A Rare Complication During Asthma Attack: Pneumomediastinum and Subcutaneous Emphysema

Abstract

Spontaneous pneumomediastinum is a rare childhood pathology, and usually seen along with subcutaneous emphysema. The most common cause of spontaneous pneumomediastinum in childhood is asthma, lower respiratory tract infection being another, according to the literature. It is usually benign, and subsides spontaneously. However, patients may require invasive interventions. Subcutaneous emphysema was detected in a 5-year-old male patient who was admitted to a pediatric emergency service with the cause of asthma attack, and found to have irregular asthma treatment. A pneumomediastinum was detected by chest X-ray and thoracic tube was inserted and cuts were made under the skin and discharged by healing on the 12th day. Pneumomediastinum and pneumothorax should also be considered, especially in uncontrolled asthmatic cases where there is no good response to an exacerbation treatment.

Keywords

• Asthma,Pneumomediastinum,Subcutaneous emphysema

Astım Atağı Sırasında Görülen Nadir Bir Komplikasyon: Pnömomediastinum ve Cilt Altı Amfizemi

Abstract

Genellikle cilt altı amfizemi ile birlikte görülen spontan pnömomediastinum, çocukluk çağında nadir görülen bir patolojidir. Çocuklarda en sık neden astım olmakla birlikte alt solunum yolu enfeksiyonlarına bağlı spontan pnömomedistinum da bildirilmiştir. Genellikle selim seyirli ve kendiliğinden iyileşir, nadiren şiddetli vakalarda invaziv girişim gerekebilir. Astım atağı nedeni ile çocuk acil servise getirilen ve düzensiz astım tedavisi aldığı saptanan beş yaşındaki erkek hastada cilt altı amfizemi tespit edilmesi nedeni ile çekilen akciğer grafisinde pnömomediastinum saptandı. Toraks tüpü takılıp cilt altına kesiler atılan hasta 12. günde şifa ile taburcu edildi. Özellikle kontrolsüz astımlı vakalarda, atak tedavisine iyi cevap alınamaz ise nadiren görülse de pnömomediastinum ve/veya pnömotoraks da olabileceği düşünülmelidir.

Keywords

• Astım,Pnömomediastinum,Cilt altı amfizemi

References

1. 1. Winnie GB. Pneumomediastinum. In: Kliegman RM, Stanton BMD, St. Gene JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics, 20th edition, Philedelphia: Elsevier 2016; S. 2139- 2140.
2. 2. Stack AM, Caputo GL. Pneumomediastinum in childhood asthma. Pediatr Emerg Care 1996; 12: 98-101.
3. 3. Romero KJ, Trujillo MH. Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: The Macklin effect. Heart Lung 2010;39: 444–47.
4. 4. Ender Levent, Nesrin Sarıman. Pneumomediastinum and subcutaneous emphysema without pneumothorax in an asthmatic patient. Eurasian J Pulmonol 2008; 10: 131-135.
5. 5. Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE.Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008;86:962-966.
6. 6. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum; a report of 25 cases. Chest 1991;100:93-95.
7. 7. Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001; 31: 67-75.
8. 8. Kucukosmanoglu O, Karakoc GB, Yılmaz M, et al. Pneumomediastinum and pneumopericardium: Unusual and Rare complications of asthma in a 4 years old girl. Allergol Immunopathol 2001;29: 28-30.

9. 9. Özkaya O, Türktaş İ, Demirsoy S, et al. Pneumomediastinum and subscutaneous emphysema complicating under diagnosed asthma attacks. Gazi Medical Journal 1998; 9: 146-148.
10. 10. Tokur M, Kürkçüoğlu C. Cilt Altı Amfizemi Yönetimi. J Clin Anal Med 2012;3:488-490.