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Background: Streptococcus salivarius is an opportunistic pathogen, and there have been no reported cases of Streptococcus salivarius pneumonia to date. Pneumomediastinum is usually secondary to tracheal or esophageal injury and is very rare as a complication of pneumonia. We report a case of Streptococcus salivarius pneumonia complicated by pneumomediastinum, aiming to enhance clinicians' awareness of rare pathogens and uncommon complications in pneumonia. Case presentation: The patient, a 36-year-old male, presented with a persistent cough and sputum production for one week, accompanied by a sore throat that had developed just one day prior. Chest computed tomography (CT) disclosed pneumomediastinum alongside obstructive atelectasis in the left lower lobe. Streptococcus salivarius infection was conclusively identified through bronchoalveolar lavage metagenomic next-generation sequencing (mNGS), as well as smear and culture analyses. The patient was administered intravenous amoxicillin-clavulanate potassium for a duration of seven days as part of the anti-infection regimen. Given the stability of the patient's respiratory and circulatory systems, a tube drainage procedure was deemed unnecessary. Post-treatment, the patient's clinical symptoms notably improved. A subsequent chest CT scan revealed the re-expansion of the left lower lung and near-complete resolution of pneumomediastinum. Conclusion: There are numerous pathogens that can cause pneumonia. While focusing on common pathogens, it is important not to overlook rare ones. When considering infections from rare pathogens, it is recommended to promptly perform a bronchoscopy and submit bronchoalveolar lavage fluid for mNGS to improve pathogen detection rates. During the diagnosis and treatment of pneumonia, it is crucial to be vigilant for rare complications. When a patient presents with symptoms such as dyspnea or subcutaneous emphysema, it is advisable to immediately perform a chest CT scan to rule out pneumomediastinum. [ABSTRACT FROM AUTHOR]

Barotrauma (including pneumomediastinum, pneumothorax or subcutaneous emphysema) is a frequent complication of patients with acute respiratory distress syndrome (ARDS) and is associated with worse outcome. Furthermore, some Authors hypothesize that pneumomediastinum could be a sign of ongoing patient self-inflicted lung injury (P-SILI) in patients with respiratory failure receiving non-invasive respiratory support. It has been recently found that a well-known radiological sign, the Macklin effect (or pulmonary interstitial emphysema), could be a powerful predictor of subsequent development of barotrauma in patients with ARDS (sensitivity = 89.2% (95% confidence interval (CI): 74.6 to 96.9); specificity = 95.6% (95% CI: 90.6 to 98.4)). Of note, Macklin effect is visible on chest computed tomography (CT) scan 8-12 days before overt barotrauma. Furthermore, patients with Macklin effect not currently receiving invasive ventilation have a high risk of subsequent intubation. Accordingly, it could be hypothesized that Macklin effect could be a marker of lung fragility, disease severity, and P-SILI in patients with ARDS. Therefore, detection of Macklin effect on chest CT scan could be used to stratify baseline risk of patients with ARDS, select which patients should be evaluated for alternative management algorithms, including advanced respiratory monitoring, ultraprotective ventilation, or institution of extracorporeal support without invasive ventilation. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus Disease 2019 (COVID-19) has increased the burden of hospitalised pneumonia cases and related complications. Spontaneous Pneumothorax (PT) and Pneumomediastinum (PM) have been reported in both spontaneously breathing and ventilated patients with COVID-19 pneumonia. Aim: To determine the incidence and outcomes of spontaneous alveolar air leak events in COVID-19 pneumonia. Materials and Methods: This prospective cohort study was carried out from June 2020 to June 2021 at a tertiary care centre in Western India. All incident cases of alveolar air leaks in COVID-19 pneumonia were included. Clinical and demographic data were collected, and statistical analysis was performed. The Chi-square test or Fisher's exact test were used to assess the differences in subgroup proportions. Results: A total of 79 patients (63 males and 16 females) experienced spontaneous alveolar air leaks in the form of PT, PM (mediastinal emphysema), or Subcutaneous Emphysema (SE), either isolated or in combination. A total of 58 patients (73.41%) had PT, while 8 patients (10.12%) had isolated PM and 2 patients (2.53%) had isolated SE. Of the total events, 35 (44.30%) occurred in spontaneously breathing patients, among them vigorous coughing was an important precipitating factor. At the time of the incident, 1.27%, 21.52%, and 77.21% of the affected cases belonged to mild, moderate, and severe COVID-19 categories, respectively. Male patients (n-63, 79.74%) in the age group of 30-60 years were predominantly affected. A total of 38 events (48.10%) occurred within two weeks (early) of symptom onset. The PaO2:FiO2 ratio at the time of the alveolar leak showed a significant association with the outcome. Patients with PT had a poorer outcome compared to those with other types of alveolar leaks (p-value<0.005). Major bleeding occurred in 2 (3.33%) of the total 60 Intercostal Drainage (ICD) procedures. Prolonged alveolo-pleural fistula healed spontaneously in four out of five cases. The cumulative incidence for air leak events was 1.55%, and for barotrauma, it was 6.47%. The overall mortality in this cohort was 74.68% (n=59), while it was 29.41% (5 out of 17) in the moderate severity group. Patients with late-onset events had a better outcome (p-value<0.005). Conclusion: In this cohort of COVID-19 pneumonia from Western India, the cumulative incidence of spontaneous alveolar air leaks was 1.55%, predominantly affecting males. The early occurrence of PT in severely hypoxic patients on mechanical ventilator was associated with higher mortality. [ABSTRACT FROM AUTHOR]

Hamman's syndrome, a rare complication of diabetic ketoacidosis (DKA), is characterized by subcutaneous emphysema and spontaneous pneumomediastinum. This case report discusses the occurrence of Hamman's syndrome in an 11‐year‐old adolescent male newly diagnosed with type 1 diabetes mellitus (T1DM) and presenting with severe DKA. The patient exhibited symptoms typical of DKA, including polydipsia, polyuria, abdominal pain, and fatigue, alongside signs such as dehydration, Kussmaul breathing, and tachycardia. Following initial management with intravenous fluids and insulin infusion, he was transferred to a tertiary children's hospital for further care. Subsequently, on routine examination, he exhibited bilateral neck crepitus and a mediastinal crunching sound on auscultation, indicative of Hamman's syndrome. Conservative management led to symptom resolution, and the patient was discharged with follow‐up arranged. This case highlights the importance of recognizing Hamman's syndrome as a potential complication of DKA in pediatric patients. Prompt diagnosis and management, along with differentiation from more severe conditions like Boerhaave's syndrome, are crucial for ensuring favorable outcomes. Further awareness and understanding of this rare syndrome are essential for optimal patient care and management. [ABSTRACT FROM AUTHOR]

Background: The number of migrants arriving on the shores of the Canary Islands continues to increase. The conditions under which the crossing is made, in small crowded, unsanitary boats (pateras or cayucos), have many and significant health problems. Objective: To describe the demographic, clinical, microbiological characteristics and evolution of a series of patients who recently arrived by patera and required hospitalization. Patients and methods: This observational, cross-sectional, and retrospective study included all patients newly arrived in Gran Canaria (Spain) by patera or cayuco from 2020 to 2022. Acute patera syndrome (APS) was defined as one or more of the following: dehydration, hypothermia, shock or rhabdomyolysis. Skin and soft tissue or musculoskeletal patera syndrome (SSTMSPS) was defined as conditions characterized by lesions of the skin, subcutaneous tissue, bone, or joint, excluding superficial erosions. Results: During the study period, 193 migrants were admitted, mostly males with a median age of 23 years from West Africa. A total of 36.99% presented with APS with a single diagnostic criterion (most commonly dehydration, 86.9%), 11.56% with SSTMPS and 51.44% with both syndromes. A total of 109 patients presented with SSTMSPS, the most common being lower extremity ulcers. The most frequently isolated microorganisms were gram-negative (i.e. Shewanella algae). The McMahon score effectively predicted the need for renal replacement therapy in cases of rhabdomyolysis. Twenty patients presented with pneumomediastinum, which was benign. SARS-CoV-2 infection was not a problem in any of them. Surgical intervention was required in 22% of cases, including 8 amputations, all of which were minor. No patient died during admission. Conclusion: Patera syndrome has specific characteristics that should be identified promptly to initiate the most effective treatment for optimal outcomes. [ABSTRACT FROM AUTHOR]

We present an uncommon pathology of Boerhaave's syndrome and its fatal outcome in a 77‐year‐old man who presented to the emergency room with loss of consciousness and a history of chronic cough that had increased in intensity over the past week. Radiological investigations revealed bilateral pleural effusion, initially pointing to a transudative aetiology. Diagnostic pleural aspiration showed an exudative effusion with high amylase, and an intercostal drainage tube was inserted for the left massive effusion. Contrary to the initial provisional diagnosis, the discovery of ingested milk in the intercostal drainage tube raised suspicion of Boerhaave's syndrome. Around 90% of perforations occur on the left side of the distal oesophagus, presenting as a pleural effusion on the left side. Less than 10% of patients experience bilateral pleural effusions. This patient's clinical presentation, which led to the diagnosis, is of interest. Unfortunately, he eventually lapsed into sepsis and succumbed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spontaneous pneumomediastinum is an unusual pulmonary complication of SARS-CoV-2 pneumonia. It is mostly described as a benign finding with spontaneous resolution. Some authors mention that cases with adverse outcomes (increased mortality) have been reported. Clinical experience shows a similar trend; therefore, the scientific evidence is equivocal; hence the need to document what happened in the pandemic. CLINICAL CASES: Five clinical cases of hospitalized patients aged 39 and 76 years with the following risk factors are described: smoking, asthma, chronic obstructive pulmonary disease, and obesity. Diagnosis was made by chest computed tomography and physical examination. CONCLUSIONS: Spontaneous pneumomediastinum is a complication associated with increased severity and mortality in COVID-19. A systematic review with a higher level of evidence is needed to update clinical care guidelines and reduce morbidity and mortality in COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity. Case Study: Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck. Results: The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home. Conclusion: This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Barotrauma is a frequent complication in patients with severe respiratory failure and is associated with poor outcomes. Extracorporeal membrane oxygenation (ECMO) implantation allows to introduce lung‐protective ventilation strategies that limit barotrauma development or progression, but available data are scarce. We performed a scoping review to summarize current knowledge on this therapeutic approach.We systematically searched PubMed/MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies investigating ECMO as a strategy to prevent/limit barotrauma progression in patients with respiratory failure. Pediatric studies, studies on perioperative implantation of ECMO, and studies not reporting original data were excluded. The primary outcome was the rate of barotrauma development/progression.We identified 21 manuscripts presenting data on a total of 45 ECMO patients. All patients underwent veno‐venous ECMO. Of these, 21 (46.7%) received ECMO before invasive mechanical ventilation. In most cases, ECMO implantation allowed to modify the respiratory support strategy (e.g., introduction of ultraprotective/low pressure ventilation in 12 patients, extubation while on ECMO in one case, and avoidance of invasive ventilation in 15 cases). Barotrauma development/progression occurred in <10% of patients. Overall mortality was 8/45 (17.8%).ECMO implantation to prevent barotrauma development/progression is a feasible strategy and may be a promising support option. [ABSTRACT FROM AUTHOR]

An 18‐year‐old healthy male complained of a 7‐day history of fever, cough, and sore throat, along with a three‐day history of left facial swelling. The x‐rays revealed subcutaneous emphysema in the chest, neck, face, and mediastinum region (Pneumomediastinum). Furthermore, an area of infiltration was visible, indicating pneumonia. Therefore, we immediately started him on intravenous antibiotics. We then moved the patient to an isolation room, considering pulmonary tuberculosis as one of the differential diagnoses. However, the Acid Fast Bacilli (AFB), Mycobacterium Tuberculosis Bacteria‐Polymerase Chain Reaction (MTB PCR), and sputum for gram stain and culture were all negative. On the other hand, the test for parainfluenza virus 3 was positive. The patient was observed with a daily chest x‐ray to monitor the progress of pneumonia and subcutaneous emphysema. Fortunately, the subcutaneous emphysema was significantly reduced on a daily basis until it was completely resolved before discharge home. [ABSTRACT FROM AUTHOR]

Background: Patients with severe respiratory failure due to COVID‐19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno‐venous (V‐V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V‐V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID‐19 and acute respiratory failure due to spontaneous PM. Methods: This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID‐19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V‐V ECMO support (V‐V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission. Results: Twenty‐two patients were included in this study (invasive ventilation group: 13 [59%]; V‐V ECMO group: 9 [41%]). The V‐V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12–0.97], p = 0.04). Five (38%) patients in the V‐V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V‐V ECMO support within 30 days from ICU admission. Three (33%) patients in the V‐V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48–45.3], p = 0.18). Conclusions: Preliminary data suggest that V‐V ECMO without invasive ventilation may improve survival in COVID‐19‐related acute respiratory failure due to spontaneous PM. The study's retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution. [ABSTRACT FROM AUTHOR]

Background: With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. Case presentation: A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. Conclusions: Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality. [ABSTRACT FROM AUTHOR]

Relapsing polychondritis (RP) is an immune-mediated systemic disease characterized by recurrent attacks of inflammation of cartilage and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment in the affected areas. The most common clinical features include ear and nasal chondritis, as well as polyarthritis, though potentially all cartilage areas can be affected. Delay in diagnosis is frequently encountered due to the progression of the disease and non-specific symptoms at the beginning. 30% of RP patients may have concomitant autoimmune disorders. In our case, a 42-year-old male patient diagnosed with RP was treated with methotrexate, leflunomide, tumor necrosis factor inhibitors and tociluzumab, but showed no improvement. Consequently, the patient was administered cyclophosphamide. Unfortunately, pneumomediastinum developed on the sixth day of treatment. The condition resolved without the need for surgical intervention. However, although the case received many treatments mentioned in the literature, he still did not go into complete remission. [ABSTRACT FROM AUTHOR]

Introduction: Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions. Methods: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed. Results: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86–3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001). Conclusion: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications. [ABSTRACT FROM AUTHOR]

Background: We present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use. Case presentation: This case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved. Conclusions: This case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use. [ABSTRACT FROM AUTHOR]

Background: Tension pneumomediastinum (TPM) is a rare but critical condition characterized by the accumulation of air in the mediastinum, leading to increased intrathoracic pressure and cardiovascular compromise. This case report is novel due to the rarity of TPM arising from blunt chest trauma and the necessity for emergent surgical intervention after initial conservative management failed. Case presentation: A 63-year-old male presented with severe chest pain and dyspnea following a high-impact motor vehicle collision. Initial assessment revealed tachypnea, tachycardia, and hypotension, along with extensive subcutaneous emphysema over the chest and neck. Imaging confirmed pneumomediastinum and bilateral pneumothoraxes, consistent with TPM. Despite initial management with high-flow oxygen and bilateral chest tube insertion, the patient's condition deteriorated, necessitating emergent mediastinal decompression via an anterior subxiphoid incision. This intervention resulted in immediate hemodynamic improvement. Conclusions: This case underscores the importance of recognizing TPM in patients with chest trauma and highlights the need for prompt surgical intervention in cases of hemodynamic instability. Early and accurate diagnosis and timely surgical management are crucial for improving patient outcomes in TPM. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of trans-anal barotrauma in a 25-year-old man who was shot in the anus with an air gun. The patient experienced symptoms of abdominal distension and pain, and imaging revealed air in the abdomen, chest, and scrotum. The patient underwent laparoscopic exploration and loop ileostomy, and had a successful recovery. The article emphasizes the importance of prompt diagnosis and treatment for this condition, as well as the need for education and training for users of high-pressure air equipment. The document is a systematic review of laparoscopic appendicectomy in obese patients, conducted by Dasari BVM, Baker J, Markar S, and Gardiner K and published in the International Journal of Surgery in 2015. The review examines the clinical outcomes of this surgical procedure and concludes that it leads to improvements in patient outcomes. This review provides valuable information for researchers and medical professionals interested in the topic. [Extracted from the article]

Surgeries for inguinal hernias are among the most commonly performed procedures worldwide. Compared to traditional open surgery for inguinal hernias, there has been a rise in the use of Total Extraperitoneal (TEP) repair. TEP has been recommended as a safe method for the repair of inguinal hernias. The present report describes a case of subcutaneous emphysema, a rare complication observed after TEP. Subcutaneous emphysema is defined as the de novo creation or infiltration of air in the skin's subcutaneous layer, which includes the epidermis and dermis. It can occur in various body parts. Factors contributing to the development of subcutaneous emphysema include total gas volume, gas flow rate, the use of a valveless trocar system and robotic fulcrum force. A 56-year-old male was planned for elective TEP surgery. Intraoperatively, the patient experienced a rise in Endtidal Carbon Dioxide (EtCO2), which was followed by an examination that revealed subcutaneous emphysema extending up to the neck. Immediate measures were taken, including increasing the Fraction of Inspired Oxygen (FiO2) to 100% and making nicks on the anterior chest wall and supraclavicular region. A repeat chest X-ray showed no recurrence of subcutaneous emphysema and the patient was discharged seven days postoperatively. Although subcutaneous emphysema is a rare condition, it can lead to lifethreatening complications, such as pneumothorax. Therefore, early diagnosis and prompt treatment are essential. [ABSTRACT FROM AUTHOR]

Background: Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations. Case presentation: We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia. Conclusion: Anesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation. [ABSTRACT FROM AUTHOR]

Aim: This study examines the effects of pneumothorax and pneumomediastinum on the mortality and morbidity of patients with respiratory virus infections. It analyses blood parameters and the Systemic Immune Inflammation Index (SII) in patients who acquired these complications compared to those who did not. Materials and Methods: We conducted a retrospective assessment of 2246 COVID-19 patients who received treatment at our medical facility between August 2020 and February 2021. This study included a total of 118 patients who were admitted to the hospital due to a respiratory virus illness. The patients were categorised into two groups: one consisting of individuals who experienced pneumothorax and/or pneumomediastinum, and the other consisting of individuals who did not acquire these complications. Both groups had an equal number of participants. The study analysed many factors including metabolic profiles, hemogram results, length of hospital stay, SII levels, and the incidence of pneumothorax, with a focus on their association with morbidity and mortality outcomes. Results: Significantly, female patients who experienced pneumothorax during COVID-19 treatment exhibited a worse mortality rate. Patients with pneumothorax had elevated leukocyte and neutrophil counts, along with heightened systemic immune-inflammation index (SII) and decreased levels of total protein and albumin. The data highlight the potential importance of specific blood measurements, as well as the presence of pneumothorax, as indications for death in patients with respiratory virus infections. Conclusion: For enhanced patient outcomes, it is important to closely monitor and manage female patients who get pneumothorax after receiving therapy for respiratory virus infection. [ABSTRACT FROM AUTHOR]

Objective: To describe the incidence, etiology, clinical signs, diagnostics, treatments, and outcome of noniatrogenic traumatic pneumomediastinum (TPM) in dogs and cats. Design: Retrospective study of cases (2005–2022). Setting: University veterinary teaching hospital. Animals: Fifty‐two patients (29 dogs, 23 cats). Measurements and Main Results: Data collected from the medical records included signalment, physical examination findings, animal trauma triage (ATT) score, clinicopathological data, imaging data, surgical intervention, length of hospitalization, supportive care, complications, and outcome. Most dogs presented with tachycardia and tachypnea, while cats presented with hypothermia and tachypnea. Subcutaneous emphysema, pneumothorax, and dyspnea were the most common clinical signs for both species. The median calculated ATT score was 3.5 in dogs and 4 in cats. The most common radiographic abnormalities other than pneumomediastinum were pneumothorax and lung contusions. The overall mortality rate was 18%, with a significantly higher survival rate in dogs (26/28 dogs [93%], 15/22 cats (68%); P = 0.03). Outcome was unknown in 1 dog and 1 cat. The only significant difference in treatment between survivors and nonsurvivors was the requirement in dogs for positive pressure ventilation. The median hospitalization period was 2 days for both species, with a shorter hospitalization in the nonsurvivors (0.6 vs 2 days, respectively; P = 0.006). Conclusions: TPM is an infrequent pathology in veterinary medicine and may be seen without an externally obvious injury. The most common causes for TPM in dogs were vehicular trauma and bite wounds, while high‐rise syndrome was the most common cause in cats. Most of the cases have concurrent pneumothorax and require thoracocentesis; however, direct intervention to treat TPM is not usually required. The vast majority of cases did not undergo surgery to treat TPM. The prognosis for dogs with TPM was good but was guarded for cats. [ABSTRACT FROM AUTHOR]

Background: Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management. Case presentation: A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission. Conclusions: This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations. [ABSTRACT FROM AUTHOR]

The use of specific antibodies in inflammatory myopathies has improved the characterization of this disease, identifying different clinical phenotypes. Patients with dermatomyositis and anti-MDA5 antibodies display typical skin symptoms, lesser muscular involvement, and a prevalence of interstitial lung disease of up to 91%. Beyond interstitial lung disease, spontaneous pneumomediastinum has been identified as a rare but potentially fatal pulmonary manifestation. Two cases of this complication in patients with anti-MDA5 dermatomyositis are reported. [ABSTRACT FROM AUTHOR]

Background: Pneumomediastinum refers to the presence of extraluminal gas within the mediastinum. If signs of pneumomediastinum are not present on chest X-ray and it is detected on contrast-enhanced computed tomography (CECT) thorax then it is known as occult pneumomediastinum. There is a dearth of literature regarding occult pneumomediastinum in patients with blunt chest trauma. Aims and Objectives: This study was done to see the incidence as well as outcome of occult pneumomediastinum in patients of blunt chest trauma. Materials and Methods: A prospective study was done in the department of general surgery at a tertiary care institute in which a total of 32 patients with blunt chest trauma were taken. The patients with occult pneumomediastinum were identified using CECT and appropriate management was done in all patients. Correlation of occult pneumomediastinum with subcutaneous emphysema, rib fracture, jugular venous pressure (JVP), pleural effusion, and outcome was seen. Results: It was evident from this study that 18.8% of patients of with chest trauma had occult pneumomediastinum. Incidence of blunt chest trauma is most common in the age group of 31-60 years as this age group is more vulnerable to roadside accidents and other accidents. There is a strong correlation between the presence of central subcutaneous emphysema, raised JVP, and worse outcomes with occult pneumomediastinum (P<0.05). Conclusion: This study showed a high incidence of occult pneumomediastinum in patients with chest trauma which is ultimately associated with high mortality. Hence, we should keep high index of suspicion regarding the presence of occult pneumomediastinum so that timely management of these patients can be done to prevent morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) is a significant and novel cause of acute respiratory distress syndrome (ARDS). During the COVID-19 pandemic, there has been an increase in the incidence of cases involving pneumothorax and pneumomediastinum. However, the risk factors associated with poor outcomes in these patients remain unclear. Methods: This observational study collected clinical and imaging data from COVID-19 patients with PTX and/or PNM across five tertiary hospitals in central Italy between 1 March 2020 and 1 March 2022. This study also calculated the incidence of PTX and PNM and utilized multivariable regression analysis and Kaplan–Meier curve analysis to identify predictor factors for 28-day mortality and 3-day orotracheal intubation after PTX/PNM. This study also considered the impact of the three main variants of concern (VoCs) (alfa, delta, and omicron) circulating during the study period. Results: During the study period, a total of 11,938 patients with COVID-19 were admitted. This study found several factors independently associated with a higher risk of death in COVID-19 patients within 28 days of pulmonary barotrauma. These factors included a SOFA score ≥ 4 (OR 3.22, p = 0.013), vasopressor/inotropic therapy (OR 11.8, p < 0.001), hypercapnia (OR 2.72, p = 0.021), PaO2/FiO2 ratio < 150 mmHg (OR 10.9, p < 0.001), and cardiovascular diseases (OR 7.9, p < 0.001). This study also found that a SOFA score ≥ 4 (OR 3.10, p = 0.015), PCO2 > 45 mmHg (OR 6.0, p = 0.003), and P/F ratio < 150 mmHg (OR 2.9, p < 0.042) were factors independently associated with a higher risk of orotracheal intubation (OTI) within 3 days from PTX/PNM in patients with non-invasive mechanical ventilation. SARS-CoV-2 VoCs were not associated with 28-day mortality or the risk of OTI. The estimated cumulative probability of OTI in patients after pneumothorax was 44.0% on the first day, 67.8% on the second day, and 68.9% on the third day, according to univariable survival analysis. In patients who had pneumomediastinum only, the estimated cumulative probability of OTI was 37.5%, 46.7%, and 57.7% on the first, second, and third days, respectively. The overall incidence of PTX/PNM among hospitalized COVID-19 patients was 1.42%, which increased up to 4.1% in patients receiving invasive mechanical ventilation. Conclusions: This study suggests that a high SOFA score (≥4), the need for vasopressor/inotropic therapy, hypercapnia, and PaO2/FiO2 ratio < 150 mmHg in COVID-19 patients with pulmonary barotrauma are associated with higher rates of intubation, ICU admission, and mortality. Identifying these risk factors early on can help healthcare providers anticipate and manage these patients more effectively and provide timely interventions with appropriate intensive care, ultimately improving their outcomes. [ABSTRACT FROM AUTHOR]

A 64-year-old man, who had no pre-existing health conditions, was admitted to the intensive care unit due to progressive shortness of breath resulting from COVID-19. Initially, the patient responded to non-invasive mechanical ventilation, which improved his breathing function. However, after six days, his respiratory function worsened significantly, requiring invasive ventilation. Out of nowhere, the person experienced spontaneous pneumomediastinum and extensive subcutaneous emphysema. The next day, a spontaneous pneumothorax occurred and was successfully drained later. It became evident that there was extensive subcutaneous emphysema also. The CT scan of the chest confirmed the presence of spontaneous pneumomediastinum, but it did not have any effect on the patient's hemodynamics. The physicians performed a bronchoscopy and imaging with a contrast medium, which ruled out any lesions to the trachea or esophagus. No other issues related to the problem were identified during the examination. Unfortunately, microscopic bullae of interstitial emphysema, or micro air leaks, are visible when they are an adequate size on computed tomography. Recent literature and studies not available during the case report have shown that if the Macklin effect is detected on the baseline CT scan, it could predict the occurrence of pneumothorax or pneumomediastinum. [ABSTRACT FROM AUTHOR]

A 29-year-old man presented to the emergency department with haemoptysis and thoracic pain. His vital signs and blood tests were normal, except for increased C-reactive protein levels. Fibrolaryngoscopy and esophagogastroduodenoscopy results were negative. Computed Tomography of the chest revealed abundant pneumomediastinum, air dissection along the peribronchovascular sheaths of the left lower lobe and a vegetating lesion completely occluding the distal extremity of the left main bronchus. After complete bronchoscopic excision of the lesion, histological examination revealed a carcinoid tumour not otherwise specified. After hospital discharge, 18F-fluorodeoxyglucose and 68Ga-DOTANOC positron emission tomographies ruled out distant metastases. A sleeve resection of approximately 20 mm of the distal extremity of the left main bronchus and a circumferential anastomosis between the left main bronchus and ipsilateral lobar bronchi were performed. Several bronchoscopic follow-ups did not show anastomotic dehiscence or tumour relapse. [ABSTRACT FROM AUTHOR]

We describe the case of an 87‐year‐old gentleman referred to a metropolitan hospital in Sydney with pneumomediastinum complicating immunotherapy associated pneumonitis and recent bronchoscopic intervention. The contribution of pneumonitis in the setting of interstitial lung disease has been well described to developing pneumomediastinum however this is less clear in the setting of immunotherapy associated pneumonitis and to what extent bronchoscopic intervention compounds this risk. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (SPM) is a rare condition in children and young adults that raises concern for esophageal perforation or extension of an air leak, resulting in admissions with multiple interventions performed. To assess our outcomes, and to evaluate our resource utilization, we reviewed our experience with SPM. We conducted a retrospective review of SPM cases in patients aged 5–25 years old occurring between 2011 and 2021 at a single academic tertiary care center. Clinical, demographic, and outcome variables were collected and analyzed, and cohorts were compared using Fischer's Exact Test and Welch's T Test. 166 SPM cases were identified—all of which were Emergency Department (ED) presentations. 84% of the cases were admitted. 70% had Computerized Tomography (CT) scans, with no defined criteria for imaging. Comparison of floor admissions with discharges from the ED showed no significant difference in presenting symptoms, demographics, or outcomes between the two groups. Recurrence was noted in 4 patients with a range of 5.9 months–4.9 years from the initial episode. In the largest SPM study in the pediatric and young adult population, we noted no significant difference in management or outcomes in admitted or ED discharge patients nor those with CT imaging. Our results suggest that a large number of SPM can be managed safely with discharge from the ED. [ABSTRACT FROM AUTHOR]

Purpose: Esophageal perforation (EP) can be a diagnostic challenge. Computed tomography (CT) and CT esophagography (CTE) are often used to rule out EP in the emergency setting with promising diagnostic performance, but the standard of care remains fluoroscopic esophagography (FE). We assess the diagnostic performance of CT and CTE when interpreted by expert and generalist radiologists and created an imaging workflow guide. Methods: Retrospective study of patients presenting with suspected EP. Two expert radiologists independently reviewed blinded CT/CTE studies, recorded CT findings, and assigned an esophageal injury grade. We also collected initial (general radiologist) CT findings and interpretation and FE diagnoses. We assessed inter-reader reliability and diagnostic performance. Results: EP was diagnosed in 46/139 (33%) encounters. The most common CT/CTE findings in EP were esophageal wall thickening (46/46, 100%), pneumomediastinum (42/46, 91%), and mediastinal stranding (39/46, 85%). CT and CTE sensitivity for detecting EP was 89% and 89% for expert radiologists, respectively, and 79% and 82% for general radiologists, compared with 46% for FE. Inter-reader agreement for detecting EP by CT and CTE was kappa 0.35 and 0.42 (both p <.001) between expert and generalist radiologists. We present radiographic images for key CT/CTE findings and a suggested workflow for the evaluation of possible EP. Conclusion: CT and CTE are more sensitive than FE for EP in the emergency setting. Due to the rarity of EP and current wide variability in imaging interpretation, an imaging workflow and injury grading system based on esophageal and mediastinal CT findings are offered to help guide management. [ABSTRACT FROM AUTHOR]

The article discusses ventilator-induced lung injury (VILI), which refers to the lung damage caused by mechanical ventilation. The different types of VILI, including barotrauma, volutrauma, atelectrauma, biotrauma, and ergotrauma, are explained. The article also explores the pathogenesis of VILI in healthy and injured lungs, as well as the assessment and clinical approach to VILI. The authors argue for a broader definition of VILI to include all direct and indirect pathological changes caused by mechanical ventilation. [Extracted from the article]

Surgical airway management is one of the most effective techniques for safe airway management. Within the training programs relating to knowledge and skills required by otorhinolaryngologists, tracheostomy and postoperative management are important items that must be fully understood by airway surgeons. We performed a nationwide survey to identify problems within tracheostomy and postoperative management in Japan in order to establish practical and safe guidelines for surgical airway management. We conducted a questionnaire survey of the current status of tracheostomy and postoperative management at core institution of otorhinolaryngology training programs in Japan. Responses were obtained from all 101 core training institutions in Japan. Tracheostomy was performed in the operating room at 61.4% of institutions and in the ICU at 26.7%. 89.1% of them performed surgical tracheostomy (ST) in all cases. Even in the remaining 10.9%, percutaneous dilatational tracheostomy (PDT) was performed in less than 10% of cases. The primary surgeon was an otorhinolaryngology resident at 89.1% of institutions. The method of securing the tube immediately after surgery was by securing it with an attached cord at 48.5% of institutions, by suturing to the skin at 25.7%, and using a Velcro band at 24.8%. The first tube change after tracheostomy was performed on the seventh postoperative day at 81.2% of institutions. 87.1% had more than one person performing the first tube change. The tracheostomy postoperative complications within the past year were as follows: tracheostomal granulation: 89.1%; subcutaneous and/or mediastinal emphysema: 62.4%; tube stenosis: 55.4%; accidental tube removal: 50.5%; incorrect tube insertion or misplacement: 15.8%; hemorrhage from tracheal foramen requiring hemostasis in the operating room: 14.9%; pneumothorax: 4.0%; tracheo-innominate arterial fistula: 2.0%; and tracheoesophageal fistula: 1.0%. The method for educating otorhinolaryngology residents about tracheostomy was on-the-job training at 98.0% of institutions. For airway management in otorhinolaryngology training programs, after learning the basics of ST, PDT should also be well understood. Furthermore, in order to create safe educational programs for intraoperative and postoperative management, it is necessary to train otorhinolaryngologists with accurate knowledge and skills, and to strengthen collaboration with multiple professions in their leadership roles as airway surgeons. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk factors and etiology remain unknown. Herein, we investigated the clinical characteristics of mechanically ventilated patients with COVID-19 with PTX or PM. Methods: We examined patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit of a tertiary-level emergency medical center in Tokyo, Japan between April 1, 2020. and October 31, 2021. We collected and analyzed the clinical characteristics of the patients who presented with either PTX or PM during mechanical ventilation. Results: During the study period, a total of 165 patients required mechanical ventilation, and 15 patients with PTX/PM during mechanical ventilation were selected. Three patients with obvious causes were excluded, and the remaining 12 patients were analyzed (7.3%). The mortality rate in these patients was as high as 50%, demonstrating the difficulty of treatment in the presence of PTX/PM. PTX/PM occurred 14.5 days after intubation. A peak pressure of > 30 cmH2O was only apparent in one patient, suggesting that high positive pressure ventilation may be less involved than mentioned in the literature. In addition, the inspiratory effort was not strong in our group of patients. (P0.1 was 2.1 cm H2O [1.0–3.8]). Conclusion: Various factors are associated with the development of PTX/PM in patients on mechanical ventilation for COVID-19. We did not find a strong correlation between PTM/PM and barotrauma or strong inspiratory efforts, which have been identified as potential causes in previous studies. [ABSTRACT FROM AUTHOR]

This article, published in the Arab Journal of Interventional Radiology, presents a rare case study of a patient who developed acute pancreatitis, pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum after undergoing an ERCP procedure. The case highlights the need for increased awareness and tailored management of complications that can arise from ERCP. The patient in this case was successfully treated with conservative management, including cholecystectomy and stone extraction, without the need for surgical intervention. The authors aim to enhance awareness, classification, and patient safety in ERCP procedures through sharing this experience. [Extracted from the article]

Extra-medullary hematopoiesis is a rare condition that corresponds to the ectopic development of hematopoietic tissue outside the bone marrow in response to bone marrow hyperstimulation. This phenomenon occurs mainly in embryonic hematopoiesis sites (spleen, liver, lymph nodes), sometimes in other organs such as the kidneys and lungs. Mediastinal localization is more rare. We present the observation of a patient in whom the diagnosis of beta-thalassemia was evoked in front of paravertebral tissue masses related to extra-medullary hematopoiesis. Observation: A 36-year-old patient hospitalized in our NYHA dyspnea department for the last three weeks, a thoracic CT scan was performed showing the presence on both sides of the dorsal spine of the 02 spontaneously dense masses enhanced after contrast. Biologically, the blood smear showed 78% erythroblastemia of Howell-Jolly’s acidophilic erythroblasts and the presence of red blood cell anisopoikylocytosis with target red blood cells and sickle cell disease. Electrophoresis of hemoglobin showed a hemoglobin F level at 90 %, we completed with molecular biology, this result is in favor of a β0 thalassemia (β0/β0 allele). Conclusion: Our observation describes an exceptional case of spinal extra-medullary hematopoiesis whose diagnosis of B-thallasemia was made on molecular biology. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) is a well–established method for treating early esophageal carcinomas. However, data on the safety and efficacy of esophageal ESD in older patients in the United States are limited. Methods: This retrospective study investigated the outcomes of esophageal ESD in patients aged ≥80 years and included those who underwent esophageal ESD between June 2018 and April 2023 at a single center in the United States. Patients were divided into two age groups for comparison: ≥80 and <80 years. Treatment outcomes and complications were evaluated and compared between these groups. Results: A total of 53 cases of esophageal ESD for malignant neoplasms were included, with 12 patients in the ≥80 years age group. No significant differences were observed in the patients' background and characteristics, except for a prior history of interventions (p = 0.04). The en bloc resection rate was 100% in both groups. The R0 resection rate was lower in the ≥80 years age group (75% vs. 88%). There were no complications requiring additional intervention in the ≥80 years age group, such as post–ESD bleeding, perforation, mediastinal emphysema, or pneumonia. Conclusions: Esophageal ESD may be a safe and feasible procedure for treating esophageal carcinomas in older patients. [ABSTRACT FROM AUTHOR]

Tracheal rupture is a very rare but life‑threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55‑year‑old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad‑spectrum antibiotic therapy was decided because of patients’ vital signs stability and the absence of esophageal injury. The follow‑up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection is associated with respiratory complications, especially during the acute phase. We report an unusual case of an adolescent boy who presented with cough, dyspnea and unilaterally absent breath sounds on auscultation. Two weeks prior to the admission, the patient reported lowgrade fever and mild cough. A rapid SARS-CoV-2 antigen test was positive. On admission, the child tested positive for SARS-CoV-2 with polymerase chain reaction (PCR). The diagnosis of spontaneous pneumothorax was confirmed by a chest X-ray. A chest tube was inserted, and symptoms gradually resolved. This case report highlights that SARS-CoV-2 infection may cause serious respiratory complications in children, even after the resolution of acute infection. [ABSTRACT FROM AUTHOR]

Tracheal Diverticulum(TD), or paratracheal cyst, is an uncommonly encountered and reported clinical entity. The incidence of TD is approximately 1% in adults and 0.3% in children.1,2 There are 2 types of TD-acquired and congenital. Acquired diverticula are thought to be outpouchings at weaknesses in the posterior tracheal wall due to coughing or blunt injury.1,3,4,5 While congenital TD, are thought to be malformed supernumerary branches of the trachea.¹ Patients may present with chronic cough, dyspnoea, stridor, hoarseness of voice, stridor, and repetitive episodes of tracheobronchitis.2,3,5 Case reports have reported difficulties in intubation, lung isolation, ventilation and pneumomediastinum secondary to accidental perforation of a diverticulum caused by tracheal intubation.3,6,7,8 We present a case of a patient who underwent an uneventful excision of his TD. Written consent was obtained from the patient for publishing this case report. Based on local ethical board requirements, no ethical review was needed. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum and its association with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection is an unusual clinical condition, which is pretended to be explained by the severe diffuse alveoli damage; which causes dissection of the intraalveolar air through the bronchovascular sheaths and arrives to the mediastinum and even to the neck, thorax and abdomen soft tissue; with a clinical manifestation on subcutaneous emphysema. All of the above is related with a poor clinical outcome, this is why the radiologist needs to know the imaging features of this condition; and to be aware of the clinician of such findings. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (SPM) is the manifestation of air in the mediastinum in the non-attendance of trauma and it is uncommon. We showed spontaneous pneumomediastinum, a rare complication after an asthma attack. ABPM is a rare disease, often associated with severe asthma. Fungal sensitization is an issue in severe asthma and this type of sensitization is important in terms of drawing attention to different complications in a case. Although the patient's mold and yeast mixture (Mx2) allergen-specific immunoglobulin E-ImmunoCAP system (Phadia 100, Phadia, Uppsala, Sweden) was positive, no susceptibility to aspergillus was detected in specific IgE and skin tests. Total IgE was 2560 kU/L. Our asthmatic patient with candida albicans and penicillium sensitivity on skin test was diagnosed with allergic bronchopulmonary mycosis (ABPM). This case highlights the importance of raising awareness that there may be an increased risk of SPM in Asthmatics with ABPM. [ABSTRACT FROM AUTHOR]

Objective: To describe and evaluate the surgical outcomes of multilayered closure of persistent tracheocutaneous fistulae (TCF) in patients with challenged wound healing. Methods: A retrospective chart review of all patients who underwent closure of TCF by the senior author between October 2011 and December 2021 was performed. Age, body mass index (BMI), time between decannulation and TCF repair, medical comorbidities, procedure duration, length of hospitalization, and postoperative complications were recorded. The primary outcomes were closure of the fistula, postoperative subcutaneous emphysema, pneumomediastinum, pneumothorax, wound infection, or breakdown. Outcomes of patients with and without challenged wound healing were compared. Results: Thirty-five patients who underwent TCF repair during the study period were identified. The mean age and BMI were 62.9 years and 28.43 respectively. Twenty-six (74%) patients met criteria for challenged wound healing at the time of the TCF repair. There was 1 (3.84%) minor complication in the challenged wound healing group and none (0%) in the control group (P = 1.00). No patients experienced wound breakdown or air leak noted on exam or chest radiography. Conclusion: Multilayered closure of persistent tracheocutaneous fistulae is a simple technique which is safe and effective even in patients with challenged wound healing. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICI) improve the prognosis of many cancers but cause immune‐related adverse events (IrAEs). Limited data are available on upper gastrointestinal (UGI) IrAEs. We describe the clinical characteristics, prognosis, and efficacy of medical therapy in patients with UGI IrAEs. Methods: This is a retrospective, multicenter cohort study of patients with UGI symptoms and moderate to severe endoscopic UGI lesions, occurring after ICI. Efficacy of induction medical therapy and at the most recent follow‐up was assessed. Results: Forty patients were included; of these, 34 (85%) received anti‐PD(L)1, either alone (n = 24) or combined with anti CTLA‐4 (n = 10). Eighteen patients (45%) had concomitant enterocolitis. All patients had severe endoscopic lesions (erosions, ulcerations, hemorrhage, or necrotic lesions). Three patients who received an inefficient initial medical treatment had a complicated course: One patient died of enterocolitis, one had a pneumomediastinum, and one developed an ulcerated stricture of the pylorus. Thirty‐five patients (88%) were treated with corticosteroids; 28 patients (80%) responded, and 20 (57%) reached clinical remission. Eight patients were treated with infliximab, and six responded (75%). After a median follow‐up of 11 months, 36 patients (90%) were in corticosteroid‐free clinical remission for their UGI symptoms. Endoscopic lesions persisted in 68% of patients. Conclusions: ICI cause severe UGI IrAEs, which are associated with enterocolitis in approximately half of the patients. Most patients with UGI IrAEs respond to corticosteroids or infliximab. These data support the recommendation to treat these patients without delay and in the same way as those with enterocolitis. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to describe the clinical characteristics and outcomes of patients with spontaneous pneumothorax (SPT) and pneumomediastinum (SPM) due to COVID-19 pneumonia. Methodology: This retrospective study evaluated inpatients at a COVID-19 pandemic hospital. Between March 11, 2020 and March 31, 2021, patients who developed complications of spontaneous pneumothorax (SPT) and pneumomediastinum (SPM) with a confirmed diagnosis of SARS-CoV-2 by polymerase chain reaction (PCR) method were included. Results: Of the 6,528 hospitalized patients, nine developed complications of SPT and SPM, with an incidence of 0.14%. Four of these patients developed SPT, one developed SPM, one developed SPT + SPM + emphysema, and three developed SPT + SPM. The mean age of the patients was 67.67 ± 13.41 years and the median was 68 (45-88) years. All patients were male. Six patients died, one of whom died of myocardial infarction from uncomplicated causes. Conclusions: Studies with more cases are needed to evaluate the causality between COVID-19 and pneumothorax (PT) and pneumomediastinum (PM). However, it should be kept in mind that PT and PM may lead to this clinic when sudden respiratory distress occurs in these patients and rapid diagnosis and treatment should be planned. As observed in this study, PT and PM are important factors in the development of mortality in COVID-19 patients. [ABSTRACT FROM AUTHOR]

What is the optimal management of spontaneous pneumomediastinum (SPM) and is there a risk of esophageal perforation in patients with SPM? We performed a retrospective case-control study of children through age 21, diagnosed with SPM in one hospital system over 10 years with the primary aim of describing the diagnostic workup, treatment patterns, and clinical outcomes. We hypothesized that SPM is a self-limited disease and is not associated with esophageal injury. Cases were identified using International Classification of Disease codes and excluded for trauma or severe infections. Median age was 16 years, 66% were male (n = 179). Chest radiography was performed in 97%, chest computed tomography (CT) in 33%, and esophagrams in 26%. Follow-up imaging showed resolution in 83% (mean = 17.2 days). SPM was not associated with esophageal perforation. We recommend avoiding CT scans and esophagrams unless there is discrete esophageal concern. Management of SPM should be guided by symptomatology. [ABSTRACT FROM AUTHOR]

This article describes a rare case of spontaneous pneumomediastinum (SPM) in a patient with interstitial lung disease (ILD). The patient also experienced pneumothorax and pneumoperitoneum. The condition was attributed to the Macklin effect, which involves the dissection of air along the broncho-alveolar sheath. The patient's symptoms included dyspnea, fever, cough, and swelling of the face, neck, and upper chest. Despite treatment, the patient's condition worsened and ultimately resulted in death. The article highlights the rarity of this co-occurrence and emphasizes the need for further research and consensus on the management of SPM. [Extracted from the article]

Objective: Rare coexistence of disease or pathology Background: There has been an increase in the use of inhalation methods to abuse drugs, including freebasing crack cocaine (alkaloid) and inhaling methamphetamine vapor. This report is of a 25-year-old man with a history of substance abuse presenting with pneumomediastinum due to methamphetamine vapor inhalation. Acute pneumomediastinum is an extremely rare complication of methamphetamine use. Case Report: A 25-year-old man was treated for polysubstance abuse following 9 days of methamphetamine abuse. EKG did not show any ST &T change. D-dimer was normal, at 0.4 mg/L, so we did not do further work-up for pulmonary embolism. His chest pain worsened in the Emergency Department (ED), and a physical exam demonstrated crepitation of the posterior neck, trapezius, and right scapula. A portable chest X-ray revealed subcutaneous air over the right scapular region, in addition to pneumomediastinum. The urine drug screen test was positive for methamphetamine. A chest CT was ordered, which showed a moderate-volume pneumomediastinum with soft-tissue air tracking into the lower neck and along the right chest wall. The patient underwent an esophagogram, which showed no air leak, and Boerhaave's syndrome was ruled out. His symptoms improved and he did not require any surgical intervention. Conclusions: Considering the higher rates of illicit substance use, especially methamphetamine, it is important to pay attention to the associated pathologies and to keep spontaneous pneumomediastinum on the list of differentials for patients using methamphetamine, particularly those who inhale it, which can cause pneumomediastinum, even without Boerhaave's syndrome. [ABSTRACT FROM AUTHOR]

Pneumomediastinum and subcutaneous emphysema usually result from alveolar rupture and rarely from colonic perforation. Although steroid use has been shown to increase the risk of complicated diverticulitis, there is limited data on the role Addison's disease may play in the development of colonic perforation. We present a rare case of a patient with Addison's disease who presented with hoarseness and was found to have massive subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum secondary to complicated diverticulitis. [ABSTRACT FROM AUTHOR]

A 76-year-old man visited our hospital complaining of pain during defecation. Rectal examination revealed an anal fissure at the 6 o'clock position. Sharp induration was suggested. The anus was highly tense owing to pain, and anoscopy confirmed the anal fissure at the 6 o'clock position. He was conservatively treated with anal ointment and analgesics and was followed up 1 week later, during which time the pain did not improve. Therefore, rectal endoscopy was performed because it was suggested that there was a fish bone stuck in the anus, resulting in the formation of a localized abscess near the anal crypt. There was a press-through pack (PTP) measuring approximately 2 cm in diameter above the anal canal, and a deep fissure had formed. The PTP was extracted using a recovery net. There was no mediastinal emphysema or free air on computed tomography, and the symptoms improved with conservative treatment. PTP is a form of drug packaging with aluminum foil and vinyl chloride, and gastrointestinal damage due to accidental ingestion is often reported, but it rarely reaches the rectum intact. We encountered a PTP-induced rectal foreign body and succeeded in endoscopically removing it. We report this case with a review of the literature. [ABSTRACT FROM AUTHOR]