Diagnostic and therapy of a cervical emphysema

Česká verzia

Authors: H. Faitlová ^1,2 ; Bukvová M. ¹; Jan Mejzlík ³ ; T. Valenta ³ ; Kortán V. ⁴; Viktor Chrobok ³ ; J. Vodička ¹
Authors place of work: Klinika otorinolaryngologie a chirurgie hlavy a krku, Nemocnice Pardubického kraje, a. s., Pardubická nemocnice ¹; Katedra patologické fyziologie, Univerzita Karlova, Lékařská fakulta v Hradci Králové ²; Klinika otorinolaryngologie a chirurgie hlavy a krku, Fakultní nemocnice Hradec Králové, Univerzita Karlova, Lékařská fakulta v Hradci Králové ³; ORL oddělení, Krajská nemocnice Liberec, a. s. ⁴
Published in the journal: Otorinolaryngol Foniatr, 71, 2022, No. 3, pp. 131-140.
Category: Original Article
doi: https://doi.org/10.48095/ccorl2022131

Summary

Introduction: Emphysema of the neck represents a crucial symptom of swallowing/respiratory pathways injuries or rarely passes to the neck area from different locations. The clinical image can develop dramatically in the first hours after onset and frequently the etiology remains unclear. Dyspnoea, dysphagia, retrosternal or interscapular pain usually follows. In the differential diagnosis, not only traumatic etiology but also other acute conditions must be considered – e. g. acute coronary syndrome etc. The size of emphysema varies, also head and chest area can also be affected. Pneumomediastinum or partial pneumothorax are also often presented. The primarily aim of this paper is to discuss a diagnostic and therapeutic possibilities, not to determine the incidence of emphysema. Methodology: This is a retrospective multicenter study involving patients from three regional ENT departments – Pardubice Hospital, Hradec Králové University Hospital and Liberec Hospital over a period of 15 years (2005–2020). Only clinically significant emphysema, emphysema of unclear origin and emphysema requiring intensive care were in-rolled. Results: In a group of 15 patients, there are the following causes of cervical emphysema – 3 laryngeal injuries, 3 Hamman’s syndromes, 2 tracheal intubations, 2 traumas of swallowing pathways, 2 in COVID-19 disease, 1 tonsillectomy, 1 urgent tracheostomy and 1 sneezing. Etiologically, the Valsalva maneuver is an important (co)factor, dominating especially in adolescents and young adults (53%, 8 patients). Traumatic etiology occurred at the age of 17–53 years (33%, 5 patients). Iatrogenic involvement is more common over the age of 55 years. Pneumomediastinum occurred in 47% and partial pneumothorax in 40% of patients. Four of those initially unclear cases are discussed in detail. Conclusion: Imaging methods and endoscopic examination are indicated in a patient with cervical emphysema of unclear origin. Prophylactic use of broad-spectrum antibio tics, observation and interdisciplinary cooperation are always necessary.

Keywords:

emphysema – Hamman’s syndrome – pneumothorax – pneumomediastinum – covid lung injury

Zdroje

1. Daley BJ. Pneumothorax. Medscape 2012 [online]. Dostupné z: https:/ / emedicine.medscape. com/ article/ 424547-overview

2. Gamboa Vidal CA, Vega Pizarro CA, Almeida Arriagada A. Subcutaneous emphysema secondary to dental treatment: case report. Med Oral Patol Oral Cir Bucal 2007; 12(1): E76–78.

3. Kopřiva F. Úrazy dýchacího ústrojí u dětí. Pediatr Praxi 2009; 10(6): 368–369.

4. Mihál V, Michálková K, Wiedermann J et al. Spontánní pneumomediastinum s podkožním emfyzémem. Pediatr Praxi 2005; 6(4): 206–208.

5. Wallach SL. Spontaneous pneumothorax. N Engl J Med 2000; 343(4): 300–301.

6. Mejzlík J, Frank M, Motyčka V. Střelné poranění hltanu jako indikace k tonzilektomii. Vojen Zdrav Listy 1999; 68(3): 64–66.

7. Abdssalam KS, Wail S, Saeed S et al. Cervical, Mediastinal, Intraspinal and Paraaortic Emphysema Secondary to Asthma Exacerbation Case Report. Acad J Ped Neonatol 2016; 2(1): 555578. Doi: 10.19080/ AJPN.2016.02.555578.

8. Hyravý M, Brož M, Salzman R. Hammanův syndrom – spontánní pneumomediastinum prezentující se rozsáhlým emfyzémem krku. Otorinolaryngol Foniatr 2020; 69(1): 31–34.

9. Waloszková M, Salzman R, Uher R et al. Pozdní postintubační pneumomediastinum a emfyzém krku. Otorinolaryngol Foniatr 2013; 62(3): 132–135.

10. Anniko M, Bernal-Sprekelsen M, Bonkowsky V et al. Otorhinolaryngology, Head and Neck Surgery: Springer Berlin Heidelberg 2010.

11. Bassetti M, Bassetti R, Sculean A et al. [Subcutaneous emphysema following non-surgical peri-implantitis therapy using an air abrasive device: a case report]. Swiss Dent J 2014; 124(7–8): 807–817.

12. Carolan PL. Pneumomediastinum. Medscape 2012. [online]. Dostupné z: https:/ / eme dicine. medscape.com/ article/ 1003409-overview.

13. Terzic A, Lübbers HT, Franze T et al. Ausgedehntes subkutanes Emphysem nach Weisheitszahn entfernung. Ein Fallbericht. Schweizer Monatsschrift für Zahnmedizin SMfZ 2006; 116(8): 823–829. Doi: 10.5167/ uzh-1566.

14. Klozar J. Speciální otorinolaryngologie. Praha: Galén 2005.

15. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944; 23(4): 281–358.

16. Gries CJ, Pierson DJ. Tracheal rupture resulting in life-threatening subcutaneous emphysema. Respir Care 2007; 52(2): 191–195.

17. Jo YY, Park WY, Choi E et al. Delayed detection of subcutaneous emphysema following routine endotracheal intubation – A case report. Korean J Anesthesiol 2010; 59(3): 220–223. Doi: 10.4097/ kjae.2010.59.3.220.

18. Tran DD, Littlefield PD. Late presentation of subcutaneous emphysema and pneumomediastinum following elective tonsillectomy. Am J Otolaryngol 2015; 36(2): 299–302. Doi: 10.1016/ j.amjoto.2014.10.034.

19. Worni A, Schaller B, Buttner M et al. Extensive mediastinal emphysema after conservative dental treatment. Case report. Schweiz Monatsschr Zahnmed 2010; 120(3): 231–238.

20. Mazeh H, Suwanabol PA, Schneider DF et al. Late manifestation of tracheal rupture after thyroidectomy: case report and literature review. Endocr Pract 2012; 18(4): e73–76. Doi: 10.4158/ EP11344.CR.

21. Huan NC, Mohamed Arifi n N, Khoo TS et al. Management of extensive subcutaneous emphysema using negative pressure wound therapy dressings. Respirol Case Rep 2020; 8(3): e00544. Doi: 10.1002/ rcr2.544.

22. Hrivnák R, Hanke I, Šandor P et al. Spontánní pneumotorax – management, terapie. Rozhl Chir 2009; 88(10): 559–562.

23. Flores-Franco RA, Limas-Frescas NE. The overused airway: lessons from a young trumpet player. Med Probl Perform Art 2010; 25(1): 35–38.

24. Fiz JA, Aguilar J, Carreras A et al. Maximum respiratory pressures in trumpet players. Chest 1993; 104(4): 1203–1204. Doi: 10.1378/ chest. 104.4.1203.

25. Veselý M, Jedlička V, Peštál A et al. Spontánní pneumomediastinum – kazuistika. Rozhl Chir 2011; 90(11): 634–636.

26. Vodička J, Špidlen V. Spontánní pneumotorax. Čas Lék čes 2006; 145(8): 611–615.

27. Adam Z, Szturz P, Pour L et al. Histiocytóza z Langerhansových buněk u dospělých osob. Postgrad Med 2010; 12(6): 704–711.

28. Bártů V. Urgentní stavy v pneumologii. Postgrad Med 2009; 11(2): 138–142.

29. Schmidt GB, Bronkhorst MW, Hartgrink HH et al. Subcutaneous cervical emphysema and pneumomediastinum due to a lower gastrointestinal tract perforation. World J Gastroenterol 2008; 14(24): 3922–3923. Doi: 10.3748/ wjg.14.3922.

30. Ruscelli P, Renzi C, Polistena A et al. Clinical signs of retroperitoneal abscess from colonic perforation: Two case reports and literature review. Medicine (Baltimore) 2018; 97(45): e13176. Doi: 10.1097/ MD.0000000000013 176.

31. Elia S, De Felice L, Varvaras D et al. Catamenial pneumothorax due to solitary localization of diaphragmatic endometriosis. Int J Surg Case Rep 2015; 12: 19–22. Doi: 10.1016/ j. ijscr.2015.05.012.

32. Alifano M, Roth T, Broet SC et al. Catamenial pneumothorax: a prospective study. Chest 2003; 124(3): 1004–1008. Doi: 10.1378/ chest. 124.3.1004.

33. Mikroulis DA, Didilis VN, Konstantinou F et al. Catamenial pneumothorax. Thorac Cardiovasc Surg 2008; 56(6): 374–375. Doi: 10.1055/ s-2006-924707.

34. Voláková E, Kolek V, Kufa J et al. Katameniální pneumotorax – kazuistiky a literální přehled. Čes Gynekol 2017; 82(4): 308–312.

35. Trčka O, Slouka D. Spontánní pneumomediastinum po požití amfetaminu. Otorinolaryngol Foniatr 2018; 67(1): 28–31.

36. Albanese J, Gross C, Azab M et al. Spontaneous pneumomediastinum: A rare complication of methamphetamine use. Respir Med Case Rep 2017; 21: 25–26. Doi: 10.1016/ j. rmcr.2017.03.007.