Air All in the Wrong Places: A Case of Pneumorrhachis Secondary to Chronic Vomiting

Abstract

Pneumorrhachis (PR) is a rare phenomenon in which air is present in the spinal canal. PR can be stratified into different categories based on etiology, with spontaneous PR being the least common. In this report, we describe the case of a 33-year-old male with a four-year history of emesis secondary to chronic gastroparesis who presented with pleuritic chest pain radiating to the neck. A CT scan of the chest showed pneumomediastinum, with air extending into the soft tissues of the neck and the spinal canal. A literature review found a trend between maneuvers that increase intrathoracic pressure, such as emesis or coughing, and the incidence of spontaneous pneumomediastinum, in which air may freely communicate with the epidural space of the spinal canal. Currently, there are no guidelines for the management of patients with PR. From our experience, conservative management of asymptomatic PR is an appropriate approach for these patients.

Spontaneous Pneumorrhachis Secondary to Rhinovirus-Associated Emesis with Demonstrated Pathophysiology

“…neumorrhachis, or air within spine canal, is a rare phenomenon in which gas has been introduced into the spinal column most commonly because of iatrogenic causes or traumatic insult 1 . However, there is an increasing number of case reports of spontaneous pneumorrhachis associated with pneumomediastinum secondary to forceful emesis or barotrauma such as heavy coughing [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Other reported etiologies include airway obstruction after foreign body aspiration 3 and physical exertion after recreational drug use (Ecstasy and marijuana) 19 .…”