Spontaneous cervicothoracolumbar pneumorrhachis, pneumomediastinum and pneumoperitoneum

Abstract

Extensive pneumorrhachis and pneumoperitoneum may simultaneously accompany pneumomediastinum and subcutaneous emphysema in the absence of an identifiable cause and still follow a benign clinical course.

Spontaneous pneumomediastinum: Time for consensus

“…[18] Air can also easily pass through the cervical region due to the close proximity between the mediastinum and the upper spine which may result in pneumorrhachis, free air in the spinal canal. [19] Airflow movement through pleural structures can explain the onset of pneumothorax or even tension pneumothorax;[18] however, its occurrence is rare. If such complications arise they should be treated emergently with chest tube placement or surgical decompression.…”

Spontaneous Pneumorachis – A Case-Based Review

“… Enterocutaneos fistula from left natal cleft None Pelvic exenteration No Discharged. 34 Lee et al( 23 ) 76/m Unknown Vacuum intervertebral disc None Left partial hemilaminectomy No Discharged 35 Kumaran et al( 24 ) 51/m None Grade 1 anterolisthesis of L5 over S1 None Spondylolisthesis correction surgery No Unknown 36 Amit et al( 25 ) 60/m Unknown Perforated sigmoid colon Pneumocephalus Hartmann’s procedure; broad-spectrum intrathecal antibiotics No Resolution of pneumocranium and pneumorachis 37 Al-Mufarrej et al( 88 ) 20/m None Unknown Pneumoperitoneum, pneumomediastinum, subcutaneous emphysema Self-limited No Resolved 38 Song et al( 82 ) 18/m None Unknown Pneumomediastinum, subcutaneous emphysema Dextromethorphan 45 mg daily No Discharged 39 Kim et al( 12 ) 64/m Unknown V...…”

A pain in the neck

“…Pneumoperitoneum1 and retroperitoneum11 have been identified in other case reports in association with pneumomediastinum and surgical emphysema; this was not actively excluded in our patient by abdominal imaging due to the absence of any abdominal signs or symptoms. If present, peritoneal air would not alter the prospective management of this patient unless it became apparent and problematic clinically and hence inappropriate tests were avoided.…”

“…Spontaneous pneumomediastinum has also been described extending into the deep fascial planes of the neck producing surgical emphysema as well as tracking of air into the extradural spaces and, via the diaphragmatic hiatus, into the peritoneum or retroperitoneum. It has been suggested by Al-Mufarrej et al 1 that a pneumomediastinum cannot be attributed solely to the Macklin effect without active exclusion of an aerodigestive tract injury and pulmonary parenchymal disease (bronchoscopy and contract swallow study). As there was no suggestion of an injury to these structures either clinically, on radiography or CT, no further investigation was considered necessary to exclude these injuries in this patient.…”