Introduction: Facial emphysema is the presence of air in the subcutaneous tissues of the facial region. They can be clinically recognized by the crackling sensation felt when the affected area is palpated. Observation...Introduction: Facial emphysema is the presence of air in the subcutaneous tissues of the facial region. They can be clinically recognized by the crackling sensation felt when the affected area is palpated. Observation: The authors describe left orbito-facial emphysema that occurred after a violent sneezing episode in a 36-year-old patient. He had significant edema of the left facial and ipsilateral periorbital region associated with major emphysema and complete closure of the left eye. Nasal cavities endoscopy revealed inflammation of the distal orifice of the nasolacrimal duct. The clinical ophthalmologic examination performed in emergency showed left chemosis, slight ocular hypertonia of mechanical origin, and a slight decrease in visual acuity. Pupillary reflexes and retinography were normal. A craniofacial computed tomography (CT) revealed a significant left orbital emphysema, a fracture of the left medial orbital wall (ethmoidal lamina papyracea) with intraconal fat incarceration without entrapment of the medial rectus and significant air infiltration of all the left hemifacial soft tissues. A broad-spectrum antibiotic and anti-inflammatory treatment were instituted, as well as practical advice to prevent a recurrence. We observed progressive resorption of the edema with a return to the normal of the soft tissues and the palpebral cleft in 15 days. Conclusion: These atypical cases can be serious. It is essential to exclude signs of visual deficit and ocular compression. Multidisciplinary management is important.展开更多
BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,es...BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.展开更多
BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to ...BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.展开更多
BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparati...BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.展开更多
Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,...Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,Cochrane Library,Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023.A total of 34 resources were selected for inclusion in this narrative review.Traumatic PR can be classified anatomically into epidural and intradural types.In the epidural type,air is present peripherally in the spinal canal and the patients are usually asymptomatic.In contrast,in intradural PR,air is seen centrally in the spinal canal and patients present with neurological symptoms,and it is a marker of severe trauma.It is frequently associated with traumatic pneumocephalus,skull fractures or thoracic spine fracture.Computed tomography(CT)is considered to be the diagnostic modality of choice.Epidural PR is self-limited and patients are generally managed conser-vatively.Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak,with a need for surgical intervention.Differentiation between epidural and intradural PR is important,because the latter is an indication of severe underlying injury.CT imaging of the entire spine must be performed to look for extension of air,as well as to identify concomitant skull,torso or spinal injuries Most patients are asymp-tomatic and are managed conservatively,but a few may develop neurological symptoms that need further evaluation and management.展开更多
Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a...Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.展开更多
This study explored the role of apoptosis of alveolar wall cells of chronic obstructive pulmonary disease (COPD) patients with pulmonary emphysema in the pathogenesis of emphysema. The subjects were divided into thr...This study explored the role of apoptosis of alveolar wall cells of chronic obstructive pulmonary disease (COPD) patients with pulmonary emphysema in the pathogenesis of emphysema. The subjects were divided into three groups: COPD patients with pulmonary emphysema (COPD group), asymptomatic smokers and non-smokers. Lung tissues were harvested and histologically assessed. TUNEL assay was employed to determine the ap'optotic cells. The expression of PCNA, Bax and SP-C in the lung alveolar wall cells were immunohistochemically determined. SP-C immunofluorescence staining was used to identify type Ⅱ alveolar cells in the TUNEL-positive cells. The mean linear interval (MLI), mean alveoli number (MAN) and mean alveoli area (MAA) in COPD group were significantly different as compared with those in asymptomatic smokers and non-smokers, respectively (P〈0.01). The proliferation index (PI), apoptosis index (AI) and the percentage of Bax-positive cells in COPD group were significantly greater than those of asymptomatic smokers and non-smokers (P〈0.01). However, the percentage of SP-C-positive cells was significantly lower in COPD group than in asymptomatic smokers and non-smokers (P〈0.01). Most of the TUNEL-positive cells expressed SP-C. In COPD group, the apoptosis of alveolar wall cells, especially apoptosis of type- Ⅱ cells, may take part in the pathogenesis of emphysema. Up-regulation of Bax expression may be responsible for the apoptosis of alveolar wall cells in the COPD patients with pulmonary emphysema.展开更多
A 39-year-old male reported fevers,weight loss,watery loose stools,and decreased visual acuity in his right eye over the prior five years.He was pancytopenic,had an elevated American council on exercise level,total bi...A 39-year-old male reported fevers,weight loss,watery loose stools,and decreased visual acuity in his right eye over the prior five years.He was pancytopenic,had an elevated American council on exercise level,total bilirubin,and alkaline phosphatase.Computed tomography revealed massive hepatosplenomegaly and emphysematous lung changes.Liver biopsy showed non caseating granulomas.The patient was diagnosed with extrapulmonary sarcoidosis and was treated with prednisone.The patient symptomatically improved but 5 mo later presented with abdominal pain caused by perforation of the cecum.He underwent a cecectomy and pathology revealed pneumatosis cystoides intestinalis.This represents the first reported association between pneumatosis cystoides intestinalis and sarcoidosis.The etiology of pneumatosis cystoides intestinalis in this case was likely multifactorial and involved both effects of the corticosteroids as well as the advanced nature of the gastrointestinal sarcoidosis.Furthermore this case has the unique features of emphysematous lung changes and pancytopenia which are uncommon with sarcoidosis.展开更多
AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were ...AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation(CO2 group, n = 24) or air insufflation(Air group, n = 22). Computed tomography(CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale(VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTS The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group(17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively(P= 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group(808 m L vs 1173 m L, P = 0.013).CONCLUSION CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.展开更多
In this study, the effect of prophylactic anti inflammation on the development of smoke induced emphysema was investigated. Young male guinea pigs aged 1.5 - 2 months (weighing 198.3±26.9 g) were randomly divi...In this study, the effect of prophylactic anti inflammation on the development of smoke induced emphysema was investigated. Young male guinea pigs aged 1.5 - 2 months (weighing 198.3±26.9 g) were randomly divided into 4 groups: group A (cigarette smoke exposure only), group B (cigarette smoke exposure plus pentoxifylline rich (PTX, 10 mg/d) forage feeding), group C (cigarette smoke exposure plus intermittent cortical steroid injection (Triamcinolone acetonide, 3 mg, im, every three weeks) and control group (group D: animals with sham smoke exposure, raised under the same conditions). Animals in group A, B and C were exposed to smoke of cigarettes for 1 to 1.5 h twice a day, 5 days a week. All animals were killed at the 16th week and followed by morphometrical analysis of the midsagittal sectioned lung slices. Smoke exposure of 16 weeks resulted in visible emphysematous development in Group A but not in Group B and C. It was evidenced by the indicator of air space size, mean linear intercept (L m): 120.6±16.0 μm in Group A; 89.8±9.2 μm in Group B and 102.4±17.7 μm in Group C. The average L m in either group B or group C was shorter than that in Group A (ANOVA and Newman Keuls test, F=8.80, P =0.0002) but comparable to that (94.8±13.2 μm) in group D ( P >0.05). It is concluded that long term prophylactic anti inflammation inhibits pulmonary emphysema induced by cigarette smoking in the guinea pigs.展开更多
AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung...AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung transplantation(SL)(n = 40) or double-lung transplant(DL)(n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization(ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL(P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL(P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival(P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained(n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted(P = 0.875).CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.展开更多
BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery a...BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.展开更多
Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical...Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions;malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.展开更多
AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three s...AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on- HRCT-were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular(CLE), paraseptal(PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia(UIP), probable UIP and nonspecific interstitial pneumonia(NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis(Coarseness), extent of emphysema(emphysema), extent of interstitial lung disease(Tot Ext ILD), extent of reticular pattern not otherwise specified(Ret NOS), extent of ground glass opacity with traction bronchiectasis(extG GOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity(DLCO) and systolic pulmonary arterial pressure were compared among the groups.RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema(P < 0.001) and a lower extent of interstitial lung disease(P < 0.002), reticular pattern not otherwise specified(P < 0.023), extent of ground glass opacity with traction bronchiectasis(P < 0.002), extent of honeycombing(P < 0.001) and coarseness of fibrosis(P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema(P < 0.05), total lung capacity(P < 0.01) and diffusion capacity(DLCO)(P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis(0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.展开更多
文摘Introduction: Facial emphysema is the presence of air in the subcutaneous tissues of the facial region. They can be clinically recognized by the crackling sensation felt when the affected area is palpated. Observation: The authors describe left orbito-facial emphysema that occurred after a violent sneezing episode in a 36-year-old patient. He had significant edema of the left facial and ipsilateral periorbital region associated with major emphysema and complete closure of the left eye. Nasal cavities endoscopy revealed inflammation of the distal orifice of the nasolacrimal duct. The clinical ophthalmologic examination performed in emergency showed left chemosis, slight ocular hypertonia of mechanical origin, and a slight decrease in visual acuity. Pupillary reflexes and retinography were normal. A craniofacial computed tomography (CT) revealed a significant left orbital emphysema, a fracture of the left medial orbital wall (ethmoidal lamina papyracea) with intraconal fat incarceration without entrapment of the medial rectus and significant air infiltration of all the left hemifacial soft tissues. A broad-spectrum antibiotic and anti-inflammatory treatment were instituted, as well as practical advice to prevent a recurrence. We observed progressive resorption of the edema with a return to the normal of the soft tissues and the palpebral cleft in 15 days. Conclusion: These atypical cases can be serious. It is essential to exclude signs of visual deficit and ocular compression. Multidisciplinary management is important.
文摘BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.
基金Supported by Soonchunhyang research fund,No.2023-0024.
文摘BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.
基金Supported by Shenzhen Science and Technology Program,No.JCYJ20220530165409022.
文摘BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.
文摘Pneumorrhachis(PR)is defined as presence of free air in the spinal canal.Trau-matic PR is very rare,and its exact incidence and pathogenesis is unknown.A comprehensive literature search was performed using the PubMed,Cochrane Library,Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023.A total of 34 resources were selected for inclusion in this narrative review.Traumatic PR can be classified anatomically into epidural and intradural types.In the epidural type,air is present peripherally in the spinal canal and the patients are usually asymptomatic.In contrast,in intradural PR,air is seen centrally in the spinal canal and patients present with neurological symptoms,and it is a marker of severe trauma.It is frequently associated with traumatic pneumocephalus,skull fractures or thoracic spine fracture.Computed tomography(CT)is considered to be the diagnostic modality of choice.Epidural PR is self-limited and patients are generally managed conser-vatively.Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak,with a need for surgical intervention.Differentiation between epidural and intradural PR is important,because the latter is an indication of severe underlying injury.CT imaging of the entire spine must be performed to look for extension of air,as well as to identify concomitant skull,torso or spinal injuries Most patients are asymp-tomatic and are managed conservatively,but a few may develop neurological symptoms that need further evaluation and management.
基金This work was supported by the Chen Xiao-ping Foundation for the Development of Science and Technology of HuBei Province:“Rui”special research fund[grant number CXPJJH1200000-07-113]。
文摘Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.
基金supported by a program of medical research of He nan Province(No.200902012)
文摘This study explored the role of apoptosis of alveolar wall cells of chronic obstructive pulmonary disease (COPD) patients with pulmonary emphysema in the pathogenesis of emphysema. The subjects were divided into three groups: COPD patients with pulmonary emphysema (COPD group), asymptomatic smokers and non-smokers. Lung tissues were harvested and histologically assessed. TUNEL assay was employed to determine the ap'optotic cells. The expression of PCNA, Bax and SP-C in the lung alveolar wall cells were immunohistochemically determined. SP-C immunofluorescence staining was used to identify type Ⅱ alveolar cells in the TUNEL-positive cells. The mean linear interval (MLI), mean alveoli number (MAN) and mean alveoli area (MAA) in COPD group were significantly different as compared with those in asymptomatic smokers and non-smokers, respectively (P〈0.01). The proliferation index (PI), apoptosis index (AI) and the percentage of Bax-positive cells in COPD group were significantly greater than those of asymptomatic smokers and non-smokers (P〈0.01). However, the percentage of SP-C-positive cells was significantly lower in COPD group than in asymptomatic smokers and non-smokers (P〈0.01). Most of the TUNEL-positive cells expressed SP-C. In COPD group, the apoptosis of alveolar wall cells, especially apoptosis of type- Ⅱ cells, may take part in the pathogenesis of emphysema. Up-regulation of Bax expression may be responsible for the apoptosis of alveolar wall cells in the COPD patients with pulmonary emphysema.
文摘A 39-year-old male reported fevers,weight loss,watery loose stools,and decreased visual acuity in his right eye over the prior five years.He was pancytopenic,had an elevated American council on exercise level,total bilirubin,and alkaline phosphatase.Computed tomography revealed massive hepatosplenomegaly and emphysematous lung changes.Liver biopsy showed non caseating granulomas.The patient was diagnosed with extrapulmonary sarcoidosis and was treated with prednisone.The patient symptomatically improved but 5 mo later presented with abdominal pain caused by perforation of the cecum.He underwent a cecectomy and pathology revealed pneumatosis cystoides intestinalis.This represents the first reported association between pneumatosis cystoides intestinalis and sarcoidosis.The etiology of pneumatosis cystoides intestinalis in this case was likely multifactorial and involved both effects of the corticosteroids as well as the advanced nature of the gastrointestinal sarcoidosis.Furthermore this case has the unique features of emphysematous lung changes and pancytopenia which are uncommon with sarcoidosis.
文摘AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation(CO2 group, n = 24) or air insufflation(Air group, n = 22). Computed tomography(CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale(VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTS The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group(17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively(P= 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group(808 m L vs 1173 m L, P = 0.013).CONCLUSION CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.
文摘In this study, the effect of prophylactic anti inflammation on the development of smoke induced emphysema was investigated. Young male guinea pigs aged 1.5 - 2 months (weighing 198.3±26.9 g) were randomly divided into 4 groups: group A (cigarette smoke exposure only), group B (cigarette smoke exposure plus pentoxifylline rich (PTX, 10 mg/d) forage feeding), group C (cigarette smoke exposure plus intermittent cortical steroid injection (Triamcinolone acetonide, 3 mg, im, every three weeks) and control group (group D: animals with sham smoke exposure, raised under the same conditions). Animals in group A, B and C were exposed to smoke of cigarettes for 1 to 1.5 h twice a day, 5 days a week. All animals were killed at the 16th week and followed by morphometrical analysis of the midsagittal sectioned lung slices. Smoke exposure of 16 weeks resulted in visible emphysematous development in Group A but not in Group B and C. It was evidenced by the indicator of air space size, mean linear intercept (L m): 120.6±16.0 μm in Group A; 89.8±9.2 μm in Group B and 102.4±17.7 μm in Group C. The average L m in either group B or group C was shorter than that in Group A (ANOVA and Newman Keuls test, F=8.80, P =0.0002) but comparable to that (94.8±13.2 μm) in group D ( P >0.05). It is concluded that long term prophylactic anti inflammation inhibits pulmonary emphysema induced by cigarette smoking in the guinea pigs.
文摘AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung transplantation(SL)(n = 40) or double-lung transplant(DL)(n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization(ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL(P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL(P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival(P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained(n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted(P = 0.875).CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.
文摘BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.
文摘Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions;malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.
文摘AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on- HRCT-were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular(CLE), paraseptal(PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia(UIP), probable UIP and nonspecific interstitial pneumonia(NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis(Coarseness), extent of emphysema(emphysema), extent of interstitial lung disease(Tot Ext ILD), extent of reticular pattern not otherwise specified(Ret NOS), extent of ground glass opacity with traction bronchiectasis(extG GOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity(DLCO) and systolic pulmonary arterial pressure were compared among the groups.RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema(P < 0.001) and a lower extent of interstitial lung disease(P < 0.002), reticular pattern not otherwise specified(P < 0.023), extent of ground glass opacity with traction bronchiectasis(P < 0.002), extent of honeycombing(P < 0.001) and coarseness of fibrosis(P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema(P < 0.05), total lung capacity(P < 0.01) and diffusion capacity(DLCO)(P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis(0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.