1/9. Rhinolalia as a presenting sign of pneumomediastinum complicating post peripheral blood stem cell transplantation bronchiolitis obliterans.A 26-year-old male with graft vs. host disease (GVHD) presented with rhinolalia (a squeaky voice of nasal quality) as a presenting sign for pneumonasopharynx and pneumomediastinum secondary to bronchiolitis obliterans. The patient underwent HLA-identical related peripheral blood stem cells transplantation 8 months before the diagnosis. Three weeks after transplantation he began to suffer from GVHD Grade III that involved the gut, liver, and skin and later on the lungs. Due to severe obstructive bronchiolitis obliterans the patient developed intensive cough evolving into pneumomediastinum and pneumonasopharynx with rhinolalia. The patient was treated conservatively with complete resolution. Although rare, pneumomediastinum and pneumonasopharynx can be a life-threatening event, and one should be aware of the signs and symptoms on physical examination, which may be as subtle as rhinolalia alone.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/9. Idiopathic spontaneous pneumomediastinum: an uncommon emergency in children.Spontaneous pneumomediastinum (SPM) occurs rarely in children. The diagnosis is based on physical examination and chest radiography. Conservative therapy usually leads to recovery. However, SPM in association with severe hypoxia, tachycardia, metabolic acidosis, and high ventilation pressures indicates clinically significant tension in the mediastinum. A collar mediastinotomy is the treatment of choice in these circumstances.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/9. 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 = 0.089428482403047keywords = physical (Clic here for more details about this article) |
4/9. Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis.Pneumomediastinum, a collection of mediastinal air, often results from the rupture of intrathoracic structures. A 41-year-old diabetic woman initially presented with signs of pneumomediastinum and nuchal subcutaneous emphysema, but was finally diagnosed with unilateral emphysematous pyelonephritis. Pneumomediastinum as a presentation in retroperitoneal infection has not been reported previously, which prompts us to discuss its etiology and emphasize the importance of physical examination.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/9. pneumopericardium and pneumomediastinum following closed chest injury.pneumopericardium and pneumomediastinum following closed chest injury are rare findings, especially when symptoms are delayed for several days and are not associated with other related traumatic entities. A case is presented of a 14-year-old boy who developed symptoms of precordial chest pains and splinting two days after sustaining a direct blow to his anterior chest wall. A work-up confirmed free air in the pericardium and mediastinum. He recovered rapidly after a three-day hospital course. The diagnosis was relatively simple, using only thorough physical examination and radiographic technique. This complication should be considered in the differential diagnosis of sudden onset of cardiorespiratory conditions following trauma.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/9. air in unusual places: some causes and ramifications of pneumomediastinum.Five unusual cases of pneumomediastinum are described. In three the probable cause was thoraco-abdominal straining against a closed glottis during violent exercise, in criminal assault, or competitive sport. The resultant increase in intra-alveolar pressure produces an air leak which passes via the pulmonary interstitium into the mediastinum. It can then pass up into the neck to produce widespread subcutaneous emphysema and down through the diaphragmatic hiatuses to produce extraperitoneal emphysema. This may outline the lower surface of the diaphragm to stimulate intraperitoneal air, but it can also leak through the parietal peritoneum to result in actual intraperitoneal air. Therefore, in the patient who has been hospitalised after violent physical stress with or without blunt trauma, pneumomediastinum does not necessarily indicate tracheobronchial or oesophageal rupture and subdiaphragmatic air does not necessarily indicate bowel rupture. Probably any form of exercise in which the Valsalva manoeuvre is performed may cause pneumomediastinum, as may other causes of increased intra-alveolar pressure such as mechanical ventilation, bronchospasm, coughing and vomiting. vomiting is a likely contributing cause in the pneumomediastinum of diabetic ketosis, of which a case is described. Another case is presented in which air passed in the opposite direction, from perforated extraperitoneal bowel up into the mediastinum.- - - - - - - - - - ranking = 0.089428482403047keywords = physical (Clic here for more details about this article) |
7/9. Oesophageal perforation: an unusual complication of a hypoglycaemic episode.A case of spontaneous oesophageal rupture following vomiting, secondary to a hypoglycaemic episode is reported. The case is of interest in its presentation and physical signs. It reflects the difficulty in diagnosing a condition associated with considerable morbidity and mortality. The importance of recognition of a pattern of symptoms, physical signs and radiographic findings is emphasized.- - - - - - - - - - ranking = 0.17885696480609keywords = physical (Clic here for more details about this article) |
8/9. Psychogenic vomiting complicated by marijuana abuse and spontaneous pneumomediastinum.OBJECTIVE: This case illustrates an unusual physical sequel of psychogenic vomiting. CLINICAL PICTURE: A 22-year-old man with a picture of psychogenic vomiting and marijuana use developed the complications of a pneumomediastinum and subcutaneous emphysema. TREATMENT: Therapy included gradual exposure to anxiety provoking stimuli, psychotropics to reduce vomiting and psychotherapeutic exploration of family relationships. OUTCOME: The patient's vomiting and physical state resolved without complication. Follow-up at 12 months revealed continued improvement with occasional less severe vomiting. CONCLUSIONS: Psychogenic vomiting as a manifestation of anxiety can result in serious physical and psychological sequelae. This patient's desperate attempts to control such vomiting complicated the picture. Successful short term intervention included the use of several treatment modalities.- - - - - - - - - - ranking = 0.26828544720914keywords = physical (Clic here for more details about this article) |
9/9. Pneumomediastinum following penetrating oral trauma.Pneumomediastinum can result from a puncture wound or laceration to the hypopharynx. This is a case report of an 18-month-old child who fell with a pen in his mouth. Initial physical examination was unremarkable, but the child developed neck swelling, fever, and irritability over the next 12 hours. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema. The pathophysiology and treatment of pneumomediastinum are reviewed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |