Letter to the Editor
Spontaneous Pneumomediastinum and Pneumopericardium with Respiratory Failure
Neumomediastino espontáneo y neumopericardio con insuficiencia respiratoria
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Other symptoms and signs include dyspnea, cough, neck pain and subcutaneous emphysema.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> On occasion, chest radiograph is insufficient to detect gas in the mediastinal compartment and a CT scan is necessary.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the absence of an associated subjacent disease, it is considered a process with little clinical impact and its recurrence is very infrequent.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Nevertheless, we have treated a patient with spontaneous NM and important gas exchange affectation who presented clinical characteristics that could cause confusion in the differential diagnosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient is a 24-year-old male who was admitted to the emergency department due to the sudden appearance of intense precordial pain radiating towards his back, with non-spinning vertigo and breathing difficulties due to the pain. When questioned, he only referred mild watery rhinitis during the previous four days, having received no treatment. He did not smoke, nor did he have any medical history of interest. Physical examination showed no alterations. Blood work revealed leukocytosis of 18.7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span> with 16.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>neutrophils/μl. C-reactive protein was 20.3<span class="elsevierStyleHsp" style=""></span>mg/l. Blood/arterial gas breathing room air showed pH 7.42, Pa02 54<span class="elsevierStyleHsp" style=""></span>mmHg, PaCO2 35<span class="elsevierStyleHsp" style=""></span>mmHg and HCO<span class="elsevierStyleInf">3</span> 23<span class="elsevierStyleHsp" style=""></span>mmol/l. Electrocardiogram showed a sinus rhythm with 115<span class="elsevierStyleHsp" style=""></span>bpm and image of S1Q3. On chest radiograph, we observed a thin pneumopericardium line. In order to rule out pulmonary embolism, thoracic CT angiography was performed, showing no vascular defects and confirming the presence of air in the mediastinal space (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and pneumopericardium. The patient received analgesic treatment and oxygen. Twenty-four hours later, he was asymptomatic, with oxyhemoglobin saturation 98% (Fi02 0.21) and leukocytosis had normalized.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Spontaneous PM is considered a mild process that does not necessitate treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, the case that we have presented showed respiratory failure, leukocytosis and clinical data that required us to rule out other processes. Although the finding of leukocytosis and neutrophilia can be frequent (in the series by Macià et al.,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 42% of the patients with spontaneous PM presented these), we have found no references to the alteration in the gas exchange in similar cases. Exceptionally, PM or tension pneumopericardium can be produced by the persistent entry of air in the mediastinal or pericardial spaces with increased pressure that can affect the venous return and the cardiac function, constituting a medical–surgical emergency<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that would explain the hypoxemia. In our patient, nevertheless, there were no data for PM or tension pneumopericardium, therefore if they had existed, there would have been transitory alterations.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our patient had no condition associated with the development of spontaneous PM. This is not uncommon as in more than half of the patients with spontaneous PM there is no identified predisposing condition, such as asthma, interstitial disease or graft-versus-host disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> The precipitating factors that are associated with spontaneous PM are those that produce a sudden increase in intrathoracic pressure, mainly vomit, drug inhalation, intense cough and physical exercise. Nevertheless, in between 30 and 50% of patients, no precipitating factor associated with PM can be identified.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We conclude that spontaneous PM, considered a process of limited clinical transcendence, can present with characteristics of greater severity than what are usually reported, although in our case there was a rapid resolution, as is usual in this process.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Kikeeva A, et al. Neumomediastino espontáneo y neumopericardio con insuficiencia respiratoria. Arch Bronconeumol. 2011;47:318-9.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 704 "Ancho" => 950 "Tamanyo" => 70841 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT: presence of air in the mediastinal compartment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.N. Iyer" 1 => "A.Y. Joshi" 2 => "J.H. Ryu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0025-6196(11)60560-0" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2009" "volumen" => "84" "paginaInicial" => "417" "paginaFinal" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19411438" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum long-term follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Freixinet" 1 => "F. García" 2 => "P.M. Rodríguez" 3 => "N.B. Santana" 4 => "C.O. Quintero" 5 => "M. Hussein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2005.02.025" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2005" "volumen" => "99" "paginaInicial" => "1160" "paginaFinal" => "1163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16085218" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neumomediastino espontáneo: estudio descriptivo de nuestra experiencia basada en 36 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Campillo-Soto" 1 => "A. Coll-Salinas" 2 => "V. Soria-Aledo" 3 => "A. Blanco-Barrio" 4 => "B. Flores-Pastor" 5 => "M. Candel-Arenas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "528" "paginaFinal" => "531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16194517" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum: 41 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Macía" 1 => "J. Moya" 2 => "R. Ramos" 3 => "R. Morera" 4 => "I. Escobar" 5 => "J. Saumench" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2007.03.008" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2007" "volumen" => "31" "paginaInicial" => "1110" "paginaFinal" => "1114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17420139" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pnemomediastinum: a comparative study and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Cáceres" 1 => "S.Z. Ali" 2 => "R. Braud" 3 => "D. Wiman" 4 => "H.E. Garret" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2008.04.067" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2008" "volumen" => "86" "paginaInicial" => "962" "paginaFinal" => "966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18721592" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome de fuga aérea por enfermedad de injerto contra huésped" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. García-Reina" 1 => "A. Gómez-Caro" 2 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 44 | 14 | 58 |
| 2024 September | 42 | 18 | 60 |
| 2024 August | 55 | 49 | 104 |
| 2024 July | 62 | 28 | 90 |
| 2024 June | 68 | 29 | 97 |
| 2024 May | 72 | 30 | 102 |
| 2024 April | 52 | 31 | 83 |
| 2024 March | 65 | 14 | 79 |
| 2024 February | 52 | 28 | 80 |
| 2023 March | 9 | 4 | 13 |
| 2023 February | 47 | 23 | 70 |
| 2023 January | 45 | 59 | 104 |
| 2022 December | 57 | 40 | 97 |
| 2022 November | 69 | 30 | 99 |
| 2022 October | 50 | 48 | 98 |
| 2022 September | 43 | 43 | 86 |
| 2022 August | 46 | 48 | 94 |
| 2022 July | 46 | 60 | 106 |
| 2022 June | 51 | 42 | 93 |
| 2022 May | 62 | 37 | 99 |
| 2022 April | 53 | 44 | 97 |
| 2022 March | 64 | 44 | 108 |
| 2022 February | 74 | 44 | 118 |
| 2022 January | 78 | 58 | 136 |
| 2021 December | 46 | 51 | 97 |
| 2021 November | 53 | 43 | 96 |
| 2021 October | 47 | 33 | 80 |
| 2021 September | 41 | 38 | 79 |
| 2021 August | 41 | 33 | 74 |
| 2021 July | 49 | 27 | 76 |
| 2021 June | 71 | 29 | 100 |
| 2021 May | 59 | 30 | 89 |
| 2021 April | 180 | 36 | 216 |
| 2021 March | 91 | 19 | 110 |
| 2021 February | 75 | 23 | 98 |
| 2021 January | 102 | 19 | 121 |
| 2020 December | 116 | 17 | 133 |
| 2020 November | 62 | 16 | 78 |
| 2020 October | 100 | 17 | 117 |
| 2020 September | 97 | 15 | 112 |
| 2020 August | 80 | 12 | 92 |
| 2020 July | 65 | 19 | 84 |
| 2020 June | 69 | 7 | 76 |
| 2020 May | 111 | 26 | 137 |
| 2020 April | 103 | 15 | 118 |
| 2020 March | 72 | 7 | 79 |
| 2020 February | 112 | 20 | 132 |
| 2020 January | 85 | 16 | 101 |
| 2019 December | 83 | 19 | 102 |
| 2019 November | 57 | 15 | 72 |
| 2019 October | 122 | 10 | 132 |
| 2019 September | 128 | 20 | 148 |
| 2019 August | 112 | 13 | 125 |
| 2019 July | 100 | 17 | 117 |
| 2019 June | 106 | 23 | 129 |
| 2019 May | 136 | 29 | 165 |
| 2019 April | 170 | 42 | 212 |
| 2019 March | 131 | 17 | 148 |
| 2019 February | 131 | 23 | 154 |
| 2019 January | 129 | 19 | 148 |
| 2018 December | 146 | 18 | 164 |
| 2018 November | 110 | 14 | 124 |
| 2018 October | 103 | 20 | 123 |
| 2018 September | 53 | 9 | 62 |
| 2018 May | 16 | 0 | 16 |
| 2018 April | 30 | 5 | 35 |
| 2018 March | 48 | 2 | 50 |
| 2018 February | 30 | 4 | 34 |
| 2018 January | 40 | 5 | 45 |
| 2017 December | 37 | 5 | 42 |
| 2017 November | 44 | 3 | 47 |
| 2017 October | 42 | 6 | 48 |
| 2017 September | 50 | 19 | 69 |
| 2017 August | 79 | 11 | 90 |
| 2017 July | 57 | 4 | 61 |
| 2017 June | 71 | 6 | 77 |
| 2017 May | 71 | 5 | 76 |
| 2017 April | 64 | 7 | 71 |
| 2017 March | 58 | 9 | 67 |
| 2017 February | 33 | 5 | 38 |
| 2017 January | 21 | 2 | 23 |
| 2016 December | 63 | 9 | 72 |
| 2016 November | 53 | 10 | 63 |
| 2016 October | 58 | 14 | 72 |
| 2016 September | 49 | 14 | 63 |
| 2016 August | 63 | 7 | 70 |
| 2016 July | 46 | 10 | 56 |
| 2016 May | 0 | 13 | 13 |
| 2016 April | 0 | 1 | 1 |
| 2016 March | 4 | 1 | 5 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 70 | 3 | 73 |
| 2015 September | 98 | 3 | 101 |
| 2015 August | 74 | 11 | 85 |
| 2015 July | 70 | 6 | 76 |
| 2015 June | 67 | 6 | 73 |
| 2015 May | 65 | 3 | 68 |
| 2015 April | 93 | 8 | 101 |
| 2015 March | 71 | 4 | 75 |
| 2015 February | 89 | 5 | 94 |
| 2015 January | 79 | 8 | 87 |
| 2014 December | 78 | 4 | 82 |
| 2014 November | 75 | 6 | 81 |
| 2014 October | 89 | 6 | 95 |
| 2014 September | 83 | 15 | 98 |
| 2014 August | 107 | 9 | 116 |
| 2014 July | 270 | 8 | 278 |
| 2014 June | 82 | 11 | 93 |
| 2014 May | 86 | 10 | 96 |
| 2014 April | 74 | 3 | 77 |
| 2014 March | 100 | 10 | 110 |
| 2014 February | 74 | 7 | 81 |
| 2014 January | 64 | 6 | 70 |
| 2013 December | 68 | 10 | 78 |
| 2013 November | 48 | 10 | 58 |
| 2013 October | 54 | 9 | 63 |
| 2013 September | 71 | 10 | 81 |
| 2013 August | 49 | 19 | 68 |
| 2013 July | 37 | 9 | 46 |
| 2013 June | 30 | 8 | 38 |
| 2013 May | 8 | 0 | 8 |
| 2013 April | 17 | 4 | 21 |
| 2013 March | 7 | 2 | 9 |
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