Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication?

Kono, Tatsuo; Kuwashima, Shigeko; Fujioka, Masashi; Kobayashi, Chie; Koike, Kenichi; Tsuchida, Masahiro; Seki, Ichiro

doi:10.1111/j.1442-200x.2007.02480.x

Cited by 23 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are several case reports of epidural air complicating spontaneous pneumomediastinum in adults but only a few in children. [3][4][5] Spontaneous pneumomediastinum most likely results from alveolar rupture secondary to increased pressure leading to air dissection along pulmonary bronchovascular sheath up to the hilum of the mediastinum and soft tissues of the cervical region. 6 The origin of epidural air is less clear.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidural Air in Child with Spontaneous Pneumomediastinum

et al. 2012

View full text Add to dashboard Cite

A 3-year-old boy was seen in the emergency room after his mother noted neck swelling, drooling, and dysphonia. This occurred after a brief coughing episode and one episode of vomiting. Although he was never diagnosed with asthma, the patient had a history of severe paroxysms of coughing. On examination, he had palpable subcutaneous emphysema of the neck, upper chest, and upper back. There were bilateral rhonchi (low pitched, snore-like sounds) on lung examination. He had no neurologic deficits. A chest X-ray showed significant subcutaneous emphysema of the soft tissues of the neck and chest. A neck and chest computed tomography (CT) scan (►Figs. 1 and 2) showed severe pneumomediastinum with extensive subcutaneous emphysema tracking along the fascial planes of the neck, supraclavicular regions, right upper extremity, anterior chest wall, and epidural space. He underwent an esophagram which was negative for perforation. He was observed in the hospital for a day and discharged to home the next day. During this hospitalization he was diagnosed with asthma and is currently being treated for such.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In a series of 42 children with spontaneous pneumomediastinum, 4 had epidural air and none had neurologic symptoms. 3 However, in adults there have been reports of reversible myelopathy and radiculopathy symptoms. 8,9 Epidural air is an unusual complication of spontaneous mediastinum in children.…”

Section: Discussionmentioning

confidence: 99%

Epidural Air in Child with Spontaneous Pneumomediastinum

et al. 2012

View full text Add to dashboard Cite

show abstract

“…It is hypothesized to originate from air leak spreading through the posterior mediastinum into the epidural space via the cervical fascia planes or neural foramen (7). Owing to its scarcity in nature, there is no established incidence of pneumorrhachis associated with SPM except for only one published study revealing 4 out of 42 cases (9.5%) of SPM as well as extensive subcutaneous emphysema, suggesting that in SPM, pneumorrhachis is uncommon but not extraordinary (8).…”

mentioning

confidence: 99%

Pneumorrhachis: an under-recognized entity correlates with severity of spontaneous pneumomediastinum

2018

View full text Add to dashboard Cite

“…It is usually accompanied with pneumomediastinum, since the air from pulmonary alveoli has to travel across the mediastinum in order to reach the epidural space 1. It is estimated that pneumorrhachis occurs in 9.5% of patients with spontaneous pneumomediastinum, which is already a rare disease entity and is responsible for 1 of 8005 to 1 of 42 000 hospital incidents and emergency admissions 1 2. Other possible origins of free air include retropharyngeal space, illicit drug use or direct trauma to the vertebral column.…”

mentioning

confidence: 99%

Teenager with chest pain and swollen neck: a leave-it-alone condition

Liao

Wang

2015

Thorax

View full text Add to dashboard Cite

A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.

show abstract

Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication?

Abstract: In patients with spontaneous pneumomediastinum, epidural air may be more common than was previously realized. It is suggested that an air leak may spread from the mediastinum into the epidural space via the cervical fascial planes and neural foramina.

Cited by 23 publications

References 28 publications

Epidural Air in Child with Spontaneous Pneumomediastinum

Epidural Air in Child with Spontaneous Pneumomediastinum

Pneumorrhachis: an under-recognized entity correlates with severity of spontaneous pneumomediastinum

Teenager with chest pain and swollen neck: a leave-it-alone condition

Contact Info

Product

Resources

About