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Background This report presents a rare case of pneumorrhachis, pneumothorax, and pneumocephalus in a patient with multiple traumatic injuries following a gunshot wound to the chest. Pneumorrhachis, the presence of air within the spinal canal, can arise from iatrogenic, nontraumatic, or traumatic causes and is classified as extradural or intradural, the latter often linked to severe trauma. Pneumothorax, air in the pleural space, may impair ventilation and presents as simple, communicating, or tension types, with causes including trauma, iatrogenesis, or spontaneous events. Pneumocephalus, an accumulation of gas within the neurocranium, typically resolves spontaneously but rarely occurs in combination with pneumothorax after thoracic gunshot trauma. This report aims to elucidate the potential pathophysiological mechanisms of air migration and highlight the multidisciplinary management challenges inherent in this rare traumatic triad. Case presentation A 45-year-old Syrian male presented with multiple traumatic injuries following a gunshot wound to the chest. Initial assessment revealed respiratory distress, hemodynamic instability, and decreased oxygen saturation. Clinical evaluation and imaging confirmed a tension pneumothorax, which was treated with an emergent chest tube placement. Subsequent computed tomography scans showed extensive pneumocephalus, with air pockets in the intracranial cavity, and pneumorrhachis, with air tracking along the spinal canal. Both findings were attributed to the high-pressure air leakage through fascial planes and anatomical pathways caused by the penetrating trauma. The patient was managed with supplemental oxygen, careful neurological monitoring, and supportive care. Despite the severe injuries, his condition stabilized, and no surgical intervention was required for the pneumorrhachis or pneumocephalus, which resolved spontaneously over time. However, the patient’s clinical course was complicated by persistent infection and respiratory failure, and he ultimately succumbed to his injuries 3 months after admission. Conclusion The coexistence of pneumorrhachis, pneumothorax, and pneumocephalus following chest gunshot trauma is exceedingly rare. This case underscores the importance of early recognition, prompt imaging, and multidisciplinary care in managing such complex injuries, contributing valuable insights to the limited literature on these conditions.

In this article, we present a case of leptomeningeal pneumocephalus and pneumorrhachis secondary to pneumothorax that occurred six years after syringopleural shunting. •Pleural effusions may develop after syringopleural shunting (SPS) procedure and may require drainage.•Pneumothorax is a possible complication of effusion drainage via tube thoracostomy.•Pneumocephalus and pneumorrhachis may be the signs of pneumothorax in the case of syringopleural shunting.

Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

Background Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations. Case presentation We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia. Conclusion Anesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.

In asymptomatic patients with penetrating neck injuries, PR can be accidently diagnosed. Because of its rarity, there are no guidelines regarding management and treatment [2]. [...]PR is a rare entity, especially if spontaneous; in most cases, no intervention is required but differential diagnosis and leading causes must be investigated.

The presence of air in the spinal canal is known as pneumorrhachis (PNR), aerorachia, intraspinal pneumocele, pneumosaccus, pneumomyelogra, or intraspinal air. Pneumorrhachis may be iatrogenic, traumatic, and nontraumatic. We treated 2 patients who had posttraumatic PNR in the cervical spine region after stab injuries. Case 1 was a 31-year-old man who was stabbed in the C5 to C6 region. He had muscle weakness (3/5) and numbness on the right side of the body. Brain computed tomographic (CT) scan showed pneumocephalus, and cervical CT scan showed PNR at the C6 level. Treatment included observation, and symptoms and weakness improved within 7 days. Case 2 was a 40-year-old man who was stabbed in the C3 to C4 region. He had muscle weakness (1/5) and numbness on the left side of the body. Brain CT scan showed pneumocephalus, and cervical CT scan showed PNR at the C3 level. Cerebrospinal fluid drainage persisted, and he was treated with surgical repair of a dural laceration. Muscle strength improved. In summary, PNR is a rare condition that usually is treated nonoperatively. However, surgical treatment may be indicated for persistent neurologic symptoms or signs; the air detected in the spinal canal with radiographic imaging may be associated with an active cerebrospinal fluid leak and may cause spinal compression.

Background Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. Case description We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient’s state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. Conclusions This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.