1/7. Persistent pneumomediastinum and dermatomyositis: a case report and review of the literature.We describe a 42-year-old man with dermatomyositis and interstitial lung disease who presented with anterior neck pain and dyspnoea. Chest radiographs showed subcutaneous emphysema, pneumomediastinum and diffuse reticulonodular infiltration in both lungs. After the administration of high doses of prednisolone, an improvement of pulmonary function and respiratory symptoms was observed but the pneumomediastinum persists 12 months after diagnosis, and without any complication. We review the cases that have been reported thus far of pneumomediastinum associated with dermatomyositis and discuss the possible mechanisms involved. We conclude that pneumomediastinum is not an uncommon complication of dermatomyositis and that its aetiopathogenesis remains very unclear.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/7. Pneumomediastinum after dental surgery.A previously healthy woman presented with chest pain and cervical swelling several hours after undergoing surgical removal of third molar teeth. Mediastinal and subcutaneous emphysema was demonstrated by chest X-ray. air had been introduced under the soft tissue flap by the high-speed turbine drill used to remove the alveolar bone, rather than the air/water syringe. Surgical handpieces that vent the air away from the surgical field should be used during such procedures. The mediastinal and subcutaneous air resolved after oxygen administration.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/7. A case of dermatomyositis complicated with pneumomediastinum successfully treated with cyclosporin A.We describe a rare case of a 46-year-old Japanese man with dermatomyositis (DM) and interstitial lung disease who developed spontaneous pneumomediastinum and subcutaneous emphysema. Relatively mild myositis, mild elevation of CK values and the absence of anti-Jo-1 antibody were observed and the case was similar to amyopathic DM. Treatment of this patient with oral prednisolone and cyclosporin A (CsA) was effective for the myositis and interstitial lung disease. The administration of CsA enabled rapid tapering of the dose of prednisolone without aggravating the disease. Pneumomediastinum and subcutaneous emphysema disappeared 5 months later without recurrence. The serum levels of KL-6 were monitored every 2 weeks to help determine whether this may have contributed to the recurrence of interstitial pneumonitis. This is a rare case of pneumomediastinum in a patient with DM.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/7. Spontaneous tracheal rupture associated with acquired tracheobronchomalacia.We report here a very rare case of pneumomediastinum due to spontaneous tracheal rupture with tracheobronchomalacia. The patient was a 74-year-old woman who had suffered nocturnal dyspnea due to productive cough for five days prior to admission and had been treated with corticosteroids for five years at another hospital after being diagnosed with bronchial asthma. Computed tomographic scanning of the chest demonstrated over 1 cm longitudinal small air collections behind the upper trachea. Crescent-type tracheobronchomalacia was diagnosed by emergency bronchoscopy. At the right side of the upper trachea, a 1-cm laceration was revealed. fibrin glue (Bolheal, Kaketsuken, Kumamoto, japan) was sprayed on the laceration through an instrument of our design for endoscopic gluing and she was intubated for three days. Furthermore, treatment including administration of antibiotics, an antitussive agent, and a mucolytic agent, in addition to pulmonary physical therapy involving pursed lip breathing exercises and smoking cessation improved her complaints one month after admission.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/7. Post partum pneumomediastinum.A 19-year-old primigravida had a normal vaginal delivery after a 90-minute second stage of labour. Within two hours she complained of dyspnoea and was noticed to have unusual swelling of the face and neck. The diagnosis of subcutaneous emphysema was confirmed by chest X-ray and pneumomediastinum was also detected. Uneventful recovery over four days followed conservative management, administration of oxygen and use of simple analgesics.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/7. A simple sore throat? Retropharyngeal emphysema secondary to free-basing cocaine.A case of retropharyngeal emphysema associated with drug abuse is presented. Although chest symptoms of pneumomediastinum have been widely reported with substance abuse, pain localized to the neck is rarely described. In the present case, localized dysphagia was the only complaint, and no free air could be demonstrated within the thorax. For uncomplicated cervical emphysema or pneumomediastinum due to substance abuse, extensive workup may be unnecessary, and conservative therapy, including administration of 100% oxygen and observation is recommended if resolution is prompt.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/7. Pulmonary alveolar septal calcinosis causing progressive respiratory failure in acute lymphoblastic leukemia in childhood.A syndrome of pulmonary alveolar septal calcinosis, pneumothorax, and pneumomediastinum, leading to rapidly progressive acute respiratory insufficiency and death was observed in 2 children with acute lymphoblastic leukemia (ALL). Primary clinical and radiological considerations in these patients were pulmonary edema and infection, and the diagnosis of pulmonary alveolar septal calcification was established only at autopsy. One patient, a 15-year-old girl, was found also to have parathyroid hyperplasia typical of familial hyperparathyroidism. The other, a 16-month-old girl, showed osteitis fibrosa of the bones and parathyroid hyperplasia of secondary type, suggesting that the pulmonary calcinosis resulted from hypercalcemia caused by a parathormone or prostaglandin-secreting tumor. The cause of pneumothorax and pneumomediastinum may have been rupture of calcified alveolar septa induced by high PEEP during ventilation of these patients. Other possible mechanisms contributing to hypercalcemia and pulmonary calcinosis in children with acute leukemia include bone resorption due to marrow infiltration, immobilization syndrome, renal failure, and administration of calcium, phosphate, or bicarbonate. This complication of acute leukemia in childhood is rare (2 patients in 430 autopsied over the period 1961-1982 at Childrens Hospital of Los Angeles). How often the process can be reversed if diagnosed before severe respiratory insufficiency is present is not known.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |