Pneumomediastinum, Pneumopericardium, and Epidural Pneumatosis following Adenotonsillectomy: A Very Rare Complication

Abstract

Adenotonsillectomy is a common surgical otolaryngology procedure that is associated with several complications, including hemorrhage, odynophagia, damage to teeth, taste disorders, atlantoaxial subluxation, lingual edema, infection, and injury of the carotid artery. Pneumomediastinum, pneumopericardium, and epidural pneumatosis are an extremely unusual condition in children with adenotonsillectomy. Treatment should be conservative in the majority of cases and based on benign self-limiting course of these diseases; early recognition can prevent further complications. The combination of pneumomediastinum with epidural pneumatosis, pneumopericardium, retropharyngeal-prevertebral pneumatosis, axillar-perihumeral pneumatosis, and subcutaneous emphysema is also a very rare condition. We present a unique case with the radiological findings of air in all of these areas in a 6-year-old male child with adenotonsillectomy. The case was unusual in that the patient developed this complication 3 hours later after adenotonsillectomy with severe vomitting. The possible mechanism, the algorithm of treatment, and precautions in such cases will be discussed.

Nontraumatic tension pneumopericardium in nonventilated pediatric patients: a review

“…Due to its rare nature, pneumopericardium in children has previously been discussed only in the context of case reports and therefore data on epidemiology are limited. The first description of pneumopericardium appears in an article by Bricheteau in 1844 and isolated cases have been described ever since . Our review is a synthesis of the available evidence and suggests that patients in the first month of life and children undergoing cardiothoracic or abdominal surgery, or with a previous history of hematological disease, and presenting with isolated pneumopericardium are at higher risk of tension pneumopericardium, which presents with a higher mortality compared with patients with other air leak syndromes.…”

“…Tension pneumopericardium affects only a minor percentage of patients but results in significant hemodynamic instability . There are very limited data available on nontraumatic pneumopericardium in pediatric patients who are nonventilated …”

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“…Concurrent adenoidectomy was performed on 8 patients. 7,11,21,25,28 The indication of surgery was recurrent tonsillitis in 20 patients. One patient had a granular tumor over the right tonsil with a bulging surface on the nasopharynx and was scheduled for a tonsillectomy and nasopharyngeal biopsy.…”