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Emphysematous pyelonephritis is a rare and severe infectious complication characterized by the presence of gas in the renal parenchyma, excretory cavities and surrounded tissues. It is due to the development of non-anaerobic gasifier bacteria. We report a new rare case of emphysematous pyelonephritis in a kidney transplant recipient, particular by its occurrence in a non-functional graft and its exceptional association with emphysematous cystitis., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Facial and orbital emphysema without any trauma is an uncommon condition that might occur after nose blowing or sneezing efforts. It is usually self-limited and resolves spontaneously within two weeks. Surgical treatment is only reserved in case of complications such as neurological deficiencies or infection of the ocular globe. We report the case of a 42 year-old patient presenting a right spontaneous facial and orbital emphysema following nose blowing, treated by conservative measures, with a systematic review of the literature., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Emphysematous pyelonephritis is a necrotizing infection of the renal parenchyma and peri-renal tissues, characterized by the presence of air within the parenchyma of the urinary tract and peri-renal space. This is a severe complication, which involves the functional prognosis of the kidney and the patient's prognosis. The emphysematous pyelonephritis is a rare complication of renal transplantation. Its gravity is linked particularly to the fragility of immunosuppressed patients. The authors report the case of an emphysematous pyelonephritis having occurred 9 months after transplantation in a patient 58 years. The evolving risks and therapeutic modalities will be outlined and discussed., (Copyright © 2017 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

The presence of gas in the spinal canal or pneumorachis is a rare imaging finding, typically incidental. Pneumorachis may be due to several degenerative, traumatic, infectious, tumoral or iatrogenic etiologies. We report three cases of pneumorachis in patients with lumbar back pain. A case occurred in a patient with advanced degenerative disk disease. Another was in a patient with posterior facet synovial cyst. The last was in a patient with locally advanced rectal carcinoma complicated by perforation. Pneumorachis was detected on MRI in two cases and on CT in all three cases.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by permanent and progressive airway obstruction. Cigarette smoking is the main cause responsible for COPD although only 15 to 25 % of smokers develop COPD. Mechanisms underlying COPD pathogenesis are not fully understood. Structural abnormalities in small airways (bronchioles < 2mm in diameter) are the main determinants of airway obstruction; obstruction of these bronchioles is related to increase in airway wall thickness (associated with peribronchiolar fibrosis) and to plugging by mucus exudates. Alveolar wall destruction (emphysema) also contributes to airway obstruction and to gas exchange abnormalities. Current knowledge related to molecular and cellular mechanisms responsible for these structural modifications are reviewed.

Treatment of advanced emphysema is not limited to medical management. Surgical options can also be envisioned for some cases, and physicians must know about them. A bullectomy may be considered for giant bullae, defined by a volume greater than a third of a hemithorax. This option must be discussed even in cases of advanced obstructive disease. Lung volume reduction surgery is useful for emphysema that is heterogeneously distributed but without individual giant bullae. A large-scale controlled study helped to identify its indications and results. The third possible surgical option is lung transplantation. It offers the greatest functional benefits but also involves considerable risks. One of the key points is therefore to define the optimal moment in a patient's life when this option should be discussed. Recent guidelines developed by a panel of international experts provide clinicians with the criteria for considering transplantation.

Orbital emphysema is often associated with orbital fracture or communication with paranasal sinuses. It is usually moderate but could be the cause of optic neuropathy or central retinal artery occlusion. We report a case of massive orbital emphysema with ocular hypertony and prethrombosis of the central retinal artery. Emergency surgical decompression performed by an ophthalmologist and an otorhinolaryngologist provided complete and prompt relief. The authors emphasize the importance of preventing nose blowing after orbital trauma or surgery.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis has a high mortality rate. We herein report one case of bilateral emphysematous pyelonephritis managed by medical therapy alone.

Emphysematous pyelonephritis is a necrotizing kidney infection characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. This rare affection occurs almost exclusively in patients with diabetes mellitus and is due to non-anaerobic gas-producing bacteria. This life-threatening condition leads to septic shock and multiple organ failure. Diagnosis is suspected when a pyelonephritis does not respond to correct treatment, especially with altered vital signs or a diabetic patient. Computed tomography scan permits visualization of the gas and a radiologic classification with a prognostic value. Current treatment modalities are based upon repeated clinical and scanographic evaluations. In addition to systematic antibiotic therapy, percutaneous drainage is probably the first therapeutic stage in the majority of cases, but should not delay emergent rescue nephrectomy if necessary.

The prevalence of urinary tract infection is high in patients with diabetes mellitus. The presence of gas in the bladder lumen or wall constitute emphysematous cystitis. This disease is usually observed in diabetic patients. Early diagnosis and treatment are important factors for the outcome and absence of after-effects. We report the case of a 85 Year old women who was admitted to the hospital because of a gastrointestinal bleeding and subsequently developed an emphysematous cystitis. We present a comprehensive review of the literature and discuss pathogenesis, diagnosis and treatment of this condition.

The authors report a case of emphysematous cystitis in a 50-year-old woman treated by corticosteroids, occurring 1 month after hysterectomy for locally advanced ovarian cancer. Although the patient presented a vesico-vaginal fistula, the presence of air in the bladder wall and only in the bladder lumen, confirmed the diagnosis of emphysematous cystitis. Despite intensive care and surgery with colostomy and Mikulicz drainage associated with urinary diversion (transparietal bladder catheter on one side and cutaneous ureterostomy on the other side), the patient died on day 10 in a context of sepsis. The circumstances of discovery, the various clinical forms and the radiological features of emphysematous cystitis described in the literature are reviewed together with the modalities of management.

Purpose: Orbital emphysema is a common complication of orbital wall fractures (50% of blow-out fractures). It is generally a benign and self-limited condition. However, it may compromise retinal and optic nerve vascularization and therefore requires rapid management., Patient and Method: We report a case of traumatic orbital emphysema resulting in ischemic optic neuritis. The orbital emphysema was drained using a 25-gauge needle mounted on a syringe filled with normal saline, with the plunger removed, and guided by air bubble eruption., Results: Vision was promptly recovered following drainage of the orbital emphysema., Conclusion: The development of orbital emphysema after an orbital fracture is a consequence of a forceful expiratory effort raising intranasal pressure. It must be drained, as described, in cases of vascular compression.

Emphysematous pyelonephritis is defined as the presence of gas-producing bacteria in the kidney and in peri-nephretic areas. Even if it is rare, the mortality rate of this affection is between 50% and 90%. The E. coli is responsible in 60% of the cases. We report a case of a 50 years old male patient, with under diagnosed diabetics, how is admitted with pains in the left flank, fever, troubled urine, hematuria and worsening of general state. The diagnostic of emphysematous pyelonephritis was confirmed by CT Scan. In spite of adapted antibiotherapy to the renal function, insulinotherapy and correction of hydro-electrolytic troubles, the patient died with septic shock associated to digestive bleeding. Based on this case and a review of the literature, the authors describe the different features of this disease. Only an urgent nephrectomy after a short reanimation can improve the prognostic.

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.

We developed within our service of intensive care a hybrid procedure combining the advantages of the techniques of Caglia and Fantoni. Ventilation downstream from the site of dilatation, thanks to a longer tracheal tube of small diameter, ensures an optimal spirometry and reduces to a minimum the time of apnea. It decreases the risks of per-operational subcutaneous emphysema. A system of camera video assembled on a flexible fibroscope allows a direct vision on television screen. The operator can, constantly, visualise his gesture in one glance, in real time. Such an approach increases the security and the effectiveness of the method. The procedure remains nevertheless simple and does not require a thorough experience in percutaneous dilatational tracheotomy.

This article reports a case of peneumoparotid in a ten-year-old girl. This pathology is caused by insufflation of air into the acini of the parotid gland via Stensen's duct. A review of the literature shows that it has many aetiologies but more frequently it presents as an occupational hazard among glassblowers and wind instrumentalists. It may also occur by auto-insufflation in adolescence who often have psychological problems. The diagnosis is made from the history and imaging. The treatment is aetiologic and symptomatic.

A case of gastric pneumatosis is described in a 6 month old girl with Down syndrome. Plain abdominal radiographs showed a radiolucent rim within the gastric wall and a dilated stomach. Ultrasonography showed diffuse echoic streaks of air in the gastric wall, pneumobilia and gastroduodenal dilatation. Upper GI series showed duodenal stenosis. Gastric pneumatosis (air within the gastric wall), is an unusual radiographic finding. It may be of mechanical or inflammatory origin or, in some rare cases, remain unexplained.

We report a rare case of spontaneous pneumorachis (epidural air in the spinal canal) after benign chest trauma without rib fracture or pneumothorax.

Emphysematous pyelonephritis is a rare, life-threatening complication of upper urinary tract infections, characterized by the presence of gas in renal parenchyma and perirenal space. It occurs in 90% of cases in diabetic patients and E coli is the most common causative germ. The pathogenesis probably involves several factors including enhanced proliferation of microorganisms due to altered immune defences, mixed acid fermentation of glucose leading to gas production, and decreased elimination of the gas because of impaired tissue perfusion. Diagnosis is often delayed because the symptoms may be non-specific, as illustrated by the two cases we report herein. In patients with diabetes and febrile urinary tract infection, obstruction of the urinary tract should first be eliminated by echography. Then, if the infection does not rapidly respond to antimicrobial therapy, a scan should be performed. Aggressive management including correction of hemodynamics, parenteral antimicrobial therapy, and diabetes control with insulin therapy is mandatory, but a surgical procedure (nephrectomy or drainage) is almost always required.

Spontaneous pneumomediastinum is a relatively rare disease, the clinical signs of which may be misleading, and the physiopathology is still unknown. The authors report 7 cases collected over a period of 3 years and note the etiology, the clinical findings and the X-ray findings. The disease often affectsyoung sybjects, without any sex predominance. The initial symptom is thoracic pain and is often accompanied by dispnea. Subcutaneous emphysema only appears secondarily and may be mild. The association with pneumothorax is not rare. Among the etiological circumstances, pneumomediastinum often occurs after an effort or a respiratory infection with dyspnea. The diagnosis depends on the discovery of subcutaneous emphysema and on radiological signs in A.P. and lateral chest views. Treatment should be as conservative as possible in the usual benign forms. It should be limited to bed rest, analgesics and sedatives. In severe cases, supra-sternal drainage permits decompression of the mediastinum. The physiopathological mechanisms are discussed, but the usually accepted theory is rupture of an alveolus into the pulmonary interstitial tissue. The pressure gradient necessary for this rupture may be due to variations in alveolar or vascular pressure.

The authors report a case of traumatic subperitoneal perforation of the rectum, the diagnosis of which was made by finding a pneumoperitoneum on straight X-rays of the abdomen, and on rectal examination. In these cases the pneumoperitoneum is generally bilateral occupying the posterior pararenal space. The course was favourable under medical treatment.

The relationship between the development of pulmonary emphysema and the presence of proteolytic enzymes with elastolytic properties released by polymorphonuclear leukocytes or by alveolar macrophages is briefly reviewed. The possible role of various antiproteolytic substances present in the lung is also described. The pathogenesis of pulmonary emphysema is discussed in the light of hypotheses recently put forward implicating an excess of proteolytic factors and/or a relative or absolute lack of protection substances.

Localisation in one lung only or in one lobe only of lesions of interstitial emphysema is surprising in a diffuse disease such as hyaline membrane disease in premature infants. In the four patients in which this unusual course was seen, cure was obtained in different ways: spontaneously in one case, by excision of a diseased lobe in two cases and by selective temporary intubation of the contralateral main bronchus in the final case. Current methods of treatment of neonatal respiratory distress favour this type of course, without any precise cause being evident. Excision surgery is often avoidable by transient ventilation of the contralateral lung only by selective intubation of the main bronchus.

One case of pneumomediastinum due to subcutaneous emphysema occurring after using a high speed air turbine drill during dental extraction was described, as only a few cases have been published in the literature. Air may have entered the soft tissues directly by being forced down the gingival crevice. The air may then have passed by way of the fascial planes to enter deeper structures and the mediastinum. The consequences of this condition after general anaesthesia were discussed, more common aetiologies being tracheal or oesophageal rupture, bronchial rupture or pneumothorax.

The use of emergency transtracheal jet ventilation in a 62 year-old female with laryngeal papillomatosis and respiratory distress is reported. Adequate ventilation of the lungs with an intermittent jet of oxygen under high pressure (5 bar) allowed anaesthesia and surgery to be carried out. Pathogenesis of the mediastinal and subcutaneous emphysema discovered at the end of the procedure is discussed.

Two cases of post-operative subcutaneous emphysema are reported. After excessive airway pressure, air or anaesthetic gases may spread to the neck, mediastinum, abdomen or pleural cavity. Pathogenesis and mechanisms are discussed. Possible aetiologic factors are outlined. The consequences of this condition are limited after adequate emergency treatment.