Pneumomediastinum and pneumorrhachis from recreational nitrous oxide inhalation: no laughing matter.

Thorax

Department of Radiology, Barnet Hospital, Royal Free London NHS Foundation Trust, London, UK.

Published: February 2018

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Source
http://dx.doi.org/10.1136/thoraxjnl-2017-210291DOI Listing

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Hamman Syndrome: A Case Report of Interlobar Pneumothorax, Pneumopericardium, and Pneumorrhachis.

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November 2024

Department of Radiology, Unidade Local de Saúde de São João, Porto, PRT.

Article Synopsis
  • Hamman syndrome is a rare, benign condition marked by air in the mediastinum without an external cause, usually affecting young adults and linked to activities that raise intrathoracic pressure, like coughing or asthma attacks.* -
  • An 18-year-old male asthmatic patient experienced shortness of breath, chest pain, and subcutaneous emphysema, leading to imaging that revealed pneumomediastinum and other related issues.* -
  • Treatment involved supplemental oxygen and pain relief, with symptoms improving and imaging showing resolution of pneumomediastinum within four days, highlighting the importance of accurate diagnosis through imaging to distinguish it from serious conditions.*
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In 1939, Hamman´s syndrome, also know as spontaneous pneumomediastinum, was characterized by the presence of pneumothorax, subcutaneous emphysema, and pneumorrhachis. It is believed to arise from barotrauma during vaginal labor, causing alveolar membrane rupture and subsequent air leakage. Clinical manifestations are often nonspecific.

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Pneumomediastinum is the presence of gas (usually air) in the mediastinum, which is rare and typically benign. Pneumomediastinum is classified into primary and secondary based on etiology. Its pathophysiology is due to high intra-alveolar pressures causing alveolar rupture, which releases air that travels along bronchoalveolar sheaths into the mediastinum.

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Unlabelled: Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status.

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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.

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