Limits...
Pneumorachis after cocaine sniffing.

Challita S, Daher M, Roche N, Alifano M, Revel MP, Rabbat A - Respir Med Case Rep (2014)

Bottom Line: The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen.Supplemental nasal oxygen can be given to accelerate nitrogen washout.The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Intensive Care Medicine of Cochin, Hotel Dieu Hospital Group, AP-HP, University Paris Descartes, 15 rue d'ULM, 75005 Paris, France.

ABSTRACT
Air in the epidural space is called pneumorachis. The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen. Alternatively, air can diffuse directly after spine traumas (e.g., blunt deceleration with vertebral dislocation) or medical procedures. Several mechanisms could explain pneumomediastinum and pneumorachis after cocaine sniffing. Passive apnea and/or cough that occur after sniffing can cause intra alveolar hyper-pressure, which is responsible for alveolar rupture and air diffusion. Another mechanism is alveolar wall fragility and rupture induced by repeated cocaine sniffing, in turn causing air diffusion to the mediastinum, sub-cutaneous tissues and the epidural space. The diagnosis is usually made on Chest tomography scan. Management consists in close monitoring in the intensive care unit to detect aggravation of pneumomediastinum and pneumorachis, which would require surgical management. Supplemental nasal oxygen can be given to accelerate nitrogen washout. We present a case of a 28 years old male who presented to the emergency department for chest pain directly after sniffing cocaine. A computed tomography scan of the chest showed pneumomediastinum, pneumorachis and sub-cutaneous emphysema. The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment.

No MeSH data available.


Related in: MedlinePlus

Unenhanced axial transverse CT image, (a) mediastinal window (b) lung parenchyma window, showing Pneumomediastinum together with air in peridural space and right axillary sub-cutaneous emphysema.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061432&req=5

fig1: Unenhanced axial transverse CT image, (a) mediastinal window (b) lung parenchyma window, showing Pneumomediastinum together with air in peridural space and right axillary sub-cutaneous emphysema.

Mentions: Electrocardiography showed sinus rhythm without signs of ischemia. Laboratory troponin test was less than 14 ng/L (normal range). Myocardial ischemia in a case of chest pain in a cocaine user was eliminated. Chest CT-Scanner showed diffusion of air into mediastinal, sub-cutaneous and epidural tissue layers (Fig. 1(a)–(b)), with no evidence of medullar compression. There was no air diffusion in deep cervical tissue layers. The patient was admitted to the hospital for 24 h and treated with painkillers. A second chest CT-scan performed 24 h after admission did not show any aggravation of the pneumomediastinum or pneumorachis. The patient was then discharged home with a final diagnosis of pneumomediastinum and pneumorachis secondary to cocaine sniffing.


Pneumorachis after cocaine sniffing.

Challita S, Daher M, Roche N, Alifano M, Revel MP, Rabbat A - Respir Med Case Rep (2014)

Unenhanced axial transverse CT image, (a) mediastinal window (b) lung parenchyma window, showing Pneumomediastinum together with air in peridural space and right axillary sub-cutaneous emphysema.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061432&req=5

fig1: Unenhanced axial transverse CT image, (a) mediastinal window (b) lung parenchyma window, showing Pneumomediastinum together with air in peridural space and right axillary sub-cutaneous emphysema.
Mentions: Electrocardiography showed sinus rhythm without signs of ischemia. Laboratory troponin test was less than 14 ng/L (normal range). Myocardial ischemia in a case of chest pain in a cocaine user was eliminated. Chest CT-Scanner showed diffusion of air into mediastinal, sub-cutaneous and epidural tissue layers (Fig. 1(a)–(b)), with no evidence of medullar compression. There was no air diffusion in deep cervical tissue layers. The patient was admitted to the hospital for 24 h and treated with painkillers. A second chest CT-scan performed 24 h after admission did not show any aggravation of the pneumomediastinum or pneumorachis. The patient was then discharged home with a final diagnosis of pneumomediastinum and pneumorachis secondary to cocaine sniffing.

Bottom Line: The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen.Supplemental nasal oxygen can be given to accelerate nitrogen washout.The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Intensive Care Medicine of Cochin, Hotel Dieu Hospital Group, AP-HP, University Paris Descartes, 15 rue d'ULM, 75005 Paris, France.

ABSTRACT
Air in the epidural space is called pneumorachis. The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen. Alternatively, air can diffuse directly after spine traumas (e.g., blunt deceleration with vertebral dislocation) or medical procedures. Several mechanisms could explain pneumomediastinum and pneumorachis after cocaine sniffing. Passive apnea and/or cough that occur after sniffing can cause intra alveolar hyper-pressure, which is responsible for alveolar rupture and air diffusion. Another mechanism is alveolar wall fragility and rupture induced by repeated cocaine sniffing, in turn causing air diffusion to the mediastinum, sub-cutaneous tissues and the epidural space. The diagnosis is usually made on Chest tomography scan. Management consists in close monitoring in the intensive care unit to detect aggravation of pneumomediastinum and pneumorachis, which would require surgical management. Supplemental nasal oxygen can be given to accelerate nitrogen washout. We present a case of a 28 years old male who presented to the emergency department for chest pain directly after sniffing cocaine. A computed tomography scan of the chest showed pneumomediastinum, pneumorachis and sub-cutaneous emphysema. The patient was admitted for 24 h: after that delay, surveillance chest tomodensitometry showed stability, and he could be discharged without further treatment.

No MeSH data available.


Related in: MedlinePlus