SESSION TITLE: Lung Pathology Student/Resident Case Report Posters
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Spontaneous pneumomediastinum (SP) is thought to be produced through the Macklin effect, which involves 3 steps: alveolar rupture, gas dissection through the broncho-vascular fascia and pulmonary interstitial dissemination into the mediastinum. Usually treatment algorithms oblige patients to remain hospitalized for long periods; however, when following our previously reported algorithm1 we can achieve a much lesser length of stay (LOS), reason for presenting this case.
CASE PRESENTATION: A 20 year-old otherwise healthy male presented to ER with a 3 days history of sudden left thoracic pain with subcutaneous emphysema. 8 days before arrival refers cough with no fever. Physical examination revealed cervical subcutaneous emphysema as an only finding. Cervical chest X-ray with subcutaneous emphysema. Chest CT revealed peri-tracheal and esophageal free air with no evidence of pneumothorax and tracheal, bronchial or esophageal rupture, as well as any active infectious gas-producing process (figure 1). Treated with supplemental oxygen only, he was discharged without any complication two days after, he continues follow-up without complications 3 months later.
DISCUSSION: SP is defined as the presence of free air in the mediastinal zones without an apparent cause, usually triggered by a Valsalva maneuver, violent coughing or intense physical exertion.2 It is also well known that when pneumothorax is present, it has a benign and self limited course. therefore is not necessary to perform any invasive diagnostic procedure or provide especial treatment unless suspicion of another cause is present.3 X-ray and chest CT scans in combination with a specific H&P and laboratory findings may give sufficient evidence for its diagnosis. Once made, the mainstay of treatment is conservative care, including reassurance, analgesics, and oxygen therapy for the relief of symptoms with close observation.3 We previously reported a mean LOS of 4.1 ± 2.3 days in a systematic review which compiled 25 of the largest series in the literature, concluding with a treatment algorithm to reduce LOS in these patients; in our case we followed it (figure 2) with favorable results.1
CONCLUSIONS: The use of the General Hospital of Mexico's treatment algorithm for patients with SP is feasible in daily clinical practice and should be implemented as a diagnostic/treatment tool in these patients to reduce hospital LOS and unnecessary tests.
Reference #1: Dajer-Fadel WL, Argüero-Sánchez R, Ibarra-Pérez C, Navarro-Reynoso FP. Systematic review of spontaneous pneumomediastinum: a survey of 22'years data. Asian Cardiovasc Thorac Ann 2014;22(8):997-1002.
Reference #2: Jung H, Lee SC, Lee DH, Kim GJ. Spontaneous pneumomediastinum with concurrent pneumorrhachis. Korean J Thorac Cardiovasc Surg 2014;47(6):569-571.
Reference #3: Lee SC, Lee DH, Kim GJ. Is primary spontaneous pneumomediastinum a truly benign entity? Emerg Med Australas 2014;26(6):573-578.
DISCLOSURE: The following authors have nothing to disclose: Diana Yepez-Ramos, Walid Dajer-Fadel, Rubén Argüero-Sánchez, Octavio Flores-Calderón, Serafín Ramírez-Castañeda, Elenilson Mejía-Melgar, Carolina Tortolero-Sánchez
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