaio-Lima
- Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal
| | - António P Ferreira
- Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Belinda Oliveira
- Anesthesiology Department: Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marta Dias-Vaz
- Anesthesiology Department: Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Óscar Camacho
- Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal
- Corresponding author: Dr Óscar Camacho, Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal,
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Wong KK, Leung JW, Ho HH, Poon TT, Mak JY, Choi W, Leung S. Spontaneous pneumo‐mediastinum ‐ a benign rarity? SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Wing‐kee Choi
- Department of Surgery Tune Mun Hospital, New Territories, HKSAR
| | - Siu‐kee Leung
- Department of Surgery Tune Mun Hospital, New Territories, HKSAR
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35
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Dirie AMH, Aydın N, Hussein AM, Osman AA, Ahmed AA. Spontaneous pneumorrhachis, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. Rare features of Hamman Syndrome. Ann Med Surg (Lond) 2022; 74:103346. [PMID: 35198173 PMCID: PMC8844783 DOI: 10.1016/j.amsu.2022.103346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Pneumorrhachis (air within the spinal canal), Pneumomediastinum (abnormal air in the mediastinum), Pneumopericardium (air in the pericardial space), and Subcutaneous emphysema (air trapped under the skin) are rare conditions which are rare features of Hamman Syndrome. Some of pulmonary diseases that relate to pneumorrhachis have been reported in the literature; but Hamman Syndrome with Pneumorrhachis and Pneumopericardium due to violent coughs that triggered by tongue scraping are very rare. Case presentation A 20-year-old male with no previous lung disease or trauma was brought to the emergency department due to acute chest pain, dyspnea, choking, syncope, and neck swelling which started after several self-induced coughs when he was brushing his tongue. Chest CT scan revealed Pneumorrhachis, pneumomediastinum, Pneumopericardium and extensive subcutaneous emphysema associated with lung contusions. Clinical discussion Barotrauma due to violent coughs that triggered by tongue scraping may lead to lung injury resulting in Hamman Syndrome with rare features of pneumorrhachis and Pneumopericardium. To our knowledge this is the first case report of Hamman syndrome with pneumorrhachis and Pneumopericardium secondary to tongue brushing-induced lung injury in Somalia. Conclusion Violent coughs from tongue scarping can lead to Hamman Syndrome with Pneumorrhachis and Pneumopericardium.
This report is very rare. Is explains relation between self induced violent coughs and lung injury. It states rare co-existence of Hamman syndrome and Pneurrhachis with pneumopericardium. It emphasizes that most of pneumorrhacchis are self limited.
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Alampoondi Venkataramanan SV, George L, Sahu KK. Spontaneous Pneumorachis - A Case-Based Review. J Asthma Allergy 2021; 14:1539-1554. [PMID: 34955642 PMCID: PMC8694274 DOI: 10.2147/jaa.s325293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Pneumorachis is characterized by the presence of free air in the spinal canal. It is referred by different names in literature such as epidural emphysema, intraspinal air, intraspinal pneumoc(o)ele, spinal epidural and subarachnoid pneumatosis, spinal and epidural emphysema, aerorachia, pneumosaccus, air myelogram, etc. Pneumorachis can be broadly classified as traumatic, iatrogenic, or spontaneous. In this case-based review, we present a case of spontaneous pneumorachis secondary to asthma exacerbation. This is followed by a systematic review of all cases of spontaneous pneumorachis identified in PubMed. The aim of this review is to understand the pathophysiology, common causes and the management of spontaneous pneumorachis.
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Affiliation(s)
| | - Lovin George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Kamal Kant Sahu
- Department of Hematology and Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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37
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Ross M, Shahin MN, O'Neill BE, Liu JJ. Lumbar Pneumorrhachis Associated With Basilar Skull Fractures. Cureus 2021; 13:e19703. [PMID: 34934572 PMCID: PMC8684351 DOI: 10.7759/cureus.19703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lumbar pneumorrhachis following head injury is rare and commonly asymptomatic but can be indicative of skull fracture and cerebrospinal fluid (CSF) leak, which may warrant intervention. A PubMed review of the literature was performed using a keyword search to identify cases examining lumbar pneumorrhachis following head injury. Our case series included two patients who had lumbar pneumorrhachis between September 2019 and May 2020 at our center. The literature review summarizes 16 patients from 14 prior reports of pneumorrhachis. In our two-patient case series, neither patient required direct intervention for either pneumorrhachis or CSF leak. Pneumorrhachis is rare following an isolated head injury and is associated with basilar skull fractures and CSF leak. Pneumorrhachis should alert clinicians to the possibility of a CSF leak, which may require intervention.
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Affiliation(s)
- Miner Ross
- Neurological Surgery, Oregon Health & Science University, Portland, USA
| | - Maryam N Shahin
- Neurological Surgery, Oregon Health & Science University, Portland, USA
| | - Brannan E O'Neill
- Neurological Surgery, Oregon Health & Science University, Portland, USA
| | - Jesse J Liu
- Neurological Surgery, Oregon Health & Science University, Portland, USA
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Vanmali A, Daji KD. Pneumorrhachis: An uncommon radiological entity. SA J Radiol 2021; 25:2255. [PMID: 34917411 PMCID: PMC8661299 DOI: 10.4102/sajr.v25i1.2255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
Pneumorrhachis (PR) is a rare and interesting phenomenon, in which air is present within the spinal canal. The aetiologies are varied, broadly grouped as traumatic, non-traumatic or iatrogenic. Pneumorrhachis secondary to spontaneous pneumomediastinum (SPM) and barotrauma of the lungs is uncommon and even rarer within the paediatric group. This report describes a paediatric patient presenting with a persistent cough who developed a SPM and subsequent PR.
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Affiliation(s)
- Atish Vanmali
- Department of Diagnostic Radiology, Jackpersad and Partners, Durban, South Africa
| | - Kamlesh D Daji
- Department of Diagnostic Radiology, Jackpersad and Partners, Durban, South Africa
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Houston R, Fiani B, Musch B, Tayag E. Holocord spontaneous pneumorrhachis in the setting of refractory emesis. Surg Neurol Int 2021; 12:602. [PMID: 34992919 PMCID: PMC8720439 DOI: 10.25259/sni_1046_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam.
Case Description:
Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3.
Conclusion:
Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.
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Affiliation(s)
- Rebecca Houston
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Brian Musch
- College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, United States
| | - Emilio Tayag
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
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Reddy V, Jajodia A, Pasricha S, Goyal S, Puri S. Rare Case of Spontaneous Pneumorrhachis in a Young Male with COVID-19. Indian J Radiol Imaging 2021; 31:761-763. [PMID: 34790333 PMCID: PMC8590553 DOI: 10.1055/s-0041-1735920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Here we present a rare case of spontaneous pneumomediastinum complicated with pneumorrhachis (PR) in a young man who is a known case of carcinoma rectosigmoid region. Our young male was diagnosed with novel coronavirus disease 2019 (COVID-19) and remained asymptomatic for any respiratory complaints. Though an association of pneumomediastinum has been reported in COVID 19 patients, to the best of our knowledge, this is the first report of PR in a COVID-19 oncological case. The role of a radiologist is to identify this condition as cases reported earlier may have serious neurological consequences. Pursuing the cause can be a diagnostic challenge but it reaps the clinical benefit in the appropriate management.
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Affiliation(s)
- Vikas Reddy
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sunil Pasricha
- Department of Histopathology, Rajiv Gandhi Cancer Institute, Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sunil Puri
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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41
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Kajiyazdi M, Norooznezhad AH. Pneumomediastinum, pneumopericardium and subcutaneous emphysema following acute lymphoblastic leukemia and chemotherapy: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S379-S382. [PMID: 34760087 PMCID: PMC8559649 DOI: 10.22088/cjim.12.0.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/12/2019] [Accepted: 12/31/2019] [Indexed: 11/07/2022]
Abstract
Background: Pneumomediastinum and subcutaneous emphysema are mostly detected in non-malignant conditions such as certain infections, thoracic surgeries, and trauma. Although this condition is asymptomatic in most cases, sometimes it could be symptomatic and may even be lethal in some patients. Case Presentation: This letter reports a 9-year-old girl with acute lymphoblastic leukemia (ALL) on chemotherapy who developed pneumothorax with the clinical feature of respiratory distress for that a chest tube was inserted immediately. Following the insertion, pneumomediastinum and pneumopericardium developed in the patient. As the next step, a pericardium window was inserted by an expert heart surgeon. During these procedures, all the evaluations for any bacterial or fungal infection were negative. Unfortunately, the patient expired before any further complementary evaluations and it was not clear that the mentioned situation was a result of chemotherapy or ALL. Conclusion: Although pneumomediastinum and subcutaneous emphysema are rare in patients with ALL, authors strongly suggest clinicians consider them in any similar patients presenting respiratory signs/symptoms for faster onset of action.
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Affiliation(s)
- Mohammad Kajiyazdi
- Pediatric Hematology and Oncology Ward, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Norooznezhad
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Lima Miranda O, Carvalho A, Almeida A, Fernandes M, Cotter J. Pneumorrhachis Secondary to an Infected Sacral Decubitus Ulcer. Cureus 2021; 13:e17502. [PMID: 34603881 PMCID: PMC8476200 DOI: 10.7759/cureus.17502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Pneumorrhachis (PR) is a rare phenomenon, which consists in the presence of air in the spinal canal. There are various aetiologies, being the most common traumatic, non-traumatic and iatrogenic. The diagnosis is primarily done through radiographic findings and it is necessary to understand the mechanism behind its origin. PR secondary to decubitus ulcer (DU) infection is rare. PR is associated with great morbidity and mortality. In selected cases, surgical intervention may be necessary. A 67-year-old woman, dependent, was admitted to the emergency room (ER) and diagnosed with an infected sacral DU, later discharged with antibiotics. She was readmitted to the ER two weeks later, with prostration and fever. On examination, she scored five points on the Glasgow coma scale, had bilateral Babinsky sign and a deep sacral ulcer with bone exposure. A cranial computerized tomography (CT) demonstrated “high cervical and endochannel emphysema in the upper slope of the cervical segment” and the CT scan of the spine showed “endochannel air along the cervical-dorsal and lumbar rachis in an epidural location and inside the dural sac (evoking laceration of the dura mater) (…) and densification of the sacrococcygeal soft tissues (diagnosis of PR secondary to DU infection)”. Broad-spectrum antibiotics were started and the patient was evaluated by General Surgery, which described a large sacral ulcer with signs of the previous debridement and bone exposure, with no indication for surgical debridement, only for chemical debridement. Despite all the measures instituted, the patient died in the ER.
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Affiliation(s)
| | | | - Angela Almeida
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Magda Fernandes
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira, Guimarães, PRT
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43
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María de Los Reyes MS, Ignacio RJ, Jaime V. Suspected iatrogenic pneumorrhachis in a cat following epidural injection. Vet Anaesth Analg 2021; 48:978-980. [PMID: 34600809 DOI: 10.1016/j.vaa.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Redondo José Ignacio
- Hospital Clínico Veterinario CEU, Facultad de Veterinaria, Universidad-CEU Cardenal Herrera, CEU Universities, Valencia, España
| | - Viscasillas Jaime
- Hospital Clínico Veterinario CEU, Facultad de Veterinaria, Universidad-CEU Cardenal Herrera, CEU Universities, Valencia, España
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44
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Moral M, Blanco C, Martínez J, Lorenzo V. Delayed traumatic pneumocephalus and cervical pneumorrhachis in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Oshimizu M, Yamaguchi Y, Tsuboi S, Sugawara Y, Hayami H, Tobias JD, Inagawa G. Combined Spinal-Epidural Anesthesia for Subtotal Colectomy in a Patient With Hamman Syndrome and Epidural Pneumatosis: A Case Report. A A Pract 2021; 15:e01511. [PMID: 34415243 DOI: 10.1213/xaa.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It remains unclear how epidural pneumatosis affects the efficacy of neuraxial anesthesia. Spontaneous pneumomediastinum (Hamman syndrome) with epidural pneumatosis is rare. Regardless of its etiology, general anesthesia with positive pressure ventilation in patients with pneumomediastinum carries the risk of pneumothorax. We present a 19-year-old patient with Hamman syndrome and epidural pneumatosis who required emergency laparotomy. Effective analgesia was obtained using neuraxial anesthesia with a combined spinal-epidural anesthesia technique.
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Affiliation(s)
- Mio Oshimizu
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yoshikazu Yamaguchi
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Sayaka Tsuboi
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yoh Sugawara
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hajime Hayami
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Gaku Inagawa
- From the Department of Anesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Hudson JS, Jeong S, Zhang X, Abel TJ. Spontaneous epidural pneumorrhachis in 14 years old. Surg Neurol Int 2021; 12:329. [PMID: 34345470 PMCID: PMC8326144 DOI: 10.25259/sni_414_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Pneumorrhachis is an exceedingly rare complication of pneumomediastinum as air tracks through tissue planes into the epidural (or subdural space). The majority of these patients present with a clear history of trauma, iatrogenic injury, pneumothorax, vomiting, or retching. Case Description: A 14-year-old male presented with the asymptomatic spontaneous onset of pneumorrhachis associated with significant pneumomediastinum of unclear etiology. Conclusion: Most patients with pneumorrhachis present with nonfocal neurological examinations. For these patients, it is critical to rule out infection as the cause of epidural gas. If other systemic signs are present, then urgent contrast-enhanced magnetic resonance imaging should be obtained. The majority of patients will demonstrate spontaneous radiographic resolution of pneumorrhachis within several days.
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Affiliation(s)
| | - Seung Jeong
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Xiaoran Zhang
- Department of Neurosurgery, UPMC, Pittsburgh, Pennsylvania, United States
| | - Taylor J Abel
- Department of Neurosurgery, UPMC, Pittsburgh, Pennsylvania, United States
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Ng CH, Walwyn T, Gibson C, Gottardo N. Rare case of spontaneous simultaneous extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum and pneumorrhachis. Arch Dis Child 2021; 106:547. [PMID: 32518137 DOI: 10.1136/archdischild-2020-319189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Chia Huan Ng
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Thomas Walwyn
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Craig Gibson
- Department of Radiology and Diagnostic Imaging, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Nicholas Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Brain Tumour Research Programme, Telethon Kids Institute, Nedlands, Western Australia, Australia
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Rodrigues J, Costa RM, Magalhães J, Santos E. Spontaneous pneumomediastinum and pneumorrhachis in a healthy girl. BMJ Case Rep 2021; 14:e241077. [PMID: 33637508 PMCID: PMC7919577 DOI: 10.1136/bcr-2020-241077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jorge Rodrigues
- Department of Pediatrics, Hospital Pediátrico, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
- Department of Pediatrics, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | | | - Joana Magalhães
- Department of Pediatrics, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
| | - Elisabete Santos
- Department of Pediatrics, Centro Hospitalar Tondela Viseu EPE, Viseu, Portugal
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Lasica N, Djilvesi D, Jelaca B, Vulekovic P. Air migration through neural foramina in pneumorrachis: case illustration. J Neurosurg Spine 2021; 34:156-157. [PMID: 33035997 DOI: 10.3171/2020.6.spine20648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Nebojsa Lasica
- 1Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad; and
| | - Djula Djilvesi
- 1Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad; and
- 2Faculty of Medicine, University of Novi Sad, Serbia
| | - Bojan Jelaca
- 1Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad; and
- 2Faculty of Medicine, University of Novi Sad, Serbia
| | - Petar Vulekovic
- 1Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad; and
- 2Faculty of Medicine, University of Novi Sad, Serbia
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Navriya SC, Kumar S, Mittal A, Bhirud DP. Pneumorrhachis in emphysematous pyelonephritis: A rare finding in an uncontrolled diabetic patient. Indian J Urol 2021; 37:97-98. [PMID: 33850367 PMCID: PMC8033220 DOI: 10.4103/iju.iju_202_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022] Open
Abstract
Emphysematous pyelonephritis (EPN) is a life-threatening infection of kidney with the presence of gas in the renal parenchyma, collecting system, and the surrounding retroperitoneum. We present a case of EPN in a diabetic patient with extension of gas into the spinal epidural space of the lumbar vertebral canal. He was managed conservatively with minimally invasive intervention along with supportive medical management and recovered well.
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Affiliation(s)
| | - Sunil Kumar
- Department of Urology, AIIMS, Rishikesh, Uttarakhand, India, E-mail:
| | - Ankur Mittal
- Department of Urology, AIIMS, Rishikesh, Uttarakhand, India
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