جستجوی مقالات مرتبط با کلیدواژه "pneumomediastinum" در نشریات گروه "پزشکی"

Pneumomediastinum (PM), the presence of air in the mediastinum, is a rare condition. Severe COVID-19 patients are at an increased risk for PM and subcutaneous emphysema (SCE) due to alveolar rupture from diffuse lung injury. Despite the increased prevalence of PM in COVID-19 patients, the optimal treatment approach remains debated.

This study investigated the prevalence, outcomes, and associated risk factors for PM and SCE in COVID-19 patients.

In this retrospective cohort study, COVID-19 patients aged 18 - 80 with a positive PCR test and chest CT scan from April to December 2021 were included. Cases of PM and SCE were identified, and an equal number of age, sex, and severity-matched COVID-19 patients were selected as the control group for comparison.

Of the 1 557 patients, 89 (5.71%) developed PM. Among these patients, 63 (4.04%) developed SCE. Patients with these complications had significantly longer hospital stays. No significant association was found between comorbidities and the occurrence of PM or SCE. The use of Venturi and non-rebreather masks (OR = 3.075, 95% CI: 1.658 - 5.705), non-invasive ventilation (NIV) (OR = 16.941, 95% CI: 6.545 - 43.851), and invasive mechanical ventilation (IMV) (OR = 5.703, 95% CI: 2.595 - 12.533) were significantly associated with these complications (P < 0.0001). The mortality rate among severe COVID-19 patients with PM was 43.8%, and 47.6% among those with SCE.

Pneumomediastinum and SCE are rare complications in COVID-19 patients, associated with prolonged hospitalization. The use of certain respiratory support methods, including NIV and IMV, significantly increased the risk of these complications. Both PM and SCE are linked to high mortality rates, highlighting the need for careful management in affected patients.

Spontaneous pneumomediastinum (SPM) is a rare and benign self-limiting condition characterized by the presence of air in the mediastinum without an apparent cause. Boerhaave syndrome, on the other hand, is a rare condition caused by spontaneous esophageal perforation due to severe vomiting. Themediastinum is a complex anatomical region housing vital organs, making clinical comprehension challenging.

There is no established approach to diagnosing and treating children with SPM. Despite similarities in the presence of air in the mediastinum, SPM and Boerhaave syndrome are distinct entities. However, the primary challenge for patients is ruling out esophageal perforation. We aimed to highlight this rare issue by presenting the results of our patient series to guide further examination in pediatric patients with mediastinal air.

We included twenty-four pediatric patients diagnosed with SPM between 2014 and 2022. Demographic and clinical characteristics, diagnostic procedures, treatments, and follow-up details were retrospectively recorded.

The mean age of the twenty male and four female patients was 14 years. Common triggers included coughing (45%), increased physical exertion (33%), and retching/vomiting (8%). All patients experienced chest pain, with additional symptoms such as dyspnea (50%), neck pain (30%), and dysphagia (12%). Symptoms resolved within two days of hospitalization. Patients were often misdiagnosed and received inappropriate treatment at other centers before being transferred to our hospital. A fluoroscopic esophagogram conducted within an average of 22 hours from admission revealed no abnormalities. Oral feeding was withheld for an average of 28 hours. The mean duration of symptom-free hospitalization without treatment was 32 hours.

It appears that emergency department physicians may lack familiarity with pneumomediastinum. Surgeons’ concerns about missing Boerhaave’s syndrome may lead to unnecessary tests, prolonged fasting, and hospital stays for patients with SPM.

 Pneumothorax (PTX), pneumomediastinum (PM), and subcutaneous emphysema (SE) are complications associated with COVID-19. It is crucial to study these risk factors, complications, and their prognosis for early diagnosis amidst the rising number of cases today.

 We conducted a case-control study involving 81 pairs of patients diagnosed with SARS-CoV-2 pneumonia complicated by Pneumothorax and pneumomediastinum, comparing them with patients who did not have these complications to assess the risk factors for and prognosis of pulmonary complications in COVID-19.

 The demographic data and medical history of comorbid diseases did not show an association with PTX, PM, and SE in COVID-19 pneumonia (all P-values > 0.05). However, laboratory data such as white blood cell count, lymphocyte count, C-reactive protein, lactate dehydrogenase, troponin, and D-dimer levels were significantly higher in the group with complications (P < 0.05). Additionally, the length of hospital stay was significantly longer in the group with complications, and intubation further extended this duration. The mortality rate was significantly higher in the case group (70% vs. 14%, P < 0.0001), with a significant odds ratio in comparison to patients without complications in the regression model (B = 2.61, Exp(B) = 13.65 with a 95% CI of 6.28 - 29.69).

 Pulmonary complications worsen the prognosis of COVID-19. The pathophysiology of COVID-19 pneumonia can lead to mechanical barotrauma, regardless of intubation status. Ventilator settings should be adjusted below the confidence level. Acute phase reactants and certain inflammatory markers, except for the erythrocyte sedimentation rate (ESR), are elevated in patients with complications, though they do not significantly predict outcomes.

Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition.

A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain.

Orbital emphysema following orbital wall fracture is typically benign and self- limited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such ct

Crigler Najjar syndrome(CNS); is a disease in which the diphosphate glucuronosyltransferase (bilirubin-UGT) enzyme function, which plays a role in the glucuronidation of bilirubin, is deficient as a result of mutation in the uridine 5'-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene.1 As a result, non-hemolytic unconjugated hyperbilirubinemia is seen. Orthotopic liver transplantation (OLT) is seen as a curative treatment option in Crigler Najjar syndrome type 1 (CNS1). In this case report, we present our patients who were 11 months old and 8 years old with a diagnosis of CNS1, whose bilirubin levels were controlled by preoperative daily phototherapy and plasmapheresis, and who had OLT from their parents to two siblings. We wanted to show the importance of a close follow-up and multidisciplinary treatment approach in the early period before OLT in CNS1 patients and thus the benefit to the patient's prognosis in the postoperative period.

The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthroscopy under GA, subcutaneous emphysema, pneumothorax and pneumomediastinum can occur due to the procedure itself, the pleural and alveolar trauma, the endotracheal intubation or extravasation of irrigation fluid during shoulder arthroscopy. In our case, it was not possible to determine the exact cause. However, it is important to keep in mind that subcutaneous emphysema, pneumothorax and pneumomediastinum can occur after arthroscopic shoulder surgery. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment.

Spontaneous pneumothorax is one of the rare complications associated with COVID-19 viral pneumonia, and its exact mechanisms are still unknown. Most often this complication occurs in the setting of mechanical ventilation. This case series reports seven patients with the first presentations of spontaneous pneumothoraxes developing in the absence of mechanical ventilation.This case series study presents seven cases of COVID-19 with a positive COVID-19 PCR test result. A few days had passed from the onset of symptoms, and they had severe pulmonary involvement and high inflammatory markers. The patients received treatment for COVID-19; however, they developed hydropneumothorax and subcutaneous emphysema before being hospitalized or on the first day of hospitalization. A ventilator was used in the case of some patients. The mortality rate was high among these patients.These cases confirm the hypothesis that unusual manifestations of COVID-19 can lead to life-threatening conditions. Therefore, the diagnosis and treatment of these special COVID-19 cases are highly important.

The novel coronavirus infection is a global health concern in 2020. Computerized tomography (CT) scan has an important role in diagnosis and follow-up with the course of the disease. The most common radiologic findings in patients are bilateral peripheral patchy ground-glass opacities and consolidations. Although in a few cases, as we reported, we encountered some rare manifestations such as pneumothorax, pneumomediastinum, and subcutaneous emphysema, which imply distinct concerns about the management and outcome of the disease. Pulmonary interstitial emphysema develops due to an increase in alveolar pressure or because of alveolar rupture, secondary to alveolar membrane damage by the virus and proceed to such a complication. Therefore, it is crucial to be aware of the complications of novel coronavirus infection in the deterioration of the disease.

A novel coronavirus, SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China in December 2019. Coronavirus Disease 2019 (COVID-19) has rapidly spread worldwide. Numerous studies have shown diverse findings on chest CT scan of the patients with COVID-19. The established well-known features of COVID-19 on chest imaging include bilateral multilobar ground-glass opacification (GGO) predominantly with peripheral distribution, mainly in the lower lobes. Atypical presentation of consolidative opacities superimposed on GGO may be found in a smaller number of cases, mainly in the elderly populations. Pleural and pericardial effusion, lymphadenopathy, cavitation, halo sign on CT scan, and pneumothorax are uncommon but may be seen with disease progression. We report a case of severe COVID-19 in an athlete man with development of bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema during progression of the disease. The only risk factor for severe COVID-19 in our patient was suggested to be chronic use of dexamethasone as anabolic steroids. Our patient also received three sessions of plasmapheresis. Unfortunately, the patient expired due to recurrence of bilateral pneumothorax and pneumomediastinum.

Pneumomediastinum (PM) is a self-limiting disease with a good prognosis. Mediastinitis is a rare but potentially fatal complication of PM. Identification of risk factors for mediastinitis is essential for better management.

This is a single-center, retrospective study conducted in a university hospital. Adult patients with PM between January 2016 and June 2020 were involved in the study. The data about age, gender, symptoms, signs, treatment, development of mediastinitis, hospital stay, and mortality were investigated.

In total, 79 patients with PM were analyzed. The most common symptom was dyspnea(58;73.4%) and the most common sign was subcutaneous emphysema (48;60.7%). Thirty(37.9%) of them were iatrogenic PM (IPM), while 22 (27.9%) were spontaneous PM (SPM) and27 (34.2%) were traumatic PM (TPM). Mediastinitis developed in 17 (12 from IPM, 4 from TPM,1 from SPM) patients, and 11 (58.8%) of these patients died. The incidence of mediastinitis in the IPM group was significantly higher than in the TPM and SPM group (respectively, P=0,03,P=0,01). There was no significant difference between the age, gender, symptoms, and signs of those with or without mediastinitis. Mortality was lower in TPM and SPM than IPM (respectively,P=0,05, P=0,03), and hematological malignancy was remarkably common in patients who died from mediastinitis in the TPM and SPM group.

Mediastinitis and mortality were significantly higher in IPM, while hematological malignancy was remarkably prevalent in patients deceased from mediastinitis in TPM and SPM.

Coronavirus disease 19 (COVID-19) can cause many radiological manifestations on chest computed tomography (CT) scans. However, the occurrence of pneumomediastinum is rare in these patients. Accordingly, this study represents the rare cases encountered during the COVID-19 epidemic.

This study focuses on describing three patients who attended our medical center during the COVID-19 epidemic showing pneumomediastinum on chest CT scans. Patients’ COVID-19 was confirmed after positive polymerase chain reaction tests. Finally, two of them were expired despite the efforts of the medical team.

Overall, the results of this study suggest the occurrence of pneumomediastinum on the CT scans of patients as a possible finding of COVID-1

The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.

We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.

This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.

Spontaneous pneumomediastinum or mediastinal emphysema is relatively a rare disease that occurs in viral and bacterial infections with the benign entity.

The patient was a 57-year-old man who, after a week of self-isolation at home, coming to the CO-VID-19 triage center of the hospital with severe shortness of breath. He was admitted to the Intensive Care Unit (ICU) due to acute respiratory failure. The patient was treated as the protocol designed and respiratory support with high flow nasal oxygen and Non-Invasive Positive Pressure Ventilation (NIPPV). Spontaneous pneumomediastinum was developed during viral pneumonia infection. The known risk factors included age, male sex, and abnormal laboratory finding. All the biochemical and hematological findings such as lymphopenia, thrombocytopenia, raised CRP, LDH, and ferritin were detected in our cases. They indicate a possible prognosis for the development of acute respiratory failure and adverse clinical outcomes.

Spontaneous pneumomediastinum has usually a benign outcome in COVID-19 Pneumonia and its prognosis is related to background conditions in patients.

Pneumomediastinum and pneumothorax are usually rare conditions after pneumonia. This study examines the progress of pneumonia of the coronavirus disease 2019 (COVID-19) to spontaneous pneumothorax and pneumomediastinum in a patient.

The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back, and chest pain. The patient used to smoke but now he quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and a ground glass view was also seen in the lungs. In the patient’s tests, RT-PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed and it was positive. Treatment was initiated and because of the progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily; and cavitary changes, air-fluid appearance, and destructive changes of lungs were reported. After eight days, the patient’s cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax, and pneumomediastinum, thus a chest tube was inserted and oxygen therapy was begun on the patient with 3-6 L/min. After 5 days in CT, the patient was relieved of pneumothorax and pneumomediastinum and after a week, the chest tube came out.

Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastinum, and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastinum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide.In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20% of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100%. A 19‑year‑old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Spontaneous pneumomediastinium (SPM) can be due to increased intrathoracic pressure. Pneumomediastinium (PM) with Diabetic Ketoacidosis (DKA) is a very rare complication that can be caused by severe vomiting or Kussmaul breathing.

Case Report:

 The patient is a 15-year-old girl with a history of type 1 diabetes mellitus (T1DM) who has been hospitalized due to nausea, severe vomiting, abdominal pain, chest pain and dyspnea. Based on physical examination and imaging (CXR and chest CT scan), PM was diagnosed. The patient underwent conservative treatment for PM and treatment for DKA and was discharged after 5 days in good general condition.

SPM with DKA is a rare complication with a benign process that usually has a good prognosis if diagnosed and treated timely.

It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery.

We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one.

It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy.

COVID-19 may have various radiological manifestations on the patient’s chest computed tomography (CT) scan. Few cases with COVID-19 and pneumomediastinum have been reported to date. Here we present a patient with COVID-19, pneumomediastinum and emphysema.

Pneumomediastinum (PM) is caused by alveolar rapture. If air leak persists, subcutaneous emphysema occurs. The PM and subcutaneous emphysema have various etiologies. Common causes are respiratory tract infections and asthma exacerbations. Rarely, the PM occurs secondary to foreign body aspiration, and the life-threatening complications will occur without proper treatment.

Case report: 

we report a 2.5- year- old boy who was presented with cough, fever, neck swelling and respiratory distress to Amirkola Childrenchr('39')s Hospital. On examination, he had subcutaneous emphysema (SCE) in neck and upper thorax. He had pneumomediastinum in radiography. The patient was treated with oxygen, antibiotic, and due to the suspicious history of foreign body aspiration he underwent bronchoscopy by which pieces of nuts removed from his right main bronchus.

PM and SCE are rare presentations of foreign body aspiration and in such circumstances, the possibility of foreign body should be considered.

The patient to be presented here was a 44-year-old man who was admitted with the muscle weakness, cough, weight loss, and dyspnea. He was a known case of dermatomyositis since 4 months ago. The characteristic features of his condition included with the purpuric cutaneous scaling rash, heliotrope rash Gottron’s papules, shawl sign, dyspnea and 25 kg weight loss. Thoracic computed tomography revealed ground glass opacities and pneumomediastinum. The patient was diagnosed with dermatomyositis. pneumomediastinum, pneumothorax and subcutaneous emphysema were observed as well. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed and the patient died...