Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 54

 

Home  | About Us | Editors | Search | Ahead Of Print | Current Issue | Archives | Submit Article | Instructions | Subscribe | Contacts | Login 
     


 
 
Table of Contents
LETTER TO THE EDITOR
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 72-73

Extensive subcutaneous emphysema complicating spontaneous pneumomediastinum


Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, New York, United States

Date of Web Publication10-Mar-2017

Correspondence Address:
Amer Hawatmeh
111 Central Avenue, Newark, New Jersey 07102
United States
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCIIS.IJCIIS_9_17

Rights and Permissions

How to cite this article:
Thawabi M, Studyvin S, Al-Halawan M, Hawatmeh A. Extensive subcutaneous emphysema complicating spontaneous pneumomediastinum. Int J Crit Illn Inj Sci 2017;7:72-3

How to cite this URL:
Thawabi M, Studyvin S, Al-Halawan M, Hawatmeh A. Extensive subcutaneous emphysema complicating spontaneous pneumomediastinum. Int J Crit Illn Inj Sci [serial online] 2017 [cited 2017 Sep 24];7:72-3. Available from: http://www.ijciis.org/text.asp?2017/7/1/72/201963

Dear Editor,

Spontaneous pneumomediastinum (SPM) is the presence of air within the confines of mediastinal fascia and subcutaneous tissues of the thorax, upper limbs, and neck. It was first reported by Hamman in 1939, and hence, the crepitus heard with the heartbeat on auscultation is known as the Hamman sign.[1] SPM is a rare clinical condition observed in young adults. Macklin proposed that a sudden pressure gradient between the lung periphery and the hilum can cause rupture of the terminal alveoli. Subsequently, air dissects along the pulmonary vasculature toward the hilum and then centrally to reach the mediastinum forming SPM. This sudden pressure gradient can be precipitated by many events such as intense coughing, emesis, or physical activity.[2]

We present a case of an 18-year-old male, with unremarkable medical history, presented with severe shortness of breath and nonproductive cough that has worsened in the past day. He also described one episode of posttussive emesis and skin bulging and crepitation over his chest and neck. He reported that his symptoms started 1 year ago and worsened recently. He denied any recent upper respiratory illness, sick contacts, recent travel, significant smoking history, or exposure to any fumes or toxins. His vital signs were significant for a respiratory rate of 22/min, heart rate 110 beats/min, and oxygen saturation 94% on room air. His physical examination was significant for subcutaneous emphysema palpated along the upper chest and neck. Lung auscultation revealed bilateral expiratory wheezing. Chest X-ray demonstrated extensive pneumomediastinum with air tracking into the soft tissues of the neck with no pneumothorax [Figure 1]. Chest and neck computerized tomography revealed extensive pneumomediastium involving the anterior, middle, and posterior mediastinum. No gross evidence of oral contrast extravasation or pneumothorax was evident [Figure 2],[Figure 3],[Figure 4]. Oxygen and bronchodilators were administered with immediate improvement in his condition. Subsequently, he underwent pulmonary function test with spirometry pre- and post-bronchodilator which was consistent with asthma.
Figure 1: Chest X-ray showing extensive pneumomediastinum with air tracking into the soft tissues of the neck with no pneumothorax

Click here to view
Figure 2: Chest computerized tomography coronal plane showing extensive pneumomediastium involving the anterior, middle, and posterior mediastinum

Click here to view
Figure 3: Chest computerized tomography axial plane at the level of the aortic arch level showing extensive pneumomediastium involving the anterior, middle, and posterior mediastinum

Click here to view
Figure 4: Neck computerized tomography showing extensive air tracking into the soft tissues of the neck

Click here to view


SPM is rare with only few case reports in the literature. Patients most commonly present with chest pain, shortness of breath, and subcutaneous emphysema. This condition can occur in healthy young adults without triggering events; however, predisposing conditions and precipitating events are usually identified. SPM appears to be a benign condition, that resolves over a week, and rarely recurs or has any sequelae.[3],[4]

The diagnosis is made with the radiographic examination. Chest X-ray is the initial imaging modality; however, around 30% of the cases can be missed by this modality. Computed tomography much more sensitive than plane X-ray and has become the gold standard for diagnosis. In addition, computed tomography can be helpful in excluding other causes of pneumomediastinum that might have an unfavorable outcome.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Ito S, Takada Y, Tanaka A, Ozeki N, Yazaki Y. A case of spontaneous pneumomediastinum in a trombonist. Kokyu To Junkan 1989;37:1359-62.  Back to cited text no. 1
    
2.
Mecklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum. Arch Int Med 1979;64:913-26.  Back to cited text no. 2
    
3.
Jougon JB, Ballester M, Delcambre F, Mac Bride T, Dromer CE, Velly JF. Assessment of spontaneous pneumomediastinum: Experience with 12 patients. Ann Thorac Surg 2003;75:1711-4.  Back to cited text no. 3
    
4.
Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE Jr. Spontaneous pneumomediastinum: A comparative study and review of the literature. Ann Thorac Surg 2008;86:962-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed489    
    Printed5    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal