Cases reported "Mediastinal Emphysema"

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1/12. Acute spontaneous pneumomediastinum in a child with Hodgkin's disease and pulmonary fibrosis.

    A case of acute spontaneous pneumomediastinum in a 13-year-old boy suffering from Hodgkin's disease and pulmonary fibrosis is reported. He was initially treated for pneumocystis carinii but his respiratory function progressively deteriorated, and fibrosis secondary to bleomycin was suspected. The day before the admission to the Pediatric Intensive Care Unit the patient complained of anterior thoracic pain, and a chest x-ray revealed a left-sided small spontaneous pneumothorax and pneumomediastinum. Although air leak responded initially to conservative treatment, acute tension pneumomediastinum with cardiopulmonary decompensation recurred 6 days later, while the patient was on mechanical ventilation. Treatment with urgent evacuation of the accumulated air via subxiphoid drainage, using an old but ill-defined technique, resulted in complete resolution of pneumomediastinum and significant improvement of the hemodynamic condition.
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2/12. life-threatening upper airway obstruction in a child caused by retropharyngeal emphysema.

    A 2 1/2-year-old boy with acute obstructive lung disease from adenovirus infection developed cough-induced paroxysms of intense dyspnoea leading to respiratory failure. Chest x-ray and fluoroscopy demonstrated retropharyngeal air occluding the airway. The clinical management of this and similar air-leak problems is discussed.
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3/12. Benign noninfectious subcutaneous emphysema of the hand.

    A 17-year-old girl presented pain and subcutaneous crepitation in the left hand. Because of lack of systemic symptoms, non-infectious cause was considered. Radiographic and magnetic resonance imaging revealed subcutaneous emphysema. A chest x-ray was reported as normal but chest computerised tomography revealed pneumomediastinum. On the third day of the hospitalisation, subcutaneous emphysema spread to arm, shoulder, head, left hemithorax, back, bilateral supraclavicular, cervical, submandibular and periorbital regions. Pneumomediastinum and subcutaneous emphysema disappeared during 6 weeks of follow up with conservative methods. This might have prevented unnecessary surgical intervention. This report demonstrates that benign non-infectious subcutaneous emphysema of the hand due to pneumomediastinum should be kept in mind in hand surgery.
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4/12. Surgical emphysema: a rare presentation of foreign body inhalation.

    An 11-year-old girl with an almond lodging in the tracheobronchial tree is described. She presented with an uncommon symptom of subcutaneous emphysema The x-ray revealed left-sided pneumothorax and pneumomediastinum. Intercostal drain was inserted, but she developed respiratory failure and was ventilated. After initial stabilization for 60 hours, she deteriorated again and her x-ray revealed right-sided collapse. After removal of the foreign body, she was discharged but presented again with stridor necessitating tracheostomy. tracheal stenosis was found and required end-to-end anastomosis. The authors feel that, while foreign bodies are uncommon in this age group with emphysema as a rarer manifestation, this cause should be kept in mind, even in the absence of forthcoming history. A high index of suspicion for tracheobronchial foreign body is required in atypical presentations of acute pediatric respiratory distress.
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keywords = x-ray
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5/12. Pneumomediastinum causing pneumoperitoneum.

    Pneumomediastinum is characterized by the presence of air in the mediastinum and has been recognized since 1827, when described by Laennec. To the best of our knowledge, pneumoperitoneum as a result of spontaneous pneumomediastinum has not yet been described in the English literature. We observed and treated a young patient in the intensive care unit who presented with spontaneous pneumomediastinum. Free intra-abdominal gas was observed on the chest x-ray film on the day after admission. Management was conservative. Intra-abdominal and mediastinal air disappeared within four days. This condition, when recognized, needs only observation; we report this as a medical curiosity.
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6/12. Delayed pneumomediastinum and pneumothorax complicating laparoscopic extraperitoneal inguinal hernia repair.

    A 53-year-old healthy man underwent elective laparoscopic, extraperitoneal, right-sided herniorrhaphy. Postoperatively, he complained of chest pain on inspiration. Chest x-ray and computed tomographic scan revealed a pneumomediastinum and a right-sided pneumothorax. Previous case reports and possible etiologies are reviewed.
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7/12. Pneumomediastinum secondary to a mandible fracture.

    Pneumomediastinum may be produced by a simple facial fracture. It may also be a sign of other aerodigestive tract injuries, and this possibility should be ruled out. A minimal patient workup should include panendoscopy and soft tissue neck x-ray films in all cases. If no other injuries are found, resolution of the pneumomediastinum may be expected without further treatment.
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8/12. Pneumomediastinum on a surgical service.

    mediastinal emphysema results from multiple etiologies and is associated with a variety of underlying disease entities. Twenty five patients with pneumomediastinum treated on a surgical service over a 6 year period were reviewed. The cause of the mediastinal emphysema was related to trauma in seven patients, attempted central venous access in four patients, cardiopulmonary resuscitation in four patients and some type of valsalva maneuver in ten patients. Besides the mediastinal emphysema, air may dissect into the peritoneal cavity, the pericardium, and the subcutaneous tissues within the neck and chest wall. Treatment of the mediastinal emphysema, per se, is expectant; success or failure is determined by treatment of the associated underlying problems. Deaths occurred in three patients after cardiopulmonary resuscitation and in one patient after crushing chest injury. One patient with an associated hydrothorax was found to have a perforated distal esophagus which was treated by emergency fundoplication. When associated diseases are absent and there is no evidence of pleural effusion or hydrothorax, no special diagnostic tests are indicated. Sequential chest x-rays are used to follow the pneumomediastinum through resolution, which usually occurs within 72 hours.
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9/12. mediastinal emphysema following Le Fort I osteotomy: report of a case.

    mediastinal emphysema is a rare but known complication of deep-space infection or maxillofacial trauma. In this case report, a healthy 17-year-old girl experienced chest pain on the third day after a Le Fort I maxillary osteotomy. An film x-ray of the chest showed air in the mediastinum. A discussion of the potential causes and management of this complication are presented.
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10/12. Unusual complications of subclavian catheterization.

    Infraclavicular subclavian vein catheterization is still a well accepted technique both in operating rooms and intensive care units. Two unusual complications are described: delayed intrathoracic haematoma and severe mediastinal emphysema needing prolonged treatment. The case reports are presented and the complications discussed. The necessity for routine chest x-ray post-operative catheterization and the danger of multiple attempts are stressed.
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