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Inicio Radiología (English Edition) Finding the bubble: atypical and unusual extrapulmonary air in the chest
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Vol. 63. Issue 4.
Pages 358-369 (July - August 2021)
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Vol. 63. Issue 4.
Pages 358-369 (July - August 2021)
Radiology through images
DOI: 10.1016/j.rxeng.2021.02.005
Finding the bubble: atypical and unusual extrapulmonary air in the chest
Buscando la burbuja: aire torácico extrapulmonar atípico e inusual
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D. Varona Porres
Corresponding author
dvarona@vhebron.net

Corresponding author.
, O. Persiva, A.L. Sánchez, L. Cabanzo, E. Pallisa, J. Andreu
Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
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Table 1. Most common causes of ectopic extrapulmonary thoracic air.
Abstract
Objective

To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.

Conclusion

In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

Keywords:
Pneumomediastina
Esophageal perforation
Tracheal rupture
Pneumopericardium
Venous air embolism
Bronchopleural fistula
Pneumothorax
Transdiaphragmatic intercostal hernia
Subcutaneous emphysema
Resumen
Objetivo

Describir los hallazgos radiológicos y revisar las causas atípicas e inusuales de aire torácico extrapulmonar, incidiendo en la importancia del diagnóstico para el manejo de estos pacientes.

Conclusión

En este artículo revisaremos una serie de casos recogidos en nuestro centro que se manifiestan como aire torácico extrapulmonar, con especial atención a las causas atípicas e infrecuentes. Según su localización anatómica, las clasificaremos en: localización mediastínica (neumomediastino espontáneo con neumorraquis, rotura traqueal, dehiscencia de sutura bronquial en trasplante pulmonar, disección intramucosa esofágica, síndrome de Boerhaave, fístula traqueoesofágica en neoplasia esofágica, perforación bronquial y fístula esofagorrespiratoria por rotura de ganglio linfático, y mediastinitis aguda), localización pericárdica (neumopericardio en neoplasia pulmonar), localización cardiovascular (embolia venosa aérea), localización pleural (fístulas broncopleurales, neumotórax espontáneo en mesotelioma pleural maligno y neoplasia pulmonar primaria, y neumotórax bilateral posbiopsia pulmonar unilateral) y localización en pared torácica (infecciones, hernia intercostal transdiafragmática y enfisema subcutáneo posbiopsia pulmonar).

Palabras clave:
Neumomediastino
Perforación esofágica
Rotura traqueal
Neumopericardio
Embolia venosa aérea
Fístula broncopleural
Neumotórax
Hernia intercostal transdiafragmática
Enfisema subcutáneo

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