Pneumorrhachis With FDG Uptake Cervical Lesions on PET/CT of a Patient With Suspected Recurrent Hypopharyngeal Cancer.

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.

Pneumorrhachis Secondary to a Locally Advanced Rectal Cancer with Pre-Sacral Abscess-Case Report and Review.

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.

Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report.

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.

Central Venous Catheter Penetrating the Spinal Canal via the Spinal Foramen: A Case Report and Literature Review.

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.

[Non traumatic pneumorrhachis]. / L'image du mois. Pneumorachis non traumatique.

Presence of air in the spinal canal, called pneumorrhachis (PR) is a rare and likely unrecognized condition often due to traumatic or iatrogenic causes. Most of PR occur after repeated epidural ponction or penetrating trauma or brutal intra-alveolar increase especially in asthma attack. Non traumatic and non iatrogenic causes are uncommon but can appear in a neoplastic context.

La présence d'air dans le canal spinal, ou pneumorachis (PR), est une entité rare, souvent méconnue, habituellement de nature traumatique ou iatrogénique. Le PR survient essentiellement à la suite de ponctions épidurales répétées, d'un traumatisme pénétrant ou d'une majoration brutale de la pression intra-alvéolaire, notamment lors d'une crise asthmatique. Le PR non traumatique et non iatrogénique est excessivement rare, survenant alors volontiers dans un contexte néoplasique.

Intramedullary pneumorrhachis following a cervical epidural steroid injection.

Pneumorrhachis (PR) is a rare radiological condition characterized by the presence of intraspinal air. PR is commonly classified as spontaneous (nontraumatic), traumatic, or iatrogenic, and iatrogenic PR is the most common and often occurs secondary to invasive procedures such as epidural anesthesia, lumbar puncture, or spinal surgery. PR is usually asymptomatic, but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of intramedullary cervical PR following a cervical epidural steroid injection (ESI) and include pertinent discussion.

Encapsulated gas accumulation in the spinal canal: Pneumorrhachis in two dogs.

A 17-year-old mongrel dog and 12-year-old Shiba Inu dog presented with ataxia and paresis of the pelvic limbs, respectively. Gas accumulation within the spinal canal adjacent to the herniated disc was suspected in both cases. Since the gas remained accumulated for a prolonged period, hemilaminectomy was performed to decompress the spinal cord. The bulged external lamina of the dura matter was removed and histopathologically examined. Granulomatous inflammation and hyperplasia of fibrous connective tissues was noted, suggesting that the gas was encapsulated and the fibrous nodules made reabsorption difficult. Clinical signs resolved post-surgery. This is the first report describing histopathological features of pneumorrhachis in dogs. The accumulated gas was successfully removed by surgery. Postoperative course remained uneventful in both cases.

Extensive Pneumorrhachis Associated with Vaping-Induced Lung Injury.

BACKGROUND: Pneumorrhachis refers to air within the spinal canal and is most commonly associated with traumatic spinal injuries or spine surgery. A link between pneumorrhachis and certain pulmonary diseases, such as asthma, has also been demonstrated in the literature; however, there are no previous reports of pneumorrhachis secondary to vaping-induced lung injury. CASE DESCRIPTION: A 15-year-old boy with vaping-induced lung injury experienced acute respiratory decompensation after straining. Computed tomography of the chest revealed bilateral pneumothoraces, extensive pneumomediastinum, and pneumorrhachis. Extensive air was seen in the spinal canal from the cervical spine down to the level of the T8 vertebrae. CONCLUSIONS: The emerging condition of vaping-induced lung injury may place patients at risk for serious complications of extrapulmonary air including pneumorrhachis. To our knowledge, this is the first report of pneumorrhachis secondary to vaping-induced lung injury.

Significance of intracranial gas on post-mortem computed tomography in traumatic cases in the context of medico-legal opinions.

The detection of intracranial gas (ICG) in people who died due to trauma became possible once postmortem computed tomography (PMCT) became available in addition to traditional post-mortem examinations. The aim of this study was to determine the importance of ICG in the context of medico-legal opinions. We assessed 159 cases of trauma-induced death. Cadavers with pronounced signs of decomposition, open skull fractures, and after neurosurgical operations were excluded. Both PMCT findings and data from autopsy reports were analyzed. ICG was found in 38.99% (n = 62) of the cadavers, 96.77% (n = 60) of which presented with pneumocephalus (PNC) and 40.23% (n = 25) with intravascular gas (IVG). There was a strong correlation between ICG and skull fractures/brain injuries, as well as chest injuries, especially lung injuries. In 13 cases, ICG presented without skull fractures; three of these cases died as a result of stab and incised wounds to the neck and chest. The mean time between trauma and death was significantly longer in the non-ICG group than the ICG group at 2.94 days (0-48 days) and 0.01 day (0-1 day), respectively (p < 0.0001). The presence of ICG is a result of severe neck and chest injuries, including stab and incised wounds. The victims die in a very short amount of time after suffering trauma resulting in ICG. The ability to demonstrate ICG on PMCT scans can be of significance in forming medico-legal opinions.

A rare case of concomitant pneumocephalus and pneumorachis after lumbar spine surgery with late presenting dural leak.

Introduction: We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon. Case presentation: A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month. Discussion: Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.

Pneumocephalus and pneumorachis after blunt chest trauma without spinal fractures: a case report.

BACKGROUND: Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. CASE DESCRIPTION: We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient's state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. CONCLUSIONS: This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.

Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports.

BACKGROUND: Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection of air into the subarachnoid or subdural space. No cases of cardiac arrest associated with these complications have been reported in the literature previously. CASE PRESENTATION: We report cases of pneumorrhachis and pneumocephalus in two Korean women who previously visited a local pain clinic and underwent epidural analgesia. Thereafter, they were admitted to the emergency department with cardiac arrest. Cardiopulmonary resuscitation was performed on these patients, and return of spontaneous circulation was achieved. The brain and spine computed tomographic scans showed pneumorrhachis and pneumocephalus, respectively. These cases demonstrate that pneumorrhachis and pneumocephalus may occur after epidural analgesia, which may be associated with cardiac arrest in patients. CONCLUSIONS: If cardiac arrest occurs after epidural analgesia, pneumocephalus and pneumorrhachis should be considered as its cause. Although epidural analgesia is a common procedure, caution is warranted during this procedure.

Extensive subcutaneous emphysema, pneumomediastinum, and pneumorrhachis following third molar surgery.

Third molar extraction is a common procedure in dental surgery. Common complications that may occur post procedure include pain, trismus, bleeding, dry socket, and nerve injuries. Subcutaneous emphysema is an uncommon complication. A rare case of extensive cervicofacial subcutaneous emphysema, pneumomediastinum, and pneumorrhachis following third molar extraction is reported here. Issues relating to the diagnosis, aetiology, and management of these complications are discussed.

Recurrent Spontaneous Pneumomediastinum With Concurrent Pneumorrhachis: A Rare Clinical Entity.

Spontaneous pneumomediastinum is the presence of interstitial air in the mediastinal structures without an apparent cause. Pneumorrhachis is defined as the presence of air in the spinal canal. Concurrent pneumorrhachis is an extremely rare epiphenomenon of spontaneous pneumomediastinum without pneumothorax. Diagnosis is confirmed by radiologic imaging of the chest. Spontaneous pneumomediastinum and pneumorrhachis usually resolve with conservative therapy such as bed rest, analgesic agents, and supplemental oxygen. A 20-year-old male patient presented with recurrent spontaneous pneumomediastinum with concurrent pneumorrhachis with a gap of 1 year between the two episodes. Pneumomediastinum and pneumorrhachis resolved with conservative management in both episodes.

Epidural Pneumorrhachis Causing Intraoperative Loss of Motor Potentials During Instrumented Fusion for Scoliosis: A Case Report.

CASE: In a patient who underwent a thoracoscopic anterior release combined with a posterior spinal fusion for juvenile idiopathic scoliosis, unilateral loss of neuromonitoring signals was noted during the posterior instrumentation, and epidural pneumorrhachis was identified by intraoperative O-arm imaging. An immediate laminectomy and decompression of epidural fat and air were performed, resulting in return of the neuromonitoring signals. The patient had no clinical motor or neurological deficits postoperatively, and the posterior spinal fusion was completed successfully 3 days later. CONCLUSION: Epidural pneumorrhachis is a possible complication of scoliosis surgery with pedicle screw fixation, which can result in the intraoperative loss of neuromonitoring signals; however, rapid identification and intervention can result in an excellent outcome.

Skull base and craniocervical bone pneumatisation: two case reports of differing presentations and a review of the literature.

We report two patients with increased central skull base and craniocervical junction bone pneumatisation complicated by extra-osseous gas. One patient presented with symptoms of increasing nasal blockage and 'sinus pressure' on a background of extensive nasal polyposis. He was subsequently found to have a history of repeated Valsalva's manoeuvre, the cessation of which resulted in a rapid decrease in the amount of extra-osseous gas on imaging. The second patient presented following a minor head trauma with dysarthria from a hypoglossal nerve palsy and neck pain, with extensive intra- and extra-cranial gas including within the spinal canal (pneumorrhachis). These radiological findings have been reported previously in patients with Eustachian tube dysfunction and/or activities leading to frequently raised middle ear pressures. We review the possible aetiologies, reported risk factors, and the range of associated imaging abnormalities that may be encountered with this rare appearance.

Postoperative symptomatic haematoma and pneumorrhachis in a dog with a thoracolumbar intervertebral disc extrusion.

CASE REPORT: A 6-year-old male neutered crossbreed dog presented with acute onset paraparesis and was diagnosed with an L1-L2 intervertebral disc extrusion. A right-sided T13-L2 hemilaminectomy was performed. However, the dog deteriorated and became paraplegic with marked thoracolumbar hyperaesthesia 48 h after surgery. A computed tomography scan of the thoracolumbar vertebral column revealed the presence of pneumorrhachis (PR) at the level of T13, possibly embedded in a haematoma, and causing marked spinal cord compression. Revision surgery confirmed the presence of a haematoma, which was removed. The dog gradually improved and was neurologically normal 6 weeks after surgery. CONCLUSION: Although PR is a rare condition, it may be considered a possible cause for early postoperative neurological deterioration in dogs undergoing decompressive spinal surgery. Surgical revision resulted in a good outcome in the presented case.