Pneumomediastinum, pneumothorax and subcutaneous emphysema with kerosene oil.
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Spontaneous emphysema is not only the rate complication of bronchial asthma but may also be the first, atypical manifestation of the disease. We have presented here the case report of a young man in whom the occurrence of spontaneous pneumomediastinum with subcutaneous emphysema and pneumothorax led to the diagnosis of bronchial asthma.
A 38-year-old man was diagnosed as having acute myelogenous leukemia in December 2001. He achieved a complete remission after undergoing three courses of induction chemotherapy. As the patient's prognosis was considered to be poor, he was then treated with a bone marrow transplant from his HLA 1 antigen mismatched sister in May 2002. Grade 2 skin graft-versus-host-disease (GVHD) developed on day 14 but reduced with methylprednisolone (mPSL). Prednisolone (PSL) was discontinued on day 104, and the patient was discharged on day 112. There was no evidence of clinical chronic GVHD, the serum creatinine level remained high, and cyclosporine (CsA) was gradually tapered off and discontinued on day 165. However chronic GVHD of the skin appeared on day 179, and CsA (100 mg/day) was restarted. On day 186 he was admitted to our hospital complaining of fever. A CT scan of the chest demonstrated bilateral interstitial infiltrates, which were considered as lung GVHD lesions and PSL was started, following which chronic GVHD of the skin and liver improved. The lung GVHD worsened, however, subcutaneous and mediastinal emphysema developed and the patient died on day 206. Interstitial pneumonia had progressively worsened as the manifestation of the chronic lung GVHD. We concluded that this clinical course was rare.
We have reviewed the spectrum of gaseous densities in the soft tissues secondary to a perforated viscus. All patients presented late and most were elderly. The most common surgical procedure was diversion of the fecal stream proximal to the perforation. In our series 4 of 7 patients died in the immediate postoperative period. Knowledge of the mechanism and differential diagnosis of this entity will prevent overlooking this possibility, as occurs too frequently, particularly with subcutaneous emphysema of the leg.
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Pneumomediastinum is uncommon in pediatric medical practice, outside the neonatal period. While asthma or respiratory infections are the most frequent underlying causes, it is important not to forget the possibility of foreign body aspiration, particularly after the clinical presentation.
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Upper aerodigestive tract injury after endotracheal intubation is a rare but serious complication. The case of a 57-year-old female, who developed extensive neck and pneumomediastinum following a knee arthroscopy under general anaesthesia, is presented. Possible mechanisms of injury and management options are discussed.