RÉSUMÉ
BACKGROUND: Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations. CASE PRESENTATION: We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia. CONCLUSION: Anesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.
Sujet(s)
Analgésie péridurale , Arthroplastie prothétique de hanche , Emphysème médiastinal , Pneumorachis , Humains , Mâle , Emphysème médiastinal/étiologie , Emphysème médiastinal/imagerie diagnostique , Sujet âgé , Analgésie péridurale/effets indésirables , Pneumorachis/étiologie , Pneumorachis/imagerie diagnostique , Arthroplastie prothétique de hanche/effets indésirables , Hémodynamique , Tomodensitométrie , Rachianesthésie/effets indésirablesRÉSUMÉ
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.
Sujet(s)
Emphysème médiastinal , Pneumorachis , Humains , Enfant , Emphysème médiastinal/imagerie diagnostique , Emphysème médiastinal/étiologie , Emphysème médiastinal/thérapie , Études rétrospectives , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Pneumorachis/thérapie , Taïwan , Tomodensitométrie/effets indésirablesRÉSUMÉ
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.
Sujet(s)
Cystite , Emphysème , Pneumorachis , Abcès du psoas , Infections urinaires , Humains , Femelle , Sujet âgé , Sujet âgé de 80 ans ou plus , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Abcès du psoas/complications , Cystite/complications , Cystite/imagerie diagnostique , Infections urinaires/complications , Infections urinaires/traitement médicamenteux , Tomodensitométrie , Emphysème/imagerie diagnostiqueRÉSUMÉ
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.
Sujet(s)
Asthme , Emphysème , Emphysème médiastinal , Pneumorachis , Mâle , Humains , Emphysème médiastinal/imagerie diagnostique , Emphysème médiastinal/étiologie , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Douleur thoracique/étiologie , Douleur thoracique/complications , Asthme/complications , Asthme/diagnosticRÉSUMÉ
A threeyearold domestic shorthair cat was referred for treatment of pelvic limb paralysis. Imaging examinations revealed air in the spinal canal (pneumorrhachis). A rightsided hemilaminectomy was performed to decompress the spinal cord, which led to full resolution of the symptoms within four weeks after the procedure. To our knowledge, this is the first reported case of spontaneous pneumorrhachis in a cat. As there are no treatment standards, we would like to add to their creation. The available literature on pneumorrhachis has also been reviewed.
Sujet(s)
Maladies des chats , Pneumorachis , Animaux , Chats , Femelle , Maladies des chats/chirurgie , Maladies des chats/imagerie diagnostique , Pneumorachis/imagerie diagnostique , Pneumorachis/médecine vétérinaire , Pneumorachis/étiologieSujet(s)
Troubles de la déglutition , Perforation de l'oesophage , Ostéophyte , Pneumorachis , Vertèbres cervicales/imagerie diagnostique , Troubles de la déglutition/imagerie diagnostique , Troubles de la déglutition/étiologie , Perforation de l'oesophage/complications , Perforation de l'oesophage/imagerie diagnostique , Humains , Ostéophyte/complications , Ostéophyte/imagerie diagnostique , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologieSujet(s)
Infections à Clostridium , Pneumocéphale , Pneumorachis , Infections à Clostridium/diagnostic , Infections à Clostridium/traitement médicamenteux , Clostridium perfringens , Humains , Pneumocéphale/imagerie diagnostique , Pneumocéphale/étiologie , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , TomodensitométrieRÉSUMÉ
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.
Sujet(s)
Cathétérisme veineux central/effets indésirables , Voies veineuses centrales , Erreurs médicales , Canal vertébral/traumatismes , Sujet âgé , Femelle , Humains , Imagerie par résonance magnétique , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Radiographie thoracique , Canal vertébral/imagerie diagnostique , Vertèbres thoraciques , TomodensitométrieSujet(s)
Dermatomyosite , Emphysème médiastinal , Pneumorachis , Emphysème sous-cutané , Dermatomyosite/complications , Dermatomyosite/imagerie diagnostique , Humains , Emphysème médiastinal/imagerie diagnostique , Emphysème médiastinal/étiologie , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Emphysème sous-cutané/imagerie diagnostique , Emphysème sous-cutané/étiologie , TomodensitométrieSujet(s)
Maladies des chats , Pneumorachis , Animaux , Maladies des chats/induit chimiquement , Maladies des chats/imagerie diagnostique , Chats , Maladie iatrogène/médecine vétérinaire , Injections épidurales/effets indésirables , Injections épidurales/médecine vétérinaire , Pneumorachis/induit chimiquement , Pneumorachis/imagerie diagnostique , Pneumorachis/médecine vétérinaireRÉSUMÉ
In this article, we present a case of leptomeningeal pneumocephalus and pneumorrhachis secondary to pneumothorax that occurred six years after syringopleural shunting.
Sujet(s)
Dérivations du liquide céphalorachidien/effets indésirables , Pneumocéphale/étiologie , Pneumorachis/étiologie , Pneumothorax/complications , Adulte , Encéphale/imagerie diagnostique , Femelle , Humains , Pneumocéphale/imagerie diagnostique , Pneumorachis/imagerie diagnostique , Pneumothorax/imagerie diagnostique , Syringomyélie/chirurgie , TomodensitométrieRÉSUMÉ
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.
Sujet(s)
COVID-19/imagerie diagnostique , Emphysème médiastinal/imagerie diagnostique , Pneumorachis/imagerie diagnostique , Pneumothorax/imagerie diagnostique , Adolescent , COVID-19/complications , Humains , Mâle , Emphysème médiastinal/étiologie , Pneumorachis/étiologie , Pneumothorax/étiologieRÉSUMÉ
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.
Sujet(s)
Asthme , Pneumorachis , Humains , Pneumorachis/imagerie diagnostique , Pneumorachis/étiologie , Canal vertébral/imagerie diagnostiqueRÉSUMÉ
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.