IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES Spontaneous Pneumomediastinum Associated with Pneumorachis Charlotte Girard, Chahera ´ Khouatra, Jean-François Cordier, and Vincent Cottin Hopital ˆ Louis Pradel, Claude Bernard Lyon 1 University, Lyon, France
Figure 1. Computed tomography demonstrating pneumorachis and pneumomediastinum. (A) Axial view at the level of transversal aortic arch showing air in the epidural space (pneumorachis, arrow), pneumomediastinum, and subcutaneous emphysema. (B) Axial view showing pneumorachis extending into the neural foramina (arrowhead), with associated pneumomediastinum. (C) Saggital view of the cervical spine demonstrating air in the epidural space (arrow).
An 18-year-old woman with a history of childhood allergic asthma was admitted for acute swelling of the face, neck, and upper chest 5 days after the onset of acute bronchitis. Further examination revealed wheezes on lung auscultation and rhinolalia. Blood pressure and oxygenation were normal. Computed tomography of the chest showed extensive pneumomediastinum with subcutaneous emphysema and pneumorachis (Figure 1, arrows) extending throughout the entire cervical and dorsal spine. Neurologic examination was normal. Management included rest, bronchodilators, and corticosteroids. The patient was discharged on Day 7 with complete recovery. Pneumorachis is defined by the presence of air in the spinal canal (1–3). It may result from trauma, but most cases are unrelated to trauma; it is present in about 10% of cases of spontaneous pneumomediastinum (3, 4). Clinicians should be aware of this complication in the setting of acute bronchitis or asthma exacerbation. Generally asymptomatic, pneumorachis can occasionally cause spinal cord compression, especially in cases of trauma. Supplemental nasal oxygen might accelerate air resorption. Outcomes are favorable most of the time (3). n Author disclosures are available with the text of this article at www.atsjournals.org.
References 1. Gordon IJ, Hardman DR. The traumatic pneumomyelogram: a previously undescribed entity. Neuroradiology 1977;13:107–108. 2. Oertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J 2006;15:636–643.
3. Chaichana KL, Pradilla G, Witham TF, Gokaslan ZL, Bydon A. The clinical significance of pneumorachis: a case report and review of the literature. J Trauma 2010;68:736–744. 4. Belotti EA, Rizzi M, Rodoni-Cassis P, Ragazzi M, ZanolariCaledrerari M, Bianchetti MG. Air within the spinal canal in spontaneous pneumomediastinum. Chest 2010;137: 1197–1200.
Author Contributions: Conception and design: C.G., C.K., J.-F.C., and V.C.; analysis and interpretation: C.G., C.K., J.-F.C., and V.C.; drafting the manuscript for important intellectual content: C.G. and V.C. Am J Respir Crit Care Med Vol 189, Iss 11, p e69, Jun 1, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201305-0900IM Internet address: www.atsjournals.org
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Figure 1. Computed tomography demonstrating pneumorachis and pneumomediastinum. (A) Axial view at the level of transversal aortic arch showing air in the epidural space (pneumorachis, arrow), pneumomediastinum, and subcutaneous emphysema. (B) Axial view showing pneumorachis extending into the neural foramina (arrowhead), with associated pneumomediastinum. (C) Saggital view of the cervical spine demonstrating air in the epidural space (arrow).
An 18-year-old woman with a history of childhood allergic asthma was admitted for acute swelling of the face, neck, and upper chest 5 days after the onset of acute bronchitis. Further examination revealed wheezes on lung auscultation and rhinolalia. Blood pressure and oxygenation were normal. Computed tomography of the chest showed extensive pneumomediastinum with subcutaneous emphysema and pneumorachis (Figure 1, arrows) extending throughout the entire cervical and dorsal spine. Neurologic examination was normal. Management included rest, bronchodilators, and corticosteroids. The patient was discharged on Day 7 with complete recovery. Pneumorachis is defined by the presence of air in the spinal canal (1–3). It may result from trauma, but most cases are unrelated to trauma; it is present in about 10% of cases of spontaneous pneumomediastinum (3, 4). Clinicians should be aware of this complication in the setting of acute bronchitis or asthma exacerbation. Generally asymptomatic, pneumorachis can occasionally cause spinal cord compression, especially in cases of trauma. Supplemental nasal oxygen might accelerate air resorption. Outcomes are favorable most of the time (3). n Author disclosures are available with the text of this article at www.atsjournals.org.
References 1. Gordon IJ, Hardman DR. The traumatic pneumomyelogram: a previously undescribed entity. Neuroradiology 1977;13:107–108. 2. Oertel MF, Korinth MC, Reinges MHT, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J 2006;15:636–643.
3. Chaichana KL, Pradilla G, Witham TF, Gokaslan ZL, Bydon A. The clinical significance of pneumorachis: a case report and review of the literature. J Trauma 2010;68:736–744. 4. Belotti EA, Rizzi M, Rodoni-Cassis P, Ragazzi M, ZanolariCaledrerari M, Bianchetti MG. Air within the spinal canal in spontaneous pneumomediastinum. Chest 2010;137: 1197–1200.
Author Contributions: Conception and design: C.G., C.K., J.-F.C., and V.C.; analysis and interpretation: C.G., C.K., J.-F.C., and V.C.; drafting the manuscript for important intellectual content: C.G. and V.C. Am J Respir Crit Care Med Vol 189, Iss 11, p e69, Jun 1, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201305-0900IM Internet address: www.atsjournals.org
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