Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema in a patient with pneumonia: A case report and literature review.

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.

Pneumorrhachis: A rare cause of headache in a patient with a traumatic spinal cord injury due to gunshot wound.

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.

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.

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.

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.

Neumorraquis y neumomediastino espontaneo, rara complicación asmática / Pneumorrhachis and spontaneous pneumomediastinum, asthmatic rare complication

No disponible

[Atraumatic pneumorrhachis in a young man with chest pain]. / Atraumatisk opstået pneumorakis hos en ung mand med brystsmerter.

A 22-year-old man experienced sudden chest pains after riding a mountain bike. The clinical examination showed subcutaneous emphysema on collum and a CAT-scan showed intraspinal air known as pneumorrhachis (PR). The treatment had to be based on the individual findings depending on the cause of PR and often needed a multidisciplinary effort. In this case the patient's condition improved and he was discharged after three days of observation without further treatment.

Pneumorachis associated with multiorgan infection due to Citrobacter koseri.

Pneumorachis rarely occurs after spreading from a contiguous site of infection or after a traumatic event. We describe an adult patient who developed sepsis and a renal abscess due to Citrobacter koseri, and computed tomographic imaging identified gas within the entire spinal canal as well as an iliopsoas abscess. This patient recovered from pneumorachis caused by disseminated infection.

Cauda equina syndrome caused by epidural pneumorrhachis: treatment with percutaneous computed tomography-guided translaminar trephination.

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To present a rare case, and its treatment, of cauda equina syndrome (CES) caused by epidural pneumorrhachis after repeated caudal epidural injections. SUMMARY OF BACKGROUND DATA: Pneumorrhachis is defined as the presence of air in the epidural or subarachnoid space. Epidural pneumorrhachis is usually asymptomatic and managed conservatively, but rare cases of lumbar radiculopathy resulting from epidural air have been reported. To the best of our knowledge, there has been no previous report of CES caused by epidural air. METHODS: A 63-year-old male presented with recent aggravation of a low backache, with pain radiating to both lower limbs. He also complained of newly developed numbness in the buttocks, groins, and perineum, and difficulty with urination and defecation, after repeated caudal epidural injections during a 3-week period. Computed tomography and magnetic resonance imaging revealed epidural pneumorrhachis compressing the lumbar dural sac at the L2-L3 and L3-L4 levels. The patient's symptoms persisted despite 3 days of oxygen inhalation therapy. Attempted needle aspiration of the epidural air was unsuccessful and percutaneous computed tomography-guided translaminar trephination was performed. RESULTS: The day after trephination, the patient's lower extremity motor strength began to improve; sphincter dysfunction began to resolve on the second day. During 8 weeks, his pain resolved and he gradually regained sensation. Two years later, the patient was free of symptoms or signs of CES. CONCLUSION: Epidural pneumorrhachis may cause dural sac compression, thus worsening a patient's previous symptoms and possibly eliciting new problems such as CES. Conservative treatment should be the first-line approach, but surgery is often necessary when the problem remains unsolved. Percutaneous computed tomography-guided translaminar trephination may be an alternative to surgical decompression of the epidural space in selected patients.