Buscar en
Open Respiratory Archives
Toda la web
Inicio Open Respiratory Archives Pneumomediastinum and Subcutaneous Emphysema After Tracheotomy Tube Decannulatio...
Journal Information
Vol. 2. Issue 3.
Pages 188-189 (July - September 2020)
Share
Share
Download PDF
More article options
Vol. 2. Issue 3.
Pages 188-189 (July - September 2020)
Clinical image
DOI: 10.1016/j.opresp.2020.01.003
Open Access
Pneumomediastinum and Subcutaneous Emphysema After Tracheotomy Tube Decannulation
Neumomediastino y enfisema subcutáneo tras decanulación de una traqueostomía
Visits
...
Yanxia Geng, Renzheng Diao, Hai Lv
Corresponding author
eeylet@163.com

Corresponding author.
, Yan Zhang
Intensive Care Unit, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Han Zhong Road, Nanjing 210029, China
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text

A 42 years old man was admitted to stomatology hospital on August 2019 due to relapse of gingival cancer (GC). As treatment procedures, patient received surgery and tracheostomy at the same time. After surgery, patient's condition was stabilized, incision of the neck appeared to be in the first stage of wound healing process and decannulation was done. On the night before discharge, patient appeared to be suffered from sudden dyspnea, unconsciousness and seizures, so emergency tracheostomy was performed, and patient was immediately transferred to Intensive Care Unit (ICU). In the process, patient suffered from transient hypotension, and ventilation via the stoma was administered. Patient didn’t receive Ambu mask during reanimation. On admission, patient's PO2 level was 100mmHg, patient had undergone CT scan and result shows that present of pneumomediastinum accompanied with subcutaneous emphysema (Figs. 1 and 2), and pulmonary embolism was excluded. Pneumomediastinum following tracheostomy is a rare occurrence, which has a percentage of 0.36 of incidence reported.1 Reviewing back his medical history, patient did complaint of chest distension 2 days ago before the onset of this scenario, and when emergency tracheostomy was performed, a lot of bubbles were seen. Therefore, we believe that there is a possibility that maybe after decannulation, pneumomediastinum was slowly formed which is very rare in the absence of positive airway pressure, and gradually compresses the heart, leading to obstructive shock, thus, when tracheostomy was performed again, patient's condition returned stabilized. CT reveals that pneumomediastinum compress the heart and lead to formation of Earth-Heart sign (Fig. 3).2 Patient return consciousness on the second day, he did a follow-up on CT scan after 5 days and result shows that pneumomediastinum and subcutaneous emphysema were completely absorbed.

Fig. 1.

Coronal computed tomography (CT) image shows the subcutaneous emphysema of the upper and lower fossa of bilateral clavicle.

(0.05MB).
Fig. 2.

Coronal (A) and axial (B) CT images showing pneumomediastinumthe.

(0.12MB).
Fig. 3.

Posteroanterior CT images showing (A) the Earth-Heart sign: the cardiac silhouette appears to be flattened which is similar to an oblate sphere; and (B) normal cardiac silhouette on 5th day after re-tracheal incision.

(0.13MB).
References
[1]
W.X. Yeo, C.Q. Phua, S. Lo.
Is routine chest X-ray after surgical and percutaneous tracheostomy necessary in adults: a systematic review of the current literature.
Clin Otolaryngol, 39 (2014), pp. 79-88
[2]
G.A. Obeso Carillo, G. Barge Caballero, M.Á. Cañizares Carretero.
The Earth-Heart sign: a new diagnostic finding in a patient with tension pneumomediastinum.
Copyright © 2020. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.