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1.
Medicina (Kaunas) ; 59(12)2023 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-38138179

RESUMO

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.


Assuntos
Pneumorraque , Neoplasias Retais , Humanos , Pneumorraque/etiologia , Abscesso/complicações , Canal Medular , Neoplasias Retais/complicações
4.
Pediatr Neonatol ; 64(6): 667-673, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37301660

RESUMO

BACKGROUND: Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM. METHODS: Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed. RESULTS: In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n = 24) and SPM plus PR (n = 6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5 mg/L), identified predisposing factors, and those with more severe grade of SPM (p = 0.005, 0.001 and < 0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p < 0.001). All patients were successfully treated without morbidity and mortality. CONCLUSION: Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.


Assuntos
Enfisema Mediastínico , Pneumorraque , Humanos , Criança , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Estudos Retrospectivos , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Pneumorraque/terapia , Taiwan , Tomografia Computadorizada por Raios X/efeitos adversos
5.
J Med Case Rep ; 17(1): 150, 2023 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-37032335

RESUMO

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.


Assuntos
Cistite , Enfisema , Pneumorraque , Abscesso do Psoas , Infecções Urinárias , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Abscesso do Psoas/complicações , Cistite/complicações , Cistite/diagnóstico por imagem , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Tomografia Computadorizada por Raios X , Enfisema/diagnóstico por imagem
6.
Pneumologie ; 77(7): 430-434, 2023 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-36750171

RESUMO

Pneumomediastinum, defined as abnormal presence of air in the mediastinum, is a rare cause of acute chest pain. The condition may occur spontaneously as well as a secondary consequence of trauma or medical interventions. The spontaneous pneumomediastinum (Hamman's syndrome) is associated with a good prognosis, even without intervention. However, undelying severe conditions such as gastrointestinal perforations should be excluded. Diagnosis might be made using conventionell chest x-ray; a CT scan may give additional useful information. A subcutanous emphysema is a common finding in patients with pneumomediastinum. The presence of air in the epidural space of the spinal canal (pneumorrhachis) is a rarely seen but likewise mostly benign complication. We report a case of a young man with Hamman's syndrome and pneumorrhachis, provoked by acute asthma exacerbation; despite pronounced symptoms, his condition could be treated conservatively.


Assuntos
Asma , Enfisema , Enfisema Mediastínico , Pneumorraque , Masculino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Dor no Peito/etiologia , Dor no Peito/complicações , Asma/complicações , Asma/diagnóstico
7.
Pediatr Pulmonol ; 58(4): 1257-1265, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36596604

RESUMO

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.


Assuntos
Enfisema Mediastínico , Pneumonia por Mycoplasma , Pneumorraque , Enfisema Pulmonar , Enfisema Subcutâneo , Masculino , Criança , Adolescente , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Pneumorraque/etiologia , Pneumorraque/complicações , Enfisema Subcutâneo/etiologia , Enfisema Subcutâneo/complicações , Tomografia Computadorizada por Raios X/métodos , Pneumonia por Mycoplasma/complicações
8.
J Spinal Cord Med ; 46(5): 870-872, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36260033

RESUMO

CONTEXT: A pneumorrhachis (PR) is a rare phenomenon in which air is found in the spinal canal. There are multiple etiologies, including iatrogenic, nontraumatic, and traumatic. Most traumatic PR are asymptomatic and resolve on their own, but a subset are symptomatic and require urgent surgical intervention. This case describes a traumatic PR in which a headache was the primary symptom. FINDINGS: A 17-year-old male sustained a gunshot wound to the left flank with associated bilateral pulmonary lacerations, multiple rib fractures, and T5-7 vertebral body fractures with displaced bony fragments causing spinal cord injury with resultant paraplegia (T3 AIS-A) was admitted to inpatient rehabilitation. Three weeks into his course of rehabilitation, he developed throbbing headaches that were found to be caused by a subarachnoid PR. He underwent a T4-7 laminectomy with repair of dural tear and theco-pleural-bronch-fistula closure, and his headaches subsequently resolved. DISCUSSION/CLINICAL RELEVANCE: This case demonstrated that a headache can be a presenting symptom of a subarachnoid PR.


Assuntos
Pneumorraque , Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Ferimentos por Arma de Fogo , Masculino , Humanos , Adolescente , Traumatismos da Medula Espinal/complicações , Ferimentos por Arma de Fogo/complicações , Pneumorraque/complicações , Cefaleia/complicações
11.
Diving Hyperb Med ; 52(1): 54-57, 2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35313374

RESUMO

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.


Assuntos
Analgesia Epidural , Oxigenoterapia Hiperbárica , Pneumorraque , Adulto , Analgesia Epidural/efeitos adversos , Cesárea , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Pneumorraque/induzido quimicamente , Pneumorraque/terapia , Gravidez
13.
Ann Vasc Surg ; 80: 393.e1-393.e4, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34780938

RESUMO

The insertion of a neck central venous catheter (CVC) is a common procedure in medical practice; however, malposition and complications frequently occur. A 66-year-old woman had CVC inserted through the right internal jugular vein. CVC malposition was observed on chest radiography and computed tomography. The catheter was accidentally inserted via the vertebral vein and had entered the C6-C7 intervertebral foramen, penetrating the spinal canal with the tip at the T2 epidural space. We present this rare CVC complication to demonstrate the possibility of incorrect insertion of the catheter and penetration of the spinal canal, possibly causing neuronal damage.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais , Erros Médicos , Canal Medular/lesões , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Radiografia Torácica , Canal Medular/diagnóstico por imagem , Vértebras Torácicas , Tomografia Computadorizada por Raios X
15.
J Emerg Med ; 61(5): e116-e119, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34736798

RESUMO

BACKGROUND: Pneumorrhachis is an uncommon radiographic finding and is typically found in adult patients secondary to trauma or pneumocephalus. It is extremely rare in the pediatric population. Our case report describes a young boy who was found to have pneumorrhachis, but initially presented with an isolated back laceration. CASE REPORT: An 8-year-old boy arrived to the emergency department as a transfer from an outside hospital after initially presenting with a back laceration. After laceration repair, he developed severe headache and vomiting when sitting upright from a supine position. He was found to have T3 fractures and pneumocephalus secondary to pneumorrhachis and was managed conservatively per neurosurgery recommendations. Why Should an Emergency Physician Be Aware of This?Although extremely rare in the pediatric population, pneumorrhachis must still be considered in any pediatric patient with a penetrating injury to the abdomen, respiratory tract, or spinal column. Cases without clear etiology require further evaluation for occult spinal injuries and fractures. Conservative management is typically sufficient, although certain situations require further intervention.


Assuntos
Lesões nas Costas , Pneumocefalia , Pneumorraque , Adulto , Criança , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumorraque/diagnóstico , Pneumorraque/etiologia
19.
Eur Rev Med Pharmacol Sci ; 25(12): 4413-4417, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34227077

RESUMO

We report a case of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, occurring in an adolescent resulting positive to SARS-CoV-2 nasopharyngeal swab. At the admission in Emergency Department, the child presented with left cervical and sternal pain, without respiratory symptoms. Radiological studies showed sizeable pneumomediastinum, bilateral apical pneumothorax, massive emphysema subcutaneous and pneumorrhachis. Patients' clinical conditions stood stable during the monitoring and he only needed conservative management. To our knowledge, this is the first description of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, in a COVID-19 adolescent without concomitant pneumonia.


Assuntos
COVID-19/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Adolescente , COVID-19/complicações , Humanos , Masculino , Enfisema Mediastínico/etiologia , Pneumorraque/etiologia , Pneumotórax/etiologia
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