Asian Journal of Case Reports in Surgery

Spontaneous Pneumomediastinum an Elusive Condition for Surgeons: A Case Study

W. J. Wan Izzah *

Department of Surgery, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

Z. Hazwan

Department of Surgery, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

I. Ismayudin

Department of Surgery, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

T. Vethunan

Department of Surgery, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

S. Khairuzi

Department of Surgery, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

A. K. Siti Baizura

Department of Radiology, Hospital Sultanah Nora Ismail, Batu Pahat, Johor, Malaysia.

*Author to whom correspondence should be addressed.

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Abstract

Pneumomediastinum is defined as the presence of free air in the mediastinum. It may appear sinister to some surgeons and any medical practitioner because it can be fatal if the underlying cause and complications are not addressed. Other possible causes must be investigated and identified, as secondary pneumomediastinum can have disastrous consequences if not treated. On the other hand, spontaneous pneumomediastinum is usually harmless and is treated conservatively most of the time. We present a case of spontaneous pneumomediastinum in a 15-year-old teenager who was admitted for bronchial asthma exacerbation and presented with shortness of breath, chest tightness and wheezing.

Keywords: Asthma, pneumomediastinum, lung parenchyma

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References

Caceres M, Ali Sz, Braud R, Weiman D, Garrett He Jr. Spontaneous pneumomediastinum: A comparative study and review of the literature. Ann Thorac Surg. 2008;86(3):962-6.

DOI: 10.1016/J.Athoracsur.2008.04.067 PMID: 18721592.

Mondello B, Pavia R, Ruggeri P, Barone M, Barresi P, Monaco M. Spontaneous pneumomediastinum: Experience in 18 adult patients. Lung. 2007;185(1):9-14.

DOI: 10.1007/S00408-006-0002-7

Epub 2007 Feb 15 PMID: 17310299

José Meireles, Sara Neves, Alexandra Castro, Margarida França. Spontaneous pneumomediastinum revisited. Respiratory Medicine Cme. 2011;4(4):181-183. ISSN:1755-0017

Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: Clinical implications. Arch Intern Med (Chic). 1939;64(5):913–926.

Cicak B, Verona E, Mihatov-Stefanović I, Vrsalović R. Spontaneous pneumomediastinum in a healthy adolescent. Acta Clin Croat. 2009;48(4):461-7. PMID: 20405645

Tortajada-Girbés M, Moreno-Prat M, Ainsa-Laguna D, Mas S. Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: Case report and literature review. Therapeutic Advances In Respiratory Disease. 2016;10(5):402–409.

Chassagnon G, Favelle O, Derogis V, Cottier JP. Spontaneous pneumo-mediastinum due to the Macklin effect: Less is more. Intern Emerg Med. 2015; 10(6):759-61.

DOI: 10.1007/S11739-015-1229-1.

Epub 2015 Mar 25 PMID: 25804499

Dajer-Fadel WL, Arguero-Sanchez R, Ibarra-Perez C, Navarro-Reynoso FP. Systematic review of spontaneous pneumomediastinum: A survey of 22 years data. Asian Cardiovasc Thorac Ann. 2014;22(8):997-1002.

Elhakim TS, Abdul HS, Pelaez Romero C, et al. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: A rare case and literature review. BMJ Case Reports CP. 2020;13:e239489.

Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: An autopsy series from New Orleans. Lancet Respir Med. 2020;8(7): 681-686.

Russell DW, Watts JR Jr, Powers TA. Searching for the source of the leak: PIE and the Macklin effect. Ann Am Thorac Soc. 2018;15(11):1354-1356.

Al-Mufarrej F, Badar J, Gharagozloo F, Tempesta B, Strother E, Margolis M. Spontaneous pneumomediastinum: Diagnostic and therapeutic interventions. J Cardiothorac Surg. 2008;3:59.

Kouritas V, Papagiannopoulos K, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, Kioumis I, Pitsiou G, Papaiwannou A, Karavergou A, Kipourou M, Lada M, Organtzis J, Katsikogiannis N, Tsakiridis K, Zarogoulidis K, Zarogoulidis P. Pneumomediastinum. Journal of Thoracic Disease. 2015;7(1);S44-S49.

Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: Time for consensus. N Am J Med Sci. 2013;5(8):460-4.