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Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient.

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Transesophageal echocardiography (TEE) is one of the cornerstones of cardiac imaging in inpatient and intra-operative settings. TEE is considered a safe procedure, but it may result in serious complications, such as esophageal injury, vocal cord paralysis, arrhythmia, hypotension, seizure, and cardiac arrest. Herein, we discuss one of the rare complications, esophageal perforation, and a conservative approach to managing the patient in a 64-year-old female who underwent a TEE prior to a scheduled valvular surgery.

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Article Synopsis
  • Pneumomediastinum, often occurring silently post-trauma, complicates diagnoses especially when paired with other conditions like pneumothorax and pneumoperitoneum, largely due to the Macklin effect where air escapes from ruptured alveoli.
  • An 18-year-old male involved in a car crash was found with severe pneumothorax and subcutaneous emphysema but showed no signs of significant esophageal or bronchial injury upon further evaluation.
  • Despite alarming initial imaging, the patient's treatment was conservative, allowing for a gradual healing process and eventual discharge without complications, illustrating the need for careful assessment in trauma management.
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Non-invasive management of severe subcutaneous emphysema in a pediatric asthma exacerbation: a case report and review.

Int J Emerg Med

December 2024

Pediatric Intensive Care Unit, King Salman Medical City, Madinah, Saudi Arabia.

Background: Spontaneous pneumomediastinum (SPM) and subcutaneous emphysema (SE) are rare, severe, and potentially life-threatening complications associated with asthma exacerbation. Most of these conditions are benign and self-limiting. However, the overlapping symptoms between asthma exacerbation and pneumomediastinum (PM) may delay diagnosis.

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Spontaneous pneumomediastinum (SPM) is an uncommon condition caused by alveolar rupture due to increased intra-alveolar pressure resulting in air tracking along the tracheobronchial tree. While chest pain, neck pain, and dyspnea are the most commonly described symptoms, bradycardia could be an associated manifestation occasionally. In the majority of cases, pneumomediastinum is usually diagnosed on chest X-ray.

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