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Pneumomediastinum is a rare but potentially serious complication characterized by the presence of air within the mediastinal structures. Although typically associated with thoracic trauma or vigorous coughing, it can also occur after dental procedures involving high-speed air-turbine drills. During such procedures, air may enter the cervical fascial planes and extend to the mediastinum, posing risks such as deep neck infections or mediastinitis. This report describes the case of a 38-year-old woman who developed cervical emphysema and pneumomediastinum on the same day following endodontic treatment. Computed tomography (CT) imaging revealed air densities extending from the submandibular region to the mediastinum. There was no evidence of pneumothorax, pleural effusion, or pericardial effusion. The patient was managed conservatively with oxygen therapy and intravenous antibiotics, leading to complete recovery within one week. This case underscores the importance of recognizing pneumomediastinum in patients presenting with neck swelling and subcutaneous crepitus after dental procedures. As it can be mistaken for postoperative edema, infection, or an allergic reaction, early CT imaging is essential for accurate diagnosis and prompt management. Raising awareness of this rare complication among healthcare professionals is critical to ensuring timely detection and effective treatment.

Penetrating neck injuries are rarely encountered, but have a highly mortal course because of the presence of many vital organs in this small region. We reported a tracheal rupture and pneumomediastinum case which occurred due to the penetration of a sharp piece of wood to the neck. The hemodynamically stable patient was evaluated by radiologic and endoscopic procedures and the pneumomediastinum and tracheal defect were found. The tracheal defect was left to heal spontaneously, the laceration was repaired cutaneously and the antibiotherapy was started. The patient recovered and was discharged from the clinic after 10-day follow-up. The unstable patients with active hemorrhages must undergo surgical exploration without any delays, but interventions must be initially avoided in stable patients as in our case. The wide spectrum antibiotics should be started in traumatic pneumomediastinum cases to prevent the development of mediastinitis.

Spontaneous pneumomediastinum (SPM) is a rare benign condition which must be differentiated from secondary pneumomediastinum due to chest trauma, abscess formation or Boerhaave's syndrome. We present two young women with SPM due to chronic self-induced vomiting and starvation associated with psychosis and pregnancy-associated vomiting respectively. This report highlights the exclusionary diagnostic pathway, the principles of conservative management and the need for a tailored multidisciplinary approach to enhance patient recovery and prevent future recurrence.

Reports of spontaneous pneumothorax and pneumomediastinum as a complication of coronavirus disease (COVID-19) have been increasing. COVID-19 causes inflammatory disease mainly affecting the respiratory system. Severity varies from asymptomatic pulmonary findings on imaging to acute respiratory distress syndrome along with pleural effusions, consolidations and spontaneous pneumomediastinum and pneumothorax. The aim of this paper was to review the literature to explore the association between pneumomediastinum/pneumothorax and COVID-19 respiratory disease, both in patients on ventilators and without ventilators, on a spontaneous basis. To this end, we conducted a comprehensive online literature search using PubMed for articles published with the key words of 'spontaneous pneumothorax', 'pneumomediastinum' and 'COVID-19'. Further references were obtained through cross-referencing the bibliographies cited in each publication. We found that spontaneous barotrauma is one of the complications associated with COVID-19 infection and has been observed in patients with and without mechanical ventilation. The process of pneumomediastinum and pneumothorax development is not well understood, especially in patients without underlying lung disease or on mechanical ventilation. We identified various factors that predispose to barotrauma. First, the direct infection of the Type I and Type II pneumocytes by the virus. Second, the pressure gradient between the alveoli and the pulmonary interstitium. Finally, barotrauma can occur secondary to the severe inflammatory response from the COVID-19-related cytokine storm. These conditions are all associated with severe alveolar damage and rupture of the alveolar wall that can produce pneumomediastinum and pneumothorax, both in mechanically ventilated patients and non-ventilated patients. COVID-19 is associated complications result in prolonged mechanical ventilation and length of stay, as well as overall increase in morbidity and mortality. Spontaneous pneumothorax and pneumomediastinum are two serious complications. Education regarding the adjustment of ventilation settlings in the ventilator-dependent COVID-19 patient may perhaps offset the iatrogenic component of barotrauma seen in some such patients.

Asthma is the most common chronic respiratory disease worldwide and its prevalence is increasing. Acute asthma complications are often the reason for admission to emergency healthcare service. In our article we present a case of a rare asthma complication – spontaneous pneumomediastinum with a short review of its incidence, etiology, diagnosis and management. Spontaneus pneumothorax is important to differentiate with secondary pneumomediastinum as well as other conditions as cardiac diseases (acute coronary syndrome, pericarditis, cardiac tamponade, pneumopericardium), lung diseases (pneumothorax, pulmonary embolism, tracheobronchial tree rupture), musculoskeletal disorders, and diseases of the esophagus (rupture and perforation o the esophagus). A chest X-ray is often reliable for diagnosis of spontaneous pneumomediastinum and when inconclusive, can be followed by CT. The management is usually conservative with oxygen and analgesia. Surgery is required only in cases of tracheobronchial compression.

Background Spontaneous pneumomediastinum and/or pneumothorax (SPM/P) have been Linked to unfavorable outcome in anti-melanoma differentiation-associated gene 5 positive dermatomyositis (MDA5 + DM) patients. This study attempted to investigate the prognostic value of SPM/P and identify the predisposing factors of SPM/P in patients with interstitial lung disease (ILD) complicated with MDA5 + DM. Methods This study was conducted in a large inception cohort of MDA5 + DM-ILD (from 2014 to 2023) at Shanghai Renji Hospital. Baseline demographic data, pulmonary function tests, high-resolution CT imaging, laboratory parameters and survival status within 12 months were collected and compared between survivors and deceased patients, as well as between patients with and without SPM/P. Kaplan–Meier curves were plotted and Cox regression models were applied to identify prognostic factors. Furthermore, logistic regression analysis was employed to determine the predictors of SPM/P development. Results In a cohort of 523 MDA5 + DM-ILD patients, 92 (17.6%) developed SPM/P. Of those, 63 SPM/P cases occurred within 3 months since ILD onset and had a significantly higher 12-month mortality than those without SPM/P (82.5% versus. 35.4%, p  < 0.001). Multivariable Cox regression model identified SPM/P occurred within 3 months as an independent risk factor for survival (HR 1.59, 95% CI 1.09–2.34, P  = 0.018). Predisposing factors for SPM/P included severe restrictive ventilation dysfunction, male sex, and CMV viremia. Conclusions SPM/P occurred within 3 months since ILD onset was identified as a poor prognostic factor in MDA5 + DM-ILD. A refined FVC%-based staging system combining SPM/P was proposed for better risk stratification and to gauge clinical trial design.

Introduction: Pneumomediastinum is a rare complication of blunt traumatic injury and is thought to be due to the Macklin effect, a pathophysiologic process comprised of three steps: alveolar rupture secondary to blunt injury; air dissecting along bronchovascular sheaths; and spread of pulmonary interstitial edema into the mediastinal space. Pneumomediastinum is rarely associated with pneumoretroperitoneum.Case Report: We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum.Conclusion: This case highlights the complications that can arise from blunt trauma and how underlying lung pathology can worsen these complications.

Boerhaave´s syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave´s is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. We report the case of 21-year-old male with who developed sudden onset chest pain and dyspnoea after pentazocine induced vomiting. He was referred after lack of response to initial treatment for acute severe asthma. A chest CT scan showed pneumomediastinum, subcutaneous emphysema and oesophageal tear. He was managed conservatively with oxygen therapy, nil per mouth and antibiotics with improvement of symptoms and discharge after 8 days.

Background Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) are rare, severe, and potentially life-threatening complications associated with asthma exacerbation. Most of these conditions are benign and self-limiting. However, the overlapping symptoms between asthma exacerbation and pneumomediastinum (PM) may delay diagnosis. These conditions can usually be managed through conservative treatment, although unfamiliarity with this presentation may lead some physicians to consider surgical intervention. Case presentation We report a unique case involving a 9-year-old patient experiencing a severe bronchial asthma attack and right lobe atelectasis complicated by PM and severe SE that extended to his left eye. The condition was successfully treated conservatively, with aggressive management of asthma exacerbation and close monitoring in the intensive care unit. Conclusion This case highlights the effectiveness of conservative management of PM and SE with appropriate asthma exacerbation treatment. Early diagnosis and management can lead to a favorable prognosis and a relatively brief hospital stay. Clinical trial number Not applicable.