Pneumorrhachis
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Jay Kirkham
A 21-year-old man with a history of asthma and albuterol noncompliance presented to the emergency department with chest pain and shortness of breath. He reported 2 days of wheezing and coughing episodes. On arrival, his vital signs were normal, but auscultation revealed bilateral wheezing. A chest radiograph revealed subcutaneous emphysema and pneumopericardium (image A, arrows). A subsequent computed tomographic image showed pneumorrhachis (image B, arrow), a rare but generally benign phenomenon of intraspinal air. The patient was observed for 48 hours to monitor for complications and discharged with suggested pulmonary follow-up after 1 week.
Although most cases of pneumorrhachis are due to iatrogenic or traumatic causes, a few reports exist of pneumorrhachis caused by increased intrathoracic pressure from violent coughing.1 Most cases are asymptomatic and incidentally noted on imaging. It is thought that free air from pulmonary alveolar rupture dissects along the posterior mediastinum into the epidural space.2 Pneumorrhachis is best visualized on a computed tomographic scan of the thorax. Management is usually conservative, and decompression is reserved for those with neurologic symptoms.
References
1. Manden PK ,SiddiquiAH. Pneumorrhachis, pneumomediastinum, pneumopericardium and subcutaneous emphysema as complications of bronchial asthma.Ann Thorac Med.2009;4(3):143-145. doi:10.4103/1817-1737.53352.10.4103/1817-1737.53352Search in Google Scholar
2. Drevelengas A ,KalaitzoglouI,PetridisA. Pneumorrhachis associated with spontaneous pneumomediastinum.Eur J Radiol.1994;18(2):122-123.10.1016/0720-048X(94)90277-1Search in Google Scholar
© 2016 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Articles in the same Issue
- SURF
- Interrelationship of Structure and Function in Maxillofacial Fractures
- IN MY VIEW
- Single Accreditation System for Graduate Medical Education: An Opportunity for Lesbian, Gay, Bisexual, and Transgender Health Education Integration in Osteopathic Medicine
- AOA COMMUNICATION
- JAOA Peer Reviewers, 2015
- ORIGINAL CONTRIBUTION
- Effectiveness of the Complete Health Improvement Program in Reducing Risk Factors for Cardiovascular Disease in an Appalachian Population
- BRIEF REPORT
- Osteopathic Physicians on the Editorial Boards of Major Medical Journals Over the Past 30 Years
- CLINICAL REVIEW
- How to Monitor and Advise Vegans to Ensure Adequate Nutrient Intake
- MEDICAL EDUCATION
- Burnout Among Osteopathic Residents: A Cross-sectional Analysis
- Establishing a Professionalism Score in an Osteopathic Manipulative Medicine Curriculum
- CASE REPORT
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