Images in Paediatrics
Pneumorrhachis: A finding in spontaneous pneumomediastinum
Neumorraquis: un hallazgo en el neumomediastino espontaneo
Joana Brandão Silva
, Joana Lira, Graça Ferreira, Joana Rodrigues
Corresponding author
Departamento de Pediatría, Centro Hospitalar Vila Nova de Gaia/Espinho, Nova de Gaia, Portugal
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He was afebrile, with an oxygen saturation of 92%, a respiratory rate of 24 breaths/min, chest retractions and subcutaneous crepitus at the level of the left armpit and neck. Auscultation revealed bilateral decreased breath sounds and biphasic wheezing. The rest of the physical and neurological examination was normal. A plain radiograph of the chest revealed pneumomediastinum associated with subcutaneous emphysema and no signs of pneumothorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was admitted and treated with analgesics, high-concentration oxygen (15<span class="elsevierStyleHsp" style=""></span>L/min), inhaled salbutamol and ipratropium bromide, and intravenous methylprednisolone. Computed tomography revealed air within the spinal canal in addition to a moderate-sized emphysema and pneumomediastinum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient was discharged home after 7 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Spontaneous pneumomediastinum results from a sudden increase in intra-alveolar pressure during acute or chronic pulmonary disease, causing alveolar rupture and a leak of air that gives rise to the interstitial emphysema.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It is uncommon in the paediatric age group, and acute asthma is the most frequent cause in adolescents. The triad of acute chest pain under the sternum, subcutaneous emphysema and dyspnoea of varying severity allows its diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Pneumorrhachis occurs when air dissects from the posterior mediastinum or the retropharyngeal space through the neural foramens into the epidural space.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a> It does not generally cause neurologic symptoms and resolves spontaneously in 98% of cases, and it is now identified thanks to the increased use of computed tomography.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Spontaneous pneumomediastinum is usually benign and self-limiting, and the same approach with supportive care including clinical monitoring, rest and analgesia and treatment of the underlying disease is recommended for all patients, even in the unlikely event of concomitant pneumorrhachis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-04-07" "fechaAceptado" => "2018-05-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Brandão Silva J, Lira J, Ferreira G, Rodrigues J. Neumorraquis: un hallazgo en el neumomediastino espontaneo. An Pediatr (Barc). 2019;90:319–320.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 950 "Tamanyo" => 70746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior radiograph showing mediastinal air surrounding the heart and dissecting into the neck and left armpit (responsible for subcutaneous emphysema).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1475 "Ancho" => 2083 "Tamanyo" => 222428 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CT scan showing air in the spinal canal (pneumorrhachis, black arrow), pneumomediastinum outlining the vessels with air (white arrow) and subcutaneous emphysema on the left (dashed arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Tortajada-Girbés" 1 => "M. Moreno-Prat" 2 => "D. Ainsa-Laguna" 3 => "S. Mas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ther Adv Respir Dis" "fecha" => "2016" "volumen" => "10" "paginaInicial" => "402" "paginaFinal" => "409" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Air within the spinal canal in spontaneous pneumomediastinum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Belotti" 1 => "M. Rizzi" 2 => "P. Rodoni-Cassis" 3 => "M. Ragazzi" 4 => "M. Zanolari-Caledrerari" 5 => "M.G. Bianchetti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "1197" "paginaFinal" => "1200" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of pneumorrhachis accompanying spontaneous pneumomediastinum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Borem" 1 => "D. Stamoulis" 2 => "A. Ramos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiol Bras" "fecha" => "2017" "volumen" => "50" "paginaInicial" => "345" "paginaFinal" => "346" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009000000005/v1_201905020905/S2341287918301388/v1_201905020905/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009000000005/v1_201905020905/S2341287918301388/v1_201905020905/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301388?idApp=UINPBA00005H" ]
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