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 adversosRESUMO
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 imagemRESUMO
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/diagnósticoAssuntos
Transtornos de Deglutição , Perfuração Esofágica , Osteófito , Pneumorraque , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico por imagem , Humanos , Osteófito/complicações , Osteófito/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologiaAssuntos
Infecções por Clostridium , Pneumocefalia , Pneumorraque , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Clostridium perfringens , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Tomografia Computadorizada por Raios XRESUMO
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 XAssuntos
Dermatomiosite , Enfisema Mediastínico , Pneumorraque , Enfisema Subcutâneo , Dermatomiosite/complicações , Dermatomiosite/diagnóstico por imagem , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios XAssuntos
Doenças do Gato , Pneumorraque , Animais , Doenças do Gato/induzido quimicamente , Doenças do Gato/diagnóstico por imagem , Gatos , Doença Iatrogênica/veterinária , Injeções Epidurais/efeitos adversos , Injeções Epidurais/veterinária , Pneumorraque/induzido quimicamente , Pneumorraque/diagnóstico por imagem , Pneumorraque/veterináriaRESUMO
In this article, we present a case of leptomeningeal pneumocephalus and pneumorrhachis secondary to pneumothorax that occurred six years after syringopleural shunting.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Pneumocefalia/etiologia , Pneumorraque/etiologia , Pneumotórax/complicações , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Siringomielia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
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/etiologiaRESUMO
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.
Assuntos
Asma , Pneumorraque , Humanos , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Canal Medular/diagnóstico por imagemAssuntos
Enfisema Mediastínico , Pneumorraque , Enfisema Subcutâneo , Feminino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Pneumorraque/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios XRESUMO
Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher's exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% had penetrating injuries. Thirty-four per cent of cases were extradural PR, 21% intradural PR, and unreported PR type in 43%. Nine per cent of patients presented with symptoms directly attributed to PR: sensory radiculopathy (2%), motor radiculopathy (1%), and myelopathy (6%). CT had a 100% sensitivity for diagnosing PR, MRI 60%, and plain radiograph 48%. Concurrent injuries reported include pneumocephalus (42%), pneumothorax (36%), spine fracture (27%), skull fracture (27%), pneumomediastinum (24%), and cerebrospinal fluid leak (14%). PR was managed conservatively in every case, with spontaneous resolution in 96% on follow-up (median = 10 days). Prophylactic antibiotics for meningitis were given in 13% PR cases, but there was no association with the incidence of meningitis (overall incidence: 3%; prophylaxis group (0%) vs non-prophylaxis group (4%) (p = 1)). Occasionally, traumatic PR may present with radiculopathy or myelopathy. Traumatic PR is almost always associated with further air distributions and/or underlying injuries. There is insufficient evidence to support the use of prophylactic antibiotic in preventing meningitis in traumatic PR patients.
Assuntos
Pneumorraque/diagnóstico por imagem , Pneumorraque/cirurgia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Idoso , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Pneumorraque/etiologia , Radiografia/tendências , Canal Medular/diagnóstico por imagem , Canal Medular/cirurgia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesõesRESUMO
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.