RESUMEN
BACKGROUND: Subcutaneous emphysema is a condition where air becomes trapped under the skin, typically resulting from surgery or skin trauma. It is mostly localized and its occurrence in blood donors is exceedingly rare. Phlebotomy poses minimal risk of subcutaneous emphysema, but procedural errors may lead to such complications. STUDY DESIGN AND METHOD: This is a case report of 29-year-old repeat blood donor who experienced subcutaneous emphysema following blood donation. The donor was vigorously squeezing sponge ball during donation resulting in displacement of the needle which required readjustment. Post-donation, the donor reported a crackling sensation and mild swelling near phlebotomy site. Non-contrast computed tomography (NCCT) scans confirmed subcutaneous emphysema, attributing its development to air trapping in subcutaneous plane due to ball valve mechanism. RESULTS: Computed tomography (CT) imaging revealed subcutaneous emphysematous changes in the right cubital region and no evidence of hematoma. The swelling spontaneously subsided in 10-12 days without any intervention. The case underscores the importance of differentiating subcutaneous emphysema from common complications like hematoma. DISCUSSION: Subcutaneous emphysema in blood donors is exceptionally rare but should be managed with clear communication. Donors should be reassured that the condition, although rare, is benign and self-resolving. Healthcare providers should be equipped to handle such rare complications, offering appropriate care and documenting incidents for future prevention.
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Donación de Sangre , Enfisema Subcutáneo , Humanos , Adulto , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiología , Tomografía Computarizada por Rayos X/efectos adversos , Donantes de Sangre , Hematoma/complicacionesRESUMEN
BACKGROUND: Subcutaneous emphysema (SCE) is a common complication in laparoscopic surgery. However, its precise incidence and impact on the clinical course are partially known. In this study, the incidence and risk factors of SCE were retrospectively analyzed. METHODS: Patients who underwent laparoscopic/robotic abdominal surgery (e.g., gastrointestinal, hepatobiliary, gynecologic, and urologic surgery) between October 2019 and September 2022 were retrospectively analyzed. The presence of SCE was confirmed by either conclusive findings obtained through chest/abdominal X-ray examination immediately after operation, or intraoperative palpation conducted by nurses. X-ray examination was performed in the operation room before extubation. RESULTS: A total of 2503 patients treated with laparoscopic/robotic abdominal surgery between October 2019 and September 2022 were identified and all of them were included in the analysis. SCE was confirmed in 23.1% of the patients (i.e., 577/2503). SCE was identified by X-ray examination in 97.6% of the patients. Extubation failure was observed in 10 patients; however, pneumothorax was not observed. Female sex (odds ratio [OR]: 2.09; 95% confidence interval [95%CI]: 1.69-2.57), age ≥ 80 years (OR 1.63; 95%CI 1.19-2.22), body mass index < 20 (OR 1.32; 95%CI 1.06-1.65), operation time > 360 min (OR 1.97; 95%CI 1.53-2.54), robotic surgery (OR 2.54; 95%CI 1.91-3.38), maximum intraabdominal pressure with CO2 > 15 mmHg (OR 1.79; 95%CI 1.02-3.16), and endo-tidal CO2 > 50 mmHg (OR 1.32; 95%CI 1.08-1.62)were identified as independent factors of SCE. Regarding the extubation failure due to SCE, age (OR 5.84; 95%CI 1.27-26.8) and maximum intraabdominal pressure with CO2 (OR 21.7; 95%CI 4.76-99.3) were identified as risk factors. CONCLUSION: Although the presence of SCE is associated with a low risk of severe complications, monitoring of the perioperative intraabdominal pressure is essential for performing safe laparoscopic/robotic surgery, particularly in elderly patients.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Enfisema Subcutáneo , Humanos , Femenino , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Retrospectivos , Dióxido de Carbono , Laparoscopía/efectos adversos , Enfisema Subcutáneo/epidemiología , Enfisema Subcutáneo/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
Air leak syndromes (such as pneumomediastinum, pneumothorax, or subcutaneous emphysema) are frequent complications of acute respiratory distress syndrome (ARDS). Unfortunately, the development of air leaks is associated with worse outcomes. In addition, it has been hypothesized that the development of pneumomediastinum could be a marker of disease severity in patients with respiratory failure receiving noninvasive respiratory support or assisted ventilation. The so-called Macklin effect (or pulmonary interstitial emphysema) is the air dissection of the lung bronchovascular tree from peripheral to central airways following injury to distal alveoli. Ultimately, the progression of the Macklin effect leads to the development of pneumomediastinum, subcutaneous emphysema, or pneumothorax. The Macklin effect is identifiable on a chest computed tomography (CT) scan. The Macklin effect could be an accurate predictor of barotrauma in patients with ARDS (sensitivity = 89.2% [95% CI: 74.6-96.9]; specificity = 95.6% [95% CI: 90.6-98.4]), and may be a marker of disease severity. Accordingly, the detection of the Macklin effect on a chest CT scan could be used to select which patients with ARDS might benefit from different treatment algorithms, including advanced respiratory monitoring, early intubation, or, potentially, the institution of early extracorporeal support with or without invasive ventilation. In this video, the authors summarize the pathophysiology and potential clinical significance and applications of the Macklin effect in patients with acute respiratory failure.
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Enfisema Mediastínico , Neumotórax , Síndrome de Dificultad Respiratoria , Enfisema Subcutáneo , Humanos , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Enfisema Mediastínico/complicaciones , Pulmón , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/complicaciones , Enfisema Subcutáneo/complicacionesRESUMEN
BACKGROUND: Postoperative subcutaneous emphysema (SE) is a possible complication of thoracoscopic or laparoscopic surgery. This study investigated the risk factors and clinical significance of SE after video-assisted thoracoscopic surgery for esophageal cancer (VATS-e). METHODS: This study included 135 patients who underwent VATS-e with artificial CO2 pneumothorax. Based on the X-ray images on the first postoperative day, patients were divided into two groups: N/L group (no SE or SE localized at the thoracic area, n = 65) and SE group (SE extended to the cervical area, n = 70). We compared clinicopathological features, surgical findings, and short-term outcomes between the two groups. RESULTS: In SE group, there were more patients who received neoadjuvant chemotherapy compared to N/L group. SE group had significantly lower preoperative body mass index. SE group had more frequently two-lung ventilation than N/L group. Multivariate analysis demonstrated that low BMI, NAC, and two-lung ventilation were independent risk factors for SE extended to the cervical area. Although pulmonary complication was relatively frequent in SE group, there were no significant differences in surgical outcomes between two groups, and all patients had SE disappeared within 21 days without serious complications. CONCLUSIONS: Despite extension to the cervical area, SE had a modest impact on the short-term result of VATS-e with artificial CO2 pneumothorax.
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Neoplasias Esofágicas , Neoplasias Pulmonares , Neumotórax , Enfisema Subcutáneo , Humanos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Neumotórax/etiología , Neumotórax/cirugía , Relevancia Clínica , Dióxido de Carbono , Estudios Retrospectivos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/etiología , Enfisema Subcutáneo/etiología , Complicaciones Posoperatorias/etiología , Neoplasias Pulmonares/cirugíaRESUMEN
BACKGROUND: Subcutaneous emphysema and pneumomediastinum are rare complications associated with orbital blowout pathological fracture. CASE PRESENTATION: A 7-year old, castrated male Abbysinian cat presented with anorexia, lethargy, nausea, eyelid swelling, nasal discharge, and sneezing. Based on the clinical and diagnostic work-up, the cat was diagnosed with T cell high-grade nasal lymphoma associated with orbital pathological fracture due to the tumour invasion. After chemotherapy, the cat showed massive subcutaneous emphysema from frontal region to abdomen and pneumomediastinum due to orbital blowout pathological fracture. As the nasal mass decreased in volume; the air had moved from the maxillary sinus to the subcutaneous region and the mediastinum through fascial planes in the head and neck region. CONCLUSIONS: This is a first case report of a massive subcutaneous emphysema and pneumomediastinum due to an orbital blowout pathological fracture following chemotherapy in feline nasal lymphoma in veterinary medicine.
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Enfermedades de los Gatos , Fracturas Espontáneas , Linfoma de Células T Periférico , Linfoma de Células T , Enfisema Mediastínico , Enfisema Subcutáneo , Masculino , Gatos , Animales , Enfisema Mediastínico/etiología , Enfisema Mediastínico/veterinaria , Fracturas Espontáneas/veterinaria , Nariz , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/veterinaria , Linfoma de Células T/veterinaria , Linfoma de Células T Periférico/veterinaria , Enfermedades de los Gatos/etiologíaRESUMEN
INTRODUCTION: Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better understanding of this pathogen in children is essential. CASE PRESENTATION: We report the case of a 49-month-old female child without previous underlying pulmonary diseases but with acute lymphoblastic leukemia (ALL). The patient was complicated with pneumonia during chemotherapy, which was primarily characterized by spontaneous pneumomediastinum and subcutaneous emphysema on chest computed tomography (CT). M. abscessus sequences were detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. With mechanical ventilation, closed thoracic drainage, and anti-infective therapy for 6 months, the patient's infection was controlled. The patient completed 2.5 years of treatment for ALL, and the drugs were discontinued. The patient currently remains in complete hematologic remission. DISCUSSION: We reviewed the literature on 33 children with M. abscessus pulmonary disease. These children mostly had underlying immunodeficiency. Chest CT most often showed nodular shadows, consolidation, and bronchiectasis. Spontaneous pneumomediastinum and subcutaneous emphysema were not reported as major manifestations. CONCLUSION: Spontaneous pneumomediastinum and subcutaneous emphysema were our patient's main characteristics on chest CT, and this study enriches the knowledge regarding possible imaging changes in M. abscessus pulmonary disease in children. This case report reflects good clinical experience in maintaining the balance between chemotherapy and anti-infective therapy in childhood ALL.
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Enfermedades Pulmonares , Enfisema Mediastínico , Mycobacterium abscessus , Leucemia-Linfoma Linfoblástico de Células Precursoras , Enfisema Subcutáneo , Adulto , Niño , Femenino , Humanos , Preescolar , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicacionesRESUMEN
BACKGROUND: Trauma, pneumothorax, complication of surgery, infection, or malignancy can cause subcutaneous emphysema and although most subcutaneous emphysema cases are self-limited, extensive subcutaneous emphysema can lead to a compromised airway and cardiovascular system. In this report, we described a successful treatment strategy in which subcutaneous angiocatheter insertion was used to relieve the pressure of extensive subcutaneous emphysema. CASE REPORT: An 83-year-old man was received at the emergency department (ED) for recurrent pneumothorax and extensive subcutaneous emphysema. Six 18-gauge angiocatheters were inserted under the thoracic subcutaneous tissue and a noticeable improvement was seen 3 h after angiocatheter insertion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Subcutaneous angiocatheter insertion may be a safe and uncomplicated decompression technique to relieve extensive subcutaneous emphysema, particularly in the ED.
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Enfisema Mediastínico , Neumotórax , Enfisema Subcutáneo , Masculino , Humanos , Anciano de 80 o más Años , Tejido Subcutáneo , Neumotórax/cirugía , Neumotórax/etiología , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/cirugía , Tórax , Descompresión/efectos adversos , Enfisema Mediastínico/etiologíaRESUMEN
OBJECTIVE: In case of cochlear implantation seroma, hematoma, local wound infections or vertigo are rare but typical complications. In contrast, emphysema is seldom reported. They can occur after cochlear implantation both in the postoperative healing phase and years later. A therapeutic algorithm does not yet exist. METHODS: We report on 3 patients with subcutaneous emphysema in the area of the receiver-stimulator. An unsystematic review of the literature of cases with emphysema after cochlear implantation highlights possible risk factors and the therapeutic options. RESULTS: The 3 cases developed subcutaneous emphysema 2-11 month after cochlear implantation due to nose blowing or CPAP therapy in obstructive sleep apnea. The current literature reports another 35 cases of emphysema after cochlear implantation. Air insufflation via the Eustachian tube is the most frequently described cause. Diseases of the nose and sinuses, tube dysfunction and obstructive sleep apnea are potential risk factors. Pressure bandage, puncture, tympanic tubes, and surgical revision are common treatments. CONCLUSIONS: Most emphysema can be controlled by conservative methods such as pressure bandaging and behavioral instruction. Punctures should be avoided due to the risk of upcoming infections. The prophylactic use of antibiotics seems dispensable. Surgical revision should be considered especially in cases of pneumocephalus with suspected leakage in the dura. The coverage of the mastoidectomy by a bony cap can be precautious and beneficial in cases with risk factors.
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Implantación Coclear , Implantes Cocleares , Enfisema Subcutáneo , Humanos , Implantación Coclear/efectos adversos , Implantación Coclear/métodos , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapia , Implantes Cocleares/efectos adversos , Factores de Riesgo , Reoperación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios RetrospectivosRESUMEN
Laparoscopic totally extraperitoneal inguinal hernia repair is considered a common and safe procedure. Here, we present the case of a 31-year-old male with right indirect inguinal hernia and no medical history. The patient underwent laparoscopic totally extraperitoneal inguinal hernia repair and the operation was completed successfully. During extubation, subcutaneous emphysema was noted at the neck, chest, and above the nipples. Tracheal injury was excluded by the anaesthesiologists and otorhinolaryngologists. On arterial blood gas, the patient's oxygen saturation was 95% with nasal oxygen support. The patient was followed-up closely in the general surgery inpatient clinic. Computed tomography was performed, on which bilateral pneumothorax and pneumomediastinum were noted. Conservative management was planned and the patient was discharged on the fourth postoperative day. Laparoscopic totally extraperitoneal inguinal hernia repair is considered a routinely applied safe procedure, however, appropriate care should be taken to avoid possible complications.
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Hernia Inguinal , Laparoscopía , Enfisema Mediastínico , Neumotórax , Enfisema Subcutáneo , Masculino , Humanos , Adulto , Hernia Inguinal/cirugía , Hernia Inguinal/complicaciones , Laparoscopía/efectos adversos , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumotórax/terapia , Neumotórax/cirugía , Enfisema Subcutáneo/terapia , Enfisema Subcutáneo/complicaciones , Herniorrafia/efectos adversos , Herniorrafia/métodosRESUMEN
Robot-assisted gastrectomy with the Davinci XiTM has been performed in our department since August 2019. This technique requires elevation of the left liver lobe. In order to prevent perioperative liver injury and expansion of postoperative subcutaneous emphysema, we use a silicone disc(HAKKO MEDICAL Co., Ltd.)and thread to elevate the liver. After docking the Davinci system, we move the needle as follows:(â °). left side peritoneum near the left triangular ligament, (â ±). silicone rubber(, â ²). center of crus(, â ³). silicone rubber(, â ´). hepatic cirrus, and(â µ). right side peritoneum. Both ends of the thread are guided out of the abdominal cavity from both hepatic circumflex by end-close, forming a V-shape with the center of crus at the bottom, which provides a stable and effective view of the liver. Fifty-three cases were performed after introduction of this elevation technique. Median AST and ALT on postoperative day 1 were 37(14-1,556)IU/L and 30(10- 1,676)IU/L, respectively, although small subcutaneous emphysema confined to the anterior chest and upper abdominal wall was observed in 2 patients(3.8%). No cases of extensive subcutaneous emphysema involving the neck or extremities were observed. This elevation technique protects the liver and may reduce the incidence of postoperative subcutaneous emphysema.
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Laparoscopía , Robótica , Enfisema Subcutáneo , Humanos , Laparoscopía/métodos , Elastómeros de Silicona , Hígado/cirugía , Gastrectomía/métodos , Enfisema Subcutáneo/cirugíaRESUMEN
INTRODUCTION: The paper presents unusual symptoms as a complication of therapeutic colonoscopy. CASE REPORT: A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. CONCLUSION: Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.
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Enfisema Mediastínico , Neumoperitoneo , Neumotórax , Enfisema Subcutáneo , Humanos , Femenino , Anciano , Neumotórax/diagnóstico , Enfisema Mediastínico/terapia , Enfisema Mediastínico/complicaciones , Neumoperitoneo/etiología , Neumoperitoneo/terapia , Coagulación con Plasma de Argón/efectos adversos , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapia , Enfisema Subcutáneo/diagnósticoRESUMEN
Spontaneous pneumomediastinum (SPM) is defined as free air or gas in the mediastinum that is not associated with an obvious cause such as chest trauma. The SPM results from acutely elevated intra-alveolar pressure: The high-pressure gradient between the distal alveoli and the pulmonary interstitium leads to alveolar rupture. This causes free gas to separate through the peribronchovascular fascial sheaths (interstitial emphysema) into the hilum and then into the mediastinum. Once the gas is in the mediastinum, it can travel up to the cervical soft tissues (even the retroperitoneum) producing subcutaneous emphysema. The Macklin effect appears on thoracic computed tomography (CT) as linear air collections adjacent to bronchovascular sheaths. This case report presents CT findings of SPM due to the Macklin effect in three cases and a brief literature review on this subject.
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Enfisema Mediastínico , Enfisema Subcutáneo , Traumatismos Torácicos , Humanos , Enfisema Mediastínico/etiología , Enfisema Mediastínico/complicaciones , Cuello , Alveolos Pulmonares , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/complicaciones , Traumatismos Torácicos/complicaciones , Tomografía Computarizada por Rayos X/métodosRESUMEN
Soft tissue emphysema (including subcutaneous emphysema) is common in pneumothorax. In most cases, this condition is of little clinical significance and regresses under standard medical procedures. However, progressive soft tissue emphysema poses a threat to the patient's life in case of compression of the upper respiratory tract in some cases. The world literature describes various approaches to the treatment of these patients. Standard medical care for progressive soft tissue emphysema following pneumothorax is pleural drainage with active aspiration. Despite unequivocal treatment tactics, this may not be enough in case of massive air release. Surgical treatment may be accompanied by surgical and anesthetic difficulties including difficult intubation. The authors present persistent tension pneumothorax and soft tissue emphysema, features of surgical and anesthetic management, as well as current treatment options.
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Neumotórax , Enfisema Subcutáneo , Humanos , Neumotórax/diagnóstico , Neumotórax/etiología , Neumotórax/cirugía , Enfisema Subcutáneo/diagnóstico , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/cirugía , Pleura , Drenaje/efectos adversos , Drenaje/métodosRESUMEN
Subcutaneous emphysema is a condition when air or gas gets trapped within the subcutaneous layer. It is characterised by crackling feeling on palpation of the skin known as subcutaneous crepitation which is described as touching rice krispies. A 70 years male from hilly region of Nepal with agricultural background suffered multiple injuries sustained due to an attack by domesticated bull in his house. Upon the incident the injured male was taken to hospital, where he was declared "Brought Dead" by the Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital. His body was brought for autopsy in Department of Forensic Medicine and Toxicology of Kathmandu University School of Medical Sciences. On complete autopsy, massive subcutaneous emphysema and pneumothorax was demonstrated. The details of finding are discussed in detail as follows.
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Neumotórax , Enfisema Subcutáneo , Animales , Bovinos , Humanos , Masculino , Autopsia , Servicio de Urgencia en Hospital , Hospitales Universitarios , Neumotórax/diagnóstico , Enfisema Subcutáneo/etiología , AncianoRESUMEN
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) in an immunocompromised host is often associated with the Macklin effect, which can progress to spontaneous pneumomediastinum (SPM), subcutaneous emphysema (SCE), and pneumothorax (PNX). Diagnosing the causative organism of these conditions in non-HIV infected patients and treating hypoxemia while preventing further lung damage can be challenging. This study examines the case of a non-HIV infected male with SPM, SCE, and PNX secondary to severe Pneumocystis jirovecii (PJ) infection. CASE PRESENTATION: A 53-year-old male with pure red cell aplasia (PRCA) was admitted with fever, dry cough, and shortness of breath. His respiratory function progressively deteriorated due to the development of SPM, SCE, and PNX, eventually requiring endotracheal intubation and invasive ventilation. As a result of high pressure in his airways occasioned by lung recruitment maneuvers, his pulmonary parameters worsened, necessitating veno-venous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The early initiation of VV-ECMO facilitated ultra-protective lung ventilation and prevented the progression of SPM, SCE, and PNX. Traditional diagnostic assays were unrevealing, whereupon the patient resorted to the metagenomic next-generation sequencing technology for uncovering potential pathogens. Consequently, we detected a significantly higher infection by PJ in the patient's bronchoscopy lavage fluid. Finally, the patient was successfully treated with appropriate antimicrobials and was decannulated after nine days of ECMO support. CONCLUSIONS: SPM, SCE, and PNX are rare clinical manifestations of PJP. However, they can be considered as poor prognostic factors of the infection. Physicians should, therefore, be alert to the possibility of PJP in immunocompromised patients.
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Oxigenación por Membrana Extracorpórea , Enfisema Mediastínico , Pneumocystis carinii , Neumonía por Pneumocystis , Neumotórax , Enfisema Subcutáneo , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/terapia , Neumotórax/complicaciones , Respiración ArtificialRESUMEN
BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.
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COVID-19 , Neumotórax , Síndrome de Dificultad Respiratoria , Enfisema Subcutáneo , Humanos , Persona de Mediana Edad , COVID-19/complicaciones , Neumotórax/etiología , Enfisema Subcutáneo/complicaciones , SARS-CoV-2 , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Descompresión/efectos adversosRESUMEN
Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural pneumatosis is rare. We report a 19-year-old man who presented with dyspnoea and swelling of the chest wall following a bout of cough. Bilateral subcutaneous emphysema was palpated on the anterior chest wall from the sternum to the midaxillary regions. His chest X-ray revealed subcutaneous emphysema and pneumopericardium. His computed tomography of the thorax to rule out life-threatening conditions revealed bilateral subcutaneous emphysema, pneumomediastinum, pneumo-pericardium and pneumothorax. He was transferred to the intensive care unit. An intercostal drainage tube was inserted in the left pleural cavity. The patient was followed up with repeat chest X-rays. The patient's symptom got relieved and was discharged after day 9. Diagnosis of pneumomedia-stinum may not be as lamentable as it is seen. Close cardio-pulmonary monitoring is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management. In this case, the patient's symptoms and severe tachypnoea prompted the insertion of an intercostal drainage tube.
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Enfisema Mediastínico , Neumopericardio , Neumotórax , Enfisema Subcutáneo , Adulto , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumopericardio/diagnóstico por imagen , Neumopericardio/etiología , Neumopericardio/terapia , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/terapia , Complicaciones Posoperatorias , Radiografía , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapia , Adulto JovenRESUMEN
ABSTRACT: In the present study, the authors report rare case series with subcutaneous emphysema with or without pneumomediastinum and pneumothorax after orthognathic and facial bone contouring surgery, compare their clinical and radiologic findings, and suggest precautions. Four patients who showed subcutaneous emphysema on follow up chest X-ray and computed tomography after orthognathic and facial bone contouring surgery were included in the study. In all cases post-op subcutaneous emphysema were detected, however, the aspect and mechanisms of post-op air spread were all different. After the conservative management with administering the O 2 by nasal cannula or endotracheal tube, the symptoms were relieved except 1 patient who needed chest tube insertion and further supra-sternal incision. In conclusion, subcutaneous emphysema with or without pneumomediastinum and pneumothorax after orthognathic and facial bone contouring surgery can be occurred by cervical fascia injury or alveolar ruptures. To preventing those complications, traumatic naso-tracheal intubation, excessive positive pressure ventilation, intermaxillary fixation immediate after the surgery, and increase of intra-alveolar pressure of the patients should be avoided.
Asunto(s)
Enfisema Mediastínico , Neumotórax , Enfisema Subcutáneo , Huesos Faciales , Humanos , Intubación Intratraqueal/efectos adversos , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/terapia , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/terapiaRESUMEN
Subcutaneous emphysema (SCE) of the head, neck and mediastinum most commonly arises due to penetrating trauma and iatrogenic events facilitating air entry into these spaces [1]. Spontaneous SCE can emerge due to a pressure gradient between the intra-alveolar air and surrounding structures, causing alveolar rupture and dissection of the peribronchovascular sheath. This is known as the Macklin effect. Potential consequences include pneumomediastinum, pneumothorax, facial emphysema and pneumoracchis [1]. We aim to describe a case of SCE in a 21-year-old female presenting to the emergency department (ED) after weight training. A 21-year-old female presented to the ED with a sore throat and dysphagia after weight lifting in the gym 6 h earlier. Training involved repeat Valsalva manoeuvres. She experienced sharp pain with onset over an hour, worse with swallowing. She had a history of gastro-oesophageal reflux disease. Vital signs, local examination and systemic examination were unremarkable. The diagnosis was made with soft tissue neck X-ray, demonstrating emphysema within the prevertebral space extending from the skull base to the first thoracic vertebra (Fig. 1). Her chest X-ray showed no pneumothorax or pneumomediastinum. No intervention was required beyond analgesia, and she was discharged from the ED. She was advised to avoid heavy lifting and diving. A follow-up radiograph showed resolution of the SCE. This case is an important rare entity and highlights for clinicians that pain after physical exercise may involve injuries extending beyond the area directly trained.
Asunto(s)
Enfisema Mediastínico , Neumotórax , Enfisema Subcutáneo , Femenino , Humanos , Adulto Joven , Adulto , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Levantamiento de Peso , Tomografía Computarizada por Rayos X/efectos adversos , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/complicaciones , Dolor en el PechoRESUMEN
Subcutaneous and mediastinal emphysema are known complications of liposuction and body sculpting procedures. Treatment options are limited, and recovery is often prolonged. We discuss a case of severe subcutaneous and mediastinal emphysema after a skin-tightening procedure involving helium gas. The patient received one treatment of hyperbaric oxygen and was followed until symptom resolution. We review the known literature on hyperbaric oxygen therapy as a treatment for subcutaneous emphysema.