Teenager with Chest Pain and Swollen Neck: a Leave-It-Alone Condition

Home , Neck, Pneumatosis

3 2 1 8Mrh2015 March 18 First Online Published 2015 February 28 Accepted 2015 February 25 Received [email protected] Taiwan; 110, Taipei Street, Wu-Shing 252 Hospital, University Medical Taipei Imaging, Medical of Department and Medicine Emergency of Department Liao, Pen-Yuan Dr to Correspondence Taiwan Taipei, Hospital, University Medical Taipei Imaging, Taiwan Taipei, University, Medical Taipei Taiwan Taipei, Hospital, University Medical Taipei Medicine, eateto Medical of Department Center, Research Imaging Emergency of Department Thorax cite: To 2015; ioPY agH-J. Wang P-Y, Liao 70 :707 – 708. engrwt hs anadsolnneck: condition swollen leave-it-alone and a pain chest with Teenager THORAX IN IMAGES e-unLiao, Pen-Yuan nuaoi.Fe i isce ln h nevrerlfrmn fuprtoai etba (arrow). vertebrae thoracic upper of foramens intervertebral the along dissected air Free pneumatosis. 1 Figure additional showed pneumomediasti- CT and num. diffuse emphysema disclosed and X-ray Chest crepi- subcutaneous neck palpation. revealing skin swollen, on the be tus On examination, to were visit. appeared a physical haemodynamics shoulders ED had and On to afebrile, prior stable. also was week he 1 He triage, to for presented (ED). cold and exercise common breath department strenuous of after emergency shortness pain with chest boy 19-year-old A causes indicated. that volume large de of neurological air free self- epidural generally For is limited. condition this symptoms, without neurological pneumomediastinum spontaneous associated pneumorrhachis a with to primary patients its most to For according cause. tailored be should epidural pneumatosis of management with The young accompanied pneumomediastinum. usually healthy is otherwise It an adult. in attack asthma vomiting, or forceful cough of in instance increase in abrupt pressure by intrathoracic caused usually is Pneumorrhachis uneventfully. hospitalisation treatment of conservative days 2 with after discharged was patient additional CT showed pneumomediastinum. and emphysema diffuse on subcutaneous disclosed crepitus X-ray was Chest There palpation. swollen. skin and be neck to the appeared examination, shoulders physical On emergency . to chest department presented and exercise breath strenuous of after shortness pain with boy 19-year-old A ABSTRACT ioP-Y, Liao To h hs,soigetniesbuaeu mhsm,pemmdatnmadepidural and pneumomediastinum emphysema, subcutaneous extensive showing chest, the of CT fi tal et is ugcllmncoymybe may laminectomy surgical cits, fi . dn fari pdrlsae The space. epidural in air of nding 1,2,3 Thorax ugJn Wang Hung-Jung 2015; 70:707 fi dn farin air of nding – 0.doi:10.1136/thoraxjnl-2015-206978 708. 3 ae.Freiua rearo ag ouethat volume indicated. large be may of de more air neurological spine, free causes epidural the For emphysematous of taken. trauma speci rupture, and open aggressive oesophageal and under infection aetiologies, is as other asthma of such or pneumorrhachis emesis For control. cough, generally if is condition self-limited without this symptoms, pneumomediastinum neurological spontaneous associated cause. a pneumorrhachis primary with with its patients to most according For tailored be should il o f80 o1o 200hsia inci- hospital 000 42 of 1 to admissions. emergency 8005 respon- and of is dents and 1 entity for disease rare sible a already is pneumomediastinum, which 9.5% spontaneous in with occurs patients pneumorrhachis of that estimated is It rmploayavoihst rvlars the space. across epidural the travel reach air to to order has the in mediastinum alveoli since pulmonary pneumomediastinum, an accom- from usually in with is attack It of panied adult. asthma young instance or healthy in otherwise cough pressure vomiting, intrathoracic forceful in increase conser- with uneventfully. hospitalisation treatment of vative days 2 after ( charged space epidural osntcuesmtm;hwvr neurological large. however, usually vertebral symptoms; air the de cause free to epidural not trauma of does direct presence space, The or retropharyngeal column. use include drug air illicit free of origins h aaeeto pdrlpneumatosis epidural of management The nuorahsi sal asdb abrupt by caused usually is Pneumorrhachis fi ismyocri h oueo rearis air free of volume the if occur may cits 3 fi ue1 gure fi ramn hudb under- be should treatment c fi is ugcllaminectomy surgical cits, .Teptetwsdis- was patient The ). 12 hs clinic Chest te possible Other 707

on September 24, 2021 by guest. Protected by copyright. by Protected guest. by 2021 24, September on Chest clinic Chest clinic rvnneadpe review peer and Provenance consent Patient interests discussion. radiologist Competing of reporting parts the several was to H-JW history. contributed patient and to contributed and department, Contributors 708 hs clinic Chest -Li h anwie n rmr aepyiino emergency of physician care primary and writer main the is P-YL Obtained. None. o omsind nenlype reviewed. peer internally commissioned; Not ogK,LeK.Sotnosetaua nuorahscuigcervical causing pneumorrhachis extradural Spontaneous KB. Lee KJ, Song 3 uaaaS ioS pnaeu nuoeisiu n aki fet vriwand overview effect: Macklin pneumomediastinum and Spontaneous S. Gibo S, Murayama 1 REFERENCES ooT uahm ,FjoaM, Fujioka S, Kuwashima T, Kono 2 myelopathy. perneo optdtomography. computed on appearance nuoeisiu ncide:ucmo complication? uncommon children: in pneumomediastinum ioP-Y, Liao tal et pn J Spine . Thorax 2009;9:e16 2015; 70:707 – tal et 18. pdrlarascae ihspontaneous with associated air Epidural . ol Radiol J World – 0.doi:10.1136/thoraxjnl-2015-206978 708. 2014;6:850 eit Int Pediatr – 4. 2007;49:923

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