Case Series: Pneumorrhachis Secondary to Spontaneous Pneumomediastinum

doi:10.1016/j.jemermed.2015.09.047

The Journal of Emergency Medicine

Volume 50, Issue 2, February 2016, Pages e43-e45

https://doi.org/10.1016/j.jemermed.2015.09.047 Get rights and content

Abstract

Background

Pneumorrhachis (PR) describes the clinical finding of air within the spinal canal and rarely has been associated with spontaneous pneumomediastinum. There is little medical literature addressing the evaluation and management of these patients in the emergency department.

Case Report

We present a series of patients with PR secondary to a spontaneous pneumomediastinum and briefly review the available literature on the topic to discuss reasonable management strategies for patients presenting with this rare finding. In both cases, the patients had excellent outcomes with expectant management despite the worrisome finding of air in the spinal canal.

Why Should an Emergency Physician Be Aware of This?

Emergency physicians must be able to promptly recognize and appropriately assess even uncommon pathology. As with other rare conditions, there are no published guidelines for the ED management of PR, necessitating the use of case presentations to educate providers as to the complications and plan of care of this diagnosis.

Introduction

Pneumorrhachis (PR) is an uncommon condition characterized by the presence of air within the spinal canal, most often resulting from trauma or spinal column instrumentation, but also occasionally reported in association with spontaneous pneumomediastinum. Many clinicians are unfamiliar with this relatively rare condition. We present two cases of PR that presented to our Emergency Department (ED) in succession.

Section snippets

Case 1

A 28-year-old man without significant past medical history presented to the ED complaining of 1 day of constant pleuritic chest discomfort preceded by 2 days of nonproductive cough and odynophagia. He denied neurologic complaint, antecedent recreational drug use, trauma, air travel, and vomiting. Vital signs were within normal limits, with the exception of an initial blood pressure of 159/80 mm Hg. Physical examination was remarkable for crepitus in the neck. The neurologic examination was

Discussion

The first report of PR secondary to spontaneous pneumomediastinum was published in 1994 (1). Spontaneous pneumomediastinum is rare, occurring in approximately 1 in 30,000 patients presenting to the ED (2). Of those with spontaneous pneumomediastinum, still fewer will have PR. One retrospective study reported the incidence of PR to be 9.5% among a cohort of pediatric patients with a new diagnosis of spontaneous pneumomediastinum (3).

Alveolar rupture may occur secondary to an acute increase in

Why Should an Emergency Physician Be Aware of This?

There are no published guidelines for the ED management of spontaneous pneumomediastinum or PR. As with other rare conditions, a rigorous study of PR in the ED is not feasible. As such, the sharing of case reports may be the most practical way to educate providers of this diagnosis and to track complications necessitating adjustments to the currently accepted plans of care. Our center's experience includes two cases of PR that had excellent outcomes with conservative management by observation

References (10)

A. Drevelengas et al.
Pneumorrhachis associated with spontaneous pneumomediastinum
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A.E. Newcomb et al.
Spontaneous pneumomediastinum: a benign curiosity or a significant problem?
Chest
(2005)
M. Migeot et al.
Pneumorrhachis associated with a spontaneous pneumomediastinum
Rev Neurol (Paris)
(2013)
E.A. Belotti et al.
Air within the spinal canal in spontaneous pneumomediastinum
Chest
(2010)
K.J. Song et al.
Spontaneous extradural pneumorrhachis causing cervical myelopathy
Spine J
(2009)

There are more references available in the full text version of this article.

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Clinical Communications: AdultsCase Series: Pneumorrhachis Secondary to Spontaneous Pneumomediastinum

Abstract

Background

Case Report

Why Should an Emergency Physician Be Aware of This?

Introduction

Section snippets

Case 1

Discussion

Why Should an Emergency Physician Be Aware of This?

Eur J Radiol

Chest

Rev Neurol (Paris)

Chest

Spine J

Clinical Communications: Adults
Case Series: Pneumorrhachis Secondary to Spontaneous Pneumomediastinum