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Vol. 55. Issue 6.
Pages 328 (June 2019)
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Pneumomediastinum and Subcutaneous Emphysema After Flexible Bronchoscopy
Neumomediastino y enfisema subcutáneo tras fibrobroncoscopia
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Maite Goicoechea Irigaray, Israel Rodríguez Alvarado, M. Teresa Gómez Hernández
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Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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We report the case of an 82-year-old man referred to the respiratory medicine department with a 2-month history of dyspnea and desaturation, that did not improve with bronchodilator therapy. Chest X-ray showed bilateral lung consolidation, and chest computed tomography (CT) revealed areas of consolidation in right upper lobe (RUL) and left lower lobe (LUL) with associated reticulation. Given these findings, we decided to perform a fiberoptic bronchoscopy (FB) which showed diffuse endobronchial inflammation. Non-selective bronchial aspiration (BAS) and bronchoalveolar lavage (BAL) were performed during the procedure, without complications. Hours later, the patient reported an increase in his neck circumference. Chest X-ray showed subcutaneous emphysema (Fig. 1A) and an emergency CT showed pneumomediastinum (Fig. 1B). The patient was treated conservatively with analgesia and oxygen therapy, resulting in improved symptoms, so outpatient follow-up was recommended.

Fig. 1.

(A) Posteroanterior chest X-ray showing subcutaneous emphysema and persistent pulmonary consolidations in the RUL and LUL. (B) CT coronal reconstruction showing predominantly right-sided pneumomediastinum and subcutaneous emphysema in the cervical region.

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The origin of pneumomediastinum and subcutaneous emphysema can be spontaneous, traumatic, or iatrogenic. These complications have been described post-fiberoptic bronchoscopy in association with transbronchial biopsies.1 However, no cases have been described after simple fiberoptic bronchoscopy with BAS and BAL. The pathophysiologic mechanism of the process can be explained by the Macklin effect.2

References
[1]
J.J. Liang, D.E. Midthun.
Postbronchoscopy pneumomediastinum and subcutaneous emphysema.
Intern Med, 52 (2013), pp. 519-520
[2]
M. Wintermark, P. Schnyder.
The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma.
Chest, 120 (2001), pp. 543-547

Please cite this article as: Goicoechea Irigaray M, Rodríguez Alvarado I, Gómez Hernández MT. Neumomediastino y enfisema subcutáneo tras fibrobroncoscopia. Arch Bronconeumol. 2019;55:328.

Copyright © 2018. SEPAR
Archivos de Bronconeumología

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