1/31. Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/31. Pneumomediastinum after dental surgery.A previously healthy woman presented with chest pain and cervical swelling several hours after undergoing surgical removal of third molar teeth. Mediastinal and subcutaneous emphysema was demonstrated by chest X-ray. air had been introduced under the soft tissue flap by the high-speed turbine drill used to remove the alveolar bone, rather than the air/water syringe. Surgical handpieces that vent the air away from the surgical field should be used during such procedures. The mediastinal and subcutaneous air resolved after oxygen administration.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
3/31. pneumoperitoneum without perforation of the gastrointestinal tract.pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
4/31. Anterior pathway for transdiaphragmatic extension of pneumomediastinum.It is classically taught that mediastinal air enters the abdomen posteriorly by dissection along vascular sheaths. Present studies in infants, children, and young adults demonstrate dissection of extrapleural air to the subdiaphragmatic extraperitoneal space between the sternocostal origins of the diaphragm. The presence of extrapleural air above and extraperitoneal air below the diaphragm clearly defines the anterior diaphragmatic attachments, producing a characteristic radiographic sign. Recognition of this sign permits precise localization of air collections above and below the diaphragm, implying subdiaphragmatic extension of extraalveolar air rather than retroperitoneal perforation of a hollow viscus. Since collections of both extrapleural and intrapleural air may collect in a subpulmonic location, the ability to distinguish one from another has definite implications regarding chest tube placement.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
5/31. Pneumomediastinum, pneumopericardium, and epidural pneumatosis in DKA.Pneumomediastinum (PM) is an uncommon condition characterized by the presence of air in the mediastinum. It is associated with alveolar rupture that allows air to traverse along the bronchovascular bundle into the mediastinum. A review of the world medical literature identified 50 additional cases of PM and pneumopericardium (PC) associated with diabetic ketoacidosis (DKA). We report the occurrence of PM, PC, as well as epidural pneumatosis occurring simultaneously in a patient with DKA. Epidural pneumatosis in association with this metabolic derangement has not been previously described.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
6/31. Spontaneous mediastinal emphysema.OBJECTIVE: Spontaneous mediastinal emphysema is uncommon. Its cause has not been determined precisely, but the entity is usually associated with suddenly raised alveolar pressure. methods: Between 1980 and 2001, 114 patients with mediastinal emphysema of various causes were hospitalized in the Wolfson Medical Center. In 22 of these patients (19.3%) the emphysema occurred without an obvious preceding event and was classified as spontaneous. The commonest symptoms and signs were chest pain, dyspnea and subcutaneous emphysema. All patients were kept under observation. Contrast esophagogram was performed in two patients who vomited. Pleural drains were inserted in six patients who had concomitant pneumothorax. RESULTS: All patients recovered and were followed for at least one year. There were no complications and no recurrences. CONCLUSIONS: Spontaneous mediastinal emphysema is usually a benign condition, which can be treated expectantly. The patients should be observed for 24 h. Recurrences are rare.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
7/31. Spontaneous pneumomediastinum and myocarditis following Ecstasy use: a case report.Ecstasy is a very popular and widely used party drug with known complications such as agitation, hyperpyrexia, rhabdomyolysis or renal failure. A 16-year-old boy was admitted to our Emergency Department with a spontaneous pneumomediastinum (SPM) after Ecstasy ingestion, complicated by myocarditis. To our knowledge this is the first case described with the combination of Ecstasy ingestion, SPM and myocarditis. Although SPM is well known in inhalation drug users who try to enhance alveolar resorption with repeated valsalva manoeuvres, it is rather rare after the ingestion of party drugs. The probable causative event is the prolonged and excessive dancing in this party drug culture. The course is usually benign, with spontaneous resorption. Emergency physicians should be aware of the risk, especially if a drug user presents with neck emphysema, difficulty in swallowing, and precordial crepitations or thoracic pain. Ecstasy, similarly to cocaine, can induce cardiac symptoms.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
8/31. subcutaneous emphysema associated with pneumomediastinum after general anesthesia--closed rhinolalia as an initial presentation in one of two cases.We report two cases of subcutaneous emphysema associated with pneumomediastinum after general anesthesia. One of them was devoid of common symptoms such as chest pain and dyspnea, but significant closed rhinolalia was noted initially. Though in these two cases the chest CT scanning revealed no perivascular emphysema, we highly suspected that this phenomanum resulted from alveolar rupture with Macklin effect. Close observation was the best treatment since neither trachea injury was in evidence nor was there the occurrence of other complication. The differential diagnosis and approach to therapy are presented after review of the relevant literature.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
9/31. Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
10/31. Pneumomediastinum due to tracheal foreign body granuloma.Primary tracheal masses are rare. Secondary masses of the trachea are commonly foreign body granuloma, intubation granuloma or viral granuloma. The differential diagnoses given in such cases include both benign and malignant lesions. The otolaryngologist is often asked to perform a biopsy of the lesion to arrive at a diagnosis. However, even malignant processes can cause a granulomatous reaction. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion. A rare case of tracheal granuloma leading to pneumomediastinum in a 53-year-old female is presented. The clinical features, investigations and treatment are detailed. The tracheal granuloma was managed by excision through bronchoscopy and the pneumomediastinum was managed conservatively.- - - - - - - - - - ranking = 0.0017538373309304keywords = process (Clic here for more details about this article) |
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