Spontaneous pneumomediastinum in anorexia nervosa: A case report and review of the literature on pneumomediastinum and pneumothorax

We report a case of a 20‐year‐old white woman with the history of anorexia nervosa presenting with spontaneous pneumomediastinum (SPM). On admission, her body mass index (BMI) was 9.9 kg/m². Physical examination revealed subcutaneous crepitation especially in the axillae, the intercostal spaces, between the scapulae and along the spine. A chest X‐ray showed extensive tissue emphysema, especially in the upper mediastinum. In a computed tomography (CT) scan, additional air was found in the upper retroperitoneal space adjacent to the stomach and to the left of the aorta. The patient recovered clinically within three weeks, and a CT scan showed a complete remission of the pneumomediastinum and subcutaneous emphysema. Based on this, case review of the literature about the frequency of pneumomediastinum in young patients with low weight is presented concerning epidemiology, etiology, symptoms, diagnosis, treatment, time to recovery and prognosis. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Pneumothorax following ERCP: report of four cases and review of the literature

We report four patients with pneumothorax as a complication of ERCP with sphincterotomy. With conservative treatment all patients recovered. Previously, 16 comparable cases have been reported in the literature. The main risk factor for this rare complication seems (pre-cut) sphincterotomy. Pneumothorax is usually right-sided or bilateral and accompanied by pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema. The prognosis seems favourable with a non-surgical approach including intravenous antibiotics, fasting and when indicated chest tube drainage.     

Subcutaneous emphysema,pneumoretroperitoneum, and pneumomediastinum following rectal surgery: Report of a case and review of the literature

Summary A case of retroperitoneal, mediastinal, and subcutaneous emphysema following rectal surgery is described. This complication has not been reported in medical literature. Treatment was based on the fear of a more extensive and irreversible situation, because on the basis of the single case, it could not be demonstrated that the intestinal gas was not associated with infection.     

Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review

Here, we present the case of a woman who suffered from acute dyspnea and right cheek and neck swelling during molar extraction. The use of a high-speed dental drill may introduce air into the soft tissue and lead to subcutaneous emphysema and pneumomediastinum. After a review of the literature, we found that subcutaneous emphysema and pneumomediastinum are rare complications secondary to dental extraction. We report this case because physicians in the emergency department may misdiagnose the symptoms as an allergic reaction. Dentists should be more aware of air leak during dental extraction.     

Subcutaneous emphysema, pneumothorax, pneumomediastinum, and pneumoperitoneum during colonoscopic balloon dilation: a case report

A 77-year-old woman underwent colonoscopic balloon dilatation for colonic stricture 1 year after laparoscopic anterior resection of sigmoid colon cancer. During the balloon dilatation, panfacial swelling and apnea were noted. Emergency endotracheal intubation was undertaken. Chest X-ray revealed diffuse subcutaneous emphysema and bilateral pneumothorax. We discuss the possible mechanism and management of this uncommon complication during therapeutic colonoscopy.     

Factitious fever and self-induced infection: a report of 32 cases and review of the literature.

We review in detail the syndromes of factitious fever and self-induced infection, with discussion of 32 cases studied at the National Institutes of Health and the extensive English language literature. In addition, we describe the nature of the underlying psychiatric illnesses and present guidelines for the diagnosis and management of these patients.     

肺纤维化合并肺气肿综合征5例并文献复习

目的分析、总结肺纤维化合并肺气肿(CPFE)综合征患者的临床、肺功能及影像学特点。方法对我院2009年至2010年诊断的5例CPFE综合征患者的临床、肺功能及影像学等特点结合文献进行分析和总结。结果5例均为男性,年龄54～73岁,中位年龄63岁;4例有吸烟史,1例从事焊工30余年;5例均有活动后呼吸困难和双下肺爆裂音。...     

Catamenial pneumothorax: case report and literature review

Since the initial case report in 1958, 69 cases of catamenial pneumothorax have appeared in English-language literature. Despite the extensive case material, the pathogenesis has not been fully elucidated. Herein an additional case is reported utilizing computed tomography (CT) to search for intrathoracic endometrial implants. The four major pathogenetic theories include passage of air from the genital tract via diaphragmatic defects, spontaneous rupture of subpleural blebs, intrathoracic endometriosis, and prostaglandin-induced bronchiolar constriction resulting in alveolar rupture. Evidence for and against each theory is presented.     

Acute myelofibrosis. A report of four cases and review of the literature

Four new cases of acute myelofibrosis are reported, and 63 cases reported in the literature are reviewed. The typical features of this disease include a rapidly progressive clinical course; nonspecific symptoms such as weight loss, anorexia, fatigue and weakness; the absence of organomegaly; pancytopenia; circulating blast cells; and mild abnormalities in the red blood cell morphology. The bone marrow aspirates are usually "dry." The bone marrow biopsies are essential for the diagnosis and show four consistent features: hypercellularity, reticulin fibrosis, proliferation of blast cells and bizarre, atypical megakaryocytes. In 16 cases, the blast cells in peripheral blood and bone marrow, which are unclassifiable by conventional morphology, could be identified as megakaryoblasts by ultrastructural and immunocytochemical techniques. It is concluded that acute myelofibrosis is a definite clinicopathologic entity, which may be related to acute megakaryoblastic leukemia.     

Unusual presentations of COVID-19 pneumonia on CT scans with spontaneous pneumomediastinum and loculated pneumothorax: A report of two cases and a review of the literature.

Spontaneous pneumomediastinum (SPM) and Loculated pneumothorax (LPNX) are both generally rare clinical and radiological conditions associated with Coronavirus Disease 2019 (COVID-19). We report for the first time clinical data and radiological chest CT imaging of two patients affected by COVID-pneumonia associated with early radiological findings of SPM and LPNX.     

Anatomically localised re-expansion pulmonary oedema following pneumothorax drainage. Case report and literature review

We describe the 15th recorded case of ipsilateral pulmonary oedema following re-expansion of a pneumothorax. In contrast to previously described cases, the oedema was exclusively confined to the right middle and lower lobes, with complete sparing of the right upper lobe. This strict anatomical localisation can best be explained by the presence of a discrete temporary obstruction of the bronchus intermedius during the critical period of rapid pneumothorax re-expansion. We believe that this case lends strong support to previous contentions that bronchial occlusion plays a crucial role in the genesis of re-expansion oedema.     

Catfish-related injury and infection: report of two cases and review of the literature.

Two cases of serious infection following catfish spine-related injuries are presented, and the literature on this topic is reviewed. The organisms usually involved in such infections are Vibrio species, Aeromonas hydrophila, Enterobacteriaceae, Pseudomonas species, and components of the flora of the human skin. Irrigation, exploration, and culture of these wounds as well as immunization of the patient against tetanus are recommended. Patients with hepatic disease or chronic illness and immunocompromised individuals are at unusually high risk of fulminant infection due to Vibrio and Aeromonas species and should be treated with antibiotics after sustaining a water-associated wound. Patients with normal host defense mechanisms but with late wound care, punctures involving a bone or a joint, progressive inflammation hours after envenomation, fever, or signs of sepsis are at high risk for secondary infection and should receive definitive wound care and antibiotics. For moderate to severe infections, one of the following combinations constitutes a reasonable empirical regimen: (1) a tetracycline and a broad-spectrum, beta-lactamase-stable beta-lactam antibiotic, or (2) a tetracycline, a beta-lactamase-stable penicillin, and an aminoglycoside.     

Spontaneous pneumomediastinum and subcutaneous emphysema complicating bronchiolitis obliterans after allogeneic bone marrow transplantation--case report and review of literature

Chronic graft-versus-host disease occurring in the setting of allogeneic bone marrow transplantation (BMT) can affect many organ systems, is a cause of significant morbidity, and contributes to late deaths. Bronchiolitis obliterans is a form of obstructive airway disease; when seen in the post-BMT setting, it is considered a manifestation of chronic graft-versus-host disease. Air-leak syndromes including pneumothoraces, pneumomediastinum and subcutaneous emphysema are rare complications of bronchiolitis obliterans. Here we describe a patient who developed pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumothorax secondary to severe bronchiolitis obliterans complicating the post bone marrow transplantation course.     

肺纤维化合并肺气肿综合征3例并文献复习

目的 探讨肺纤维化合并肺气肿综合征临床特点、诊断标准及影像学表现,并提高对其认识.方法 分析2008年10月至2011年5月收治的3例肺纤维化合并肺气肿综合征病例临床特点、肺功能及影像学表现,并复习国内外文献.结果 3例患者均为重度吸烟的老年男性,均以活动后呼吸困难为主要表现.胸部CT表现为下肺纤维化及上肺野肺气肿,肺功能表现为第1秒用力呼气容积、用力肺活量及肺总量轻度下降而一氧化碳弥散功能重度下降.其中2例合并肺动脉高压.经治疗后咳嗽及喘息症状能够缓解,但肺弥散功能改善不明显.结论 诊断肺纤维化合并肺气肿综合征主要依赖胸部高分辨率CT,其特点为同时存在上肺野肺气肿和下肺野纤维化.肺功能表现为肺总量基本正常而弥散功能显著下降.临床治疗能部分缓解症状但难以改善肺弥散功能.肺纤维化合并肺气肿综合征发病机制、治疗及预后仍有待进一步研究.