Emphysema of Multi-compartment in Asthmatic Patient: Subcutaneous, Mediastinal, Pericardial, and Spinal Pneumatosis

Year 2014, Volume: 5 Issue: 6, 183 - 185, 01.06.2014

Mahmut Tokur Mehmet Ergin Derya Yenibertiz Mehmet Okumus

Abstract

Introduction: Varying degrees of emphysema can be seen in the acute phase of asthma due to increased intra-bronchial and intra-alveolar pressure induced by severe cough. Emphysemas can be simple subcutaneous to spinal pneumatosis.Case Report: A male patient, aged 22, was admitted to the emergency service with complaints of dyspnea. He was in an acute asthmatic attack and had diffuse subcutaneous emphysema. Pneumatosis was localized in the base of skull, spinal canal, mediastinum, and pericardium. During his hospital stay, he was intubated, and tube thoracotomy was performed bilaterally at the intensive care unit. His bronchoscopy revealed no pathological findings. Anti-asthmatic treatment and antibiotic therapy were also administered, and the patient was discharged from the hospital on day 14 after admission.Conclusion: The literature contains rare reports of acute asthmatic attacks and emphysemas, pneumomediastinum, and spinal pneumatosis, which are mostly isolated findings. The case reported in this paper should remind physicians that pneumatosis could be widespread among many different compartments at the same time, which can complicate the situation and require decompression together with anti-asthmatic treatment

Keywords

Asthma, pneumatosis, pneumomediastinum, spinal pneumatosis, pneumopericardium

Astım Hastasında Multikompartman Amfizem: Subkutan, Mediastinal,Perikardiyal ve Spinal Pnömotosis

Abstract

Giriş: Ciddi öksürüğün tetiklediği artmış intrabronşial ve
intraalveolar basınca bağlı olarak akut astım atağında değişen
derecelerde amfizem görülebilir. Amfizem basit subkutandan
spinal pnömotisise kadar olabilir.
Olgu Sunumu: 22 yaşında erkek hasta acil servisimize dispne
şikayeti ile başvurdu. Akut astım atağında olan hastanın diffüz
subkutan amfizemi vardı. Pnömotosisi kafatası bazali, spinal
kanal, mediastinum ve perikardiyumda mevcuttu. Hastane yatış
sürecinde yoğun bakım ünitesinde entübe edildi ve bilateral tüp
torakostomi uygulandı. Bronkoskopi sonucunda patolojik bulgu
saptanmadı. Ayrıca anti-astım ve antibiyotik tedavisi uygulanan
hasta yatışının 14.gününde hastaneden taburcu edildi.
Sonuç: Literatür - çoğunlukla izole bulgular olarak - akut astım
ve amfizem, pnömomediastinum ve spinal pnömotosis ile ilgili
nadir vaka raporları içermektedir. Bu yazıda sunulan vaka, acil
hekimleri tarafından eş zamanlı olarak bir çok kompartmanda
pnömotosis görülmesi açısından unutulmamalıdır ki; bu durum
hastanın durumunu komplike eder ve anti astım tedavisinin
yanında dekompresyon gerektirir.

Keywords

Astım, pnömotosis, pnömomediastinum, spinal pnömotosis, pnömoperikardiyum

References

• Küçükosmanoğlu O, Karakoç GB, Yılmaz M, Altintas D, Güneser Kendirli S. Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl. Allergol Immunopathol (Madr) 2001; 29: 28-30. [CrossRef]
• Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum. A report of 25 cases. Chest 1991; 100: 93-5. [CrossRef]
• Kogan I, Celli BR. Pneumomediastinum in a 63-year-old woman with asthma exacerbation. Chest 2000; 117: 1778- 81. [CrossRef]
• Miura H, Taira O, Hiraguri S, Ohtani K, Kato H. Clinical features of medical pneumomediastinum. Ann Thorac Cardiovasc Surg 2003; 9: 188-91.
• Takahashi K, Nagao K, Momokawa T, Maruyama A, Fujita H, Ono S et al. Two cases of idiopathic pneumopericardium. Kokyu To Junkan 1991; 39: 95-7.
• Zylak CM, Standen JR, Barnes C, Zylak CJ. Pneumomediastinum revisited. Radiographics 2000; 20: 1043-57. [CrossRef]
• Taupin JM, Laudinat JM, Fellinger F, Dickele MC, Lemaître C, Elaerts J, et al. Spontaneous idiopathic pneumopericardium in young patients. Review of the literature. Apropos of a new case. Ann Cardiol Angeiol 1992; 41: 485-8.
• Düz B, Pusat S, Kural C, Kırık A, Gönül E. A case of pneumocepahlus association with lumbar punctures. Türk Nöroşirürji Dergisi 2008; 18: 145-7.
• Aribas OK, Gormus N, Aydogdu Kiresi D. Epidural emphysema associated with primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2001; 20: 645-6. [CrossRef]
• Tokur M, Kürkçüoğlu C. Cilt altı amfizem yönetimi. J Clin Anal Med 2012; 3: 488-90. [CrossRef]