Tracheal rupture as a result of coughing

Akkaş, Meltem; Tiambeng, Canan; Aksu, Nalan Metin; Onur, Mehmet Ruhi

doi:10.1016/j.ajem.2018.08.027

Cited by 14 publications

(9 citation statements)

References 9 publications

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“…Different mechanisms of PTM are described in the literature, including posterior membrane tracheal lesion or rupture due to coughing [ 26 ]. The “Macklin effect” [ 27 ] describes PTM secondary to the rupture of marginal alveoli due to a steeply increased pressure gradient between the alveolus and the interstitial space.…”

Section: Discussionmentioning

confidence: 99%

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

et al. 2022

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BackgroundThere is an emerging understanding that coronavirus disease 2019 (COVID-19) is associated with increased incidence of pneumomediastinum. We aimed to determine its incidence among patients hospitalised with COVID-19 in the United Kingdom and describe factors associated with outcome.MethodsA structured survey of pneumomediastinum and its incidence was conducted from September 2020 to February 2021. United Kingdom-wide participation was solicited via respiratory research networks. Identified patients had SARS-CoV-2 infection and radiologically proven pneumomediastinum. The primary outcomes were to determine incidence of pneumomediastinum in COVID-19 and to investigate risk factors associated with patient mortality.Results377 cases of pneumomediastinum in COVID-19 were identified from 58 484 inpatients with COVID-19 at 53 hospitals during the study period, giving an incidence of 0.64%. Overall 120-day mortality in COVID-19 pneumomediastinum was 195/377 (51.7%). Pneumomediastinum in COVID-19 was associated with high rates of mechanical ventilation. 172/377 patients (45.6%) were mechanically ventilated at the point of diagnosis. Mechanical ventilation was the most important predictor of mortality in COVID-19 pneumomediastinum at the time of diagnosis and thereafter (p<0.001) along with increasing age (p<0.01) and diabetes mellitus (p=0.08). Switching patients from continuous positive airways pressure support to oxygen or high flow nasal oxygen after the diagnosis of pneumomediastinum was not associated with difference in mortality.ConclusionsPneumomediastinum appears to be a marker of severe COVID-19 pneumonitis. The majority of patients in whom pneumomediastinum was identified had not been mechanically ventilated at the point of diagnosis.

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Section: Discussionmentioning

confidence: 99%

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

et al. 2022

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“…In addition to this hypothesis, we also hypothesize that spontaneous rupture at posterior membraneous wall of tracheal rupture, which is the weakest portion of trachea, as a result of positive pressure of airway during convulsion might be causative for occurrence of SPM in the present case. [6] Because the present case complicated only SPN but not pneumothorax.…”

Section: Discussionmentioning

confidence: 62%

Pneumomediastinum after Convulsion and Vomiting

Muramatsu¹,

Omori²,

Nagasawa³

et al. 2020

AJMCR

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A 15-year-old woman had a vomiting following 10 minutes of clonic convulsion after intentional overdose of cold remedy. When emergency medical technicians checked her, convulsion had subsided, however, she had a convulsion again during transportation. On arrival, she was coma state but had clear airway. Her head computed tomography (CT) was negative, however, chest roentgen and CT showed spontaneous pneumomediastinum (SPM). Initially, physician on duty did not know that she had had overdose, she just underwent infusion of evetiracetam and tazobactam / piperacillin. Her consciousness became clear on day 2. Post admission course was no eventful and she discharged without sequlae. We present extremely rare case of SPM immediately after a convulsion. As mechanism of such complication is poorly understood, further analysis by accumulation of such cases is necessary.

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“…It is very rare to trigger tracheal rupture after TLM and most tracheal rupture are caused by intubation, tracheostomies, bronchoscopies, balloon dilation, or spontaneous tracheal rupture caused by coughing. [ 4 , 5 ] Because we took adequate protective measures during the operation, we believed that tracheal rupture had no direct correlation with TLM. In our review of relevant literature, we excluded tracheal ruptures caused by bronchoscopies and tracheoscopies since these were not performed in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Akkas et al reported that predisposing factors of spontaneous tracheal rupture included anatomical variations such as that in chronic obstructive pulmonary disease, bronchial asthma, and tracheomalacia, as well as radiotherapy. [ 5 ] Therefore, postoperative care, such as fog inhalation therapy, is particularly important and should be considered.…”

Section: Discussionmentioning

confidence: 99%

Tracheal rupture after vocal cord polyp resection

Chen

Cui

et al. 2021

Medicine

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Introduction: Transoral laser microsurgery (TLM) is one of the most common operations performed for glottic lesions. Several protection measures are taken to prevent tracheal damage. However, some protection measures and common postoperative complications may still cause delayed tracheal rupture in certain situations. Cases of tracheal rupture after surgery are extremely rare, and there are no previous reports of TLM of the glottis causing tracheal rupture. Patient concerns: A middle-aged woman who underwent TLM for bilateral vocal cord polyps developed sudden neck pain, followed by cough and subcutaneous emphysema. Diagnosis: She underwent head, neck, and chest computed tomography (CT), which revealed a 4-cm membranous tracheal tear located 4.5 cm distal to the glottis, pneumomediastinum, and subcutaneous emphysema extending from the base of skull to the chest. Interventions: The patient underwent an emergency surgical surgical chest exploration and tracheal repair. Outcomes: One month after the surgery, the patient fully recovered with no tracheal stenosis or respiratory dysfunction. Conclusions: Conventional protective measures and common postoperative complications of TLM may also cause tracheal rupture.

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Tracheal rupture as a result of coughing

Cited by 14 publications

References 9 publications

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey

Pneumomediastinum after Convulsion and Vomiting

Tracheal rupture after vocal cord polyp resection

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