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A 15-year-old boy with anterior chest pain, progressive dyspnea, and subcutaneous emphysema of the neck.

Scichilone N, Buttacavoli M, Camarda G, Marchese M, Bellia M, Spatafora M - J Allergy (Cairo) (2009)

Bottom Line: At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather.Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander.Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made.

View Article: PubMed Central - PubMed

Affiliation: Dipartimento di Medicina, Pneumologia, Fisiologia e Nutrizione Umana (DIMPEFINU), Sezione di Pneumologia e Medicina, University of Palermo, 90146 Palermo, Italy.

ABSTRACT
We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

No MeSH data available.


Related in: MedlinePlus

(a) Posteroanteriorchest radiograph that shows the mediastinal reflections of the pleura separated from the pericardium by a lucent band of air representing pneumomediastinum (arrows). (b) Lateral chest radiograph that shows the outer border of the ascending and descending thoracic aorta, which are underlined by mediastinal free air collection (arrows).
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fig1: (a) Posteroanteriorchest radiograph that shows the mediastinal reflections of the pleura separated from the pericardium by a lucent band of air representing pneumomediastinum (arrows). (b) Lateral chest radiograph that shows the outer border of the ascending and descending thoracic aorta, which are underlined by mediastinal free air collection (arrows).

Mentions: The patientwas referred for posteroanterior and lateral chest X-ray (Figures 1(a) and 1(b)), whichdemonstrated linear streaks of air in the mediastinum extending into the upperparts of the lung, more evident in the lateral projection. The radiologicalsigns were suggestive of pneumomediastinum. The radiological signs ofpneumomediastinum are multiple and include radiolucent linear streaks of air inthe mediastinum, often extending into the neck, air surrounding the mediastinalstructures; the presence of subcutaneous emphysema of soft tissues is oftendescribed. The lateral view increases the sensitivity in detecting signs ofpneumomediastinum, in that, it may reveal radiolucent bands in the retrosternalareas, such as in our patient. For further evaluation, he underwent thoracichigh-resolution computed tomography (HRCT), where air was demonstratedaround the esophagus, trachea, ascending aorta, peribronchial, and perivascularconnective tissue; partial pneumothorax on both sides was detected; this wasmore prominent at the level of the left apex of the lung. Finally, diffusesubcutaneous emphysema was present. No bullae or cystic malformations weredemonstrated in the lungs.


A 15-year-old boy with anterior chest pain, progressive dyspnea, and subcutaneous emphysema of the neck.

Scichilone N, Buttacavoli M, Camarda G, Marchese M, Bellia M, Spatafora M - J Allergy (Cairo) (2009)

(a) Posteroanteriorchest radiograph that shows the mediastinal reflections of the pleura separated from the pericardium by a lucent band of air representing pneumomediastinum (arrows). (b) Lateral chest radiograph that shows the outer border of the ascending and descending thoracic aorta, which are underlined by mediastinal free air collection (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2957592&req=5

fig1: (a) Posteroanteriorchest radiograph that shows the mediastinal reflections of the pleura separated from the pericardium by a lucent band of air representing pneumomediastinum (arrows). (b) Lateral chest radiograph that shows the outer border of the ascending and descending thoracic aorta, which are underlined by mediastinal free air collection (arrows).
Mentions: The patientwas referred for posteroanterior and lateral chest X-ray (Figures 1(a) and 1(b)), whichdemonstrated linear streaks of air in the mediastinum extending into the upperparts of the lung, more evident in the lateral projection. The radiologicalsigns were suggestive of pneumomediastinum. The radiological signs ofpneumomediastinum are multiple and include radiolucent linear streaks of air inthe mediastinum, often extending into the neck, air surrounding the mediastinalstructures; the presence of subcutaneous emphysema of soft tissues is oftendescribed. The lateral view increases the sensitivity in detecting signs ofpneumomediastinum, in that, it may reveal radiolucent bands in the retrosternalareas, such as in our patient. For further evaluation, he underwent thoracichigh-resolution computed tomography (HRCT), where air was demonstratedaround the esophagus, trachea, ascending aorta, peribronchial, and perivascularconnective tissue; partial pneumothorax on both sides was detected; this wasmore prominent at the level of the left apex of the lung. Finally, diffusesubcutaneous emphysema was present. No bullae or cystic malformations weredemonstrated in the lungs.

Bottom Line: At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather.Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander.Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made.

View Article: PubMed Central - PubMed

Affiliation: Dipartimento di Medicina, Pneumologia, Fisiologia e Nutrizione Umana (DIMPEFINU), Sezione di Pneumologia e Medicina, University of Palermo, 90146 Palermo, Italy.

ABSTRACT
We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

No MeSH data available.


Related in: MedlinePlus