A Case of Tension Pneumomediastinum Treated With Mediastinal Drainage Using a Semi-flexible Fiberscope Via a Subxiphoid Approach

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Apr 23

PMID 38650778

Authors

Yuji Matsumoto

Hiroshi Mizuuchi

Kokoro Honjo

Masahiro Hata

Takehiko Shigenaga

Affiliations

Soon will be listed here.

Abstract

Tension pneumomediastinum with hemodynamic failure is a rare but life-threatening condition. Rapid decompression of the mediastinum by drainage is essential to save the patient's life. This report presents a case of tension pneumomediastinum that developed during conservative management of a pneumomediastinum associated with idiopathic pulmonary fibrosis. Endoscopically guided mediastinal drainage was successfully performed in the emergency situation of tension pneumomediastinum. Using the semi-flexible fiberscope inserted through a subxiphoid approach, the drainage catheter was easily and safely placed at the appropriate site in the mediastinum. Good mediastinal decompression was achieved, and the patient was out of this critical condition.

References

Brito J, Gregorio P, Mariani A, DAmbrosio P, Filho M, Ferreira L . Pneumomediastinum in COVID-19 disease: Outcomes and relation to the Macklin effect. Asian Cardiovasc Thorac Ann. 2021; 29(6):541-548. DOI: 10.1177/02184923211010089. View

Cavalleri J, Kisoka G, Verscheure S, Canivet J, Misset B . [Danger of mechanical ventilation : Macklin effect during induced barotrauma]. Rev Med Liege. 2021; 76(7-8):579-582. View

Wintermark M, Schnyder P . The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001; 120(2):543-7. DOI: 10.1378/chest.120.2.543. View

Dondelinger R, Coulon M, Kurdziel J, Hemmer M . Tension mediastinal emphysema: emergency percutaneous drainage with CT guidance. Eur J Radiol. 1992; 15(1):7-10. DOI: 10.1016/0720-048x(92)90193-d. View

Rachid C, Romane L, Ait Batahar S, Amro L . Spontaneous Pneumomediastinum Revealing Asthma: The Macklin Effect. Cureus. 2022; 14(5):e24978. PMC: 9109653. DOI: 10.7759/cureus.24978. View

Fujiwara T . Pneumomediastinum in pulmonary fibrosis. Detection by computed tomography. Chest. 1993; 104(1):44-6. DOI: 10.1378/chest.104.1.44. View

Watanabe H, Ishikawa H, Inui T, Kawashima K, Namiki T, Sakamoto T . The Macklin effect in tension pneumomediastinum in a patient with interstitial pneumonia. Respirol Case Rep. 2022; 10(11):e01045. PMC: 9522639. DOI: 10.1002/rcr2.1045. View

Shaikh N, Al Ameri G, Shaheen M, Abdaljawad W, Prabhakaran S, Al Wraidat M . Tension Pneumomediastinum: A life-threatening condition in patients with COVID-19. Qatar Med J. 2021; 2021(3):55. PMC: 8529628. DOI: 10.5339/qmj.2021.55. View

Buschmann C, Tsokos M, Kurz S, Kleber C . [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation]. Anaesthesist. 2015; 64(7):520-6. DOI: 10.1007/s00101-015-0042-6. View

10.

Thuan P, Phuong P, Anh H, Long L, Minh Khoi L . Surgical treatment of tension pneumomediastinum in patients with covid-19 at the field hospital: a case series. J Cardiothorac Surg. 2022; 17(1):202. PMC: 9399585. DOI: 10.1186/s13019-022-01966-9. View

11.

Van Stiegmann G, Brantigan C, Hopeman A . Tension pneumomediastinum. Arch Surg. 1977; 112(10):1212-5. DOI: 10.1001/archsurg.1977.01370100066012. View

12.

Ganessane E, Devendiran A, Ramesh S, Uthayakumar A, Chandrasekar V, Sadasivam A . Pneumomediastinum in COVID-19 disease: Clinical review with emphasis on emergency management. J Am Coll Emerg Physicians Open. 2023; 4(2):e12935. PMC: 10086517. DOI: 10.1002/emp2.12935. View

13.

Gabor S, Renner H, Maier A, Smolle Juttner F . Tension pneumomediastinum after severe vomiting in a 21-year-old female. Eur J Cardiothorac Surg. 2005; 28(3):502-3. DOI: 10.1016/j.ejcts.2005.05.015. View

14.

Hong J, Hong S, Chen X, Zhou S, Chen Q, Huang J . Computed tomography imaging-guided parasternal approach drainage for children with tension pneumomediastinum: a case series. BMC Pediatr. 2023; 23(1):587. PMC: 10664601. DOI: 10.1186/s12887-023-04417-z. View

15.

Melhorn J, Achaiah A, Conway F, Thompson E, Skyllberg E, Durrant J . Pneumomediastinum in COVID-19: a phenotype of severe COVID-19 pneumonitis? The results of the UK POETIC survey. Eur Respir J. 2022; 60(3. PMC: 8832377. DOI: 10.1183/13993003.02522-2021. View

16.

Argiro R, Di Donna C, Morosetti D, Da Ros V, Spiritigliozzi L, Wlderk A . CT-guided Emergency Drainage of Tension Pneumomediastinum in a Young Patient With Acute Lymphoid Leukemia and Aspergillus fumigatus Pulmonary Infection. J Bronchology Interv Pulmonol. 2020; 28(3):e36-e39. DOI: 10.1097/LBR.0000000000000727. View

17.

Banki F, Estrera A, Harrison R, Miller 3rd C, Leake S, Mitchell K . Pneumomediastinum: etiology and a guide to diagnosis and treatment. Am J Surg. 2013; 206(6):1001-6. DOI: 10.1016/j.amjsurg.2013.08.009. View

18.

Colombi D, Ehlers-Tenenbaum S, Palmowski K, Heussel C, Sverzellati N, Silva M . Spontaneous Pneumomediastinum as a Potential Predictor of Mortality in Patients with Idiopathic Pulmonary Fibrosis. Respiration. 2016; 92(1):25-33. DOI: 10.1159/000447430. View

19.

Barbosa P, Stefanini F, Bitencourt A, Gross J, Chojniak R . Computed tomography-guided percutaneous drainage of tension pneumomediastinum. Radiol Bras. 2022; 55(1):62-63. PMC: 8864686. DOI: 10.1590/0100-3984.2021.0065. View