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An approach from the neck to drain expanding pneumomediastinum: a case report

BACKGROUND: Several methods for draining pneumomediastinum have been advocated, but no consensus has been established. We propose a novel method for draining air from pneumomediastinum. CASE DESCRIPTION: We used an approach from the neck to drain pneumomediastinum that had started to compress the he...

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Autores principales: Oka, Naoki, Kuriyama, Akira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061455/
https://www.ncbi.nlm.nih.gov/pubmed/37007542
http://dx.doi.org/10.21037/atm-22-5054
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author Oka, Naoki
Kuriyama, Akira
author_facet Oka, Naoki
Kuriyama, Akira
author_sort Oka, Naoki
collection PubMed
description BACKGROUND: Several methods for draining pneumomediastinum have been advocated, but no consensus has been established. We propose a novel method for draining air from pneumomediastinum. CASE DESCRIPTION: We used an approach from the neck to drain pneumomediastinum that had started to compress the heart in a 33-year-old man with coronavirus disease 2019 (COVID-19) on mechanical ventilation. Computed tomography showed extension of pneumomediastinum to the lateral and dorsal aspects of the right sternocleidomastoid muscle, presenting as subcutaneous emphysema at the neck. We made a 4-cm incision lateral to the right sternocleidomastoid muscle. After incising the platysma muscle, the dorsal side of the sternocleidomastoid muscle was easily stripped off due to the presence of air, allowing placement of a 14-Fr Nelaton catheter. Subcutaneous emphysema as well as pneumopericardium on X-rays improved and disappeared by 3 days after starting drainage. Positive end-expiratory pressure (PEEP) was titrated in a stepwise manner from 6 to 10 cmH(2)O, with no re-appearance of subcutaneous emphysema. The Nelaton catheter at the neck was removed and the skin was sutured using 3-0 Nylon monofilament. CONCLUSIONS: We propose this approach from the neck to release air and prevent deterioration of pneumomediastinum communicating with subcutaneous emphysema at the neck.
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spelling pubmed-100614552023-03-31 An approach from the neck to drain expanding pneumomediastinum: a case report Oka, Naoki Kuriyama, Akira Ann Transl Med Case Report BACKGROUND: Several methods for draining pneumomediastinum have been advocated, but no consensus has been established. We propose a novel method for draining air from pneumomediastinum. CASE DESCRIPTION: We used an approach from the neck to drain pneumomediastinum that had started to compress the heart in a 33-year-old man with coronavirus disease 2019 (COVID-19) on mechanical ventilation. Computed tomography showed extension of pneumomediastinum to the lateral and dorsal aspects of the right sternocleidomastoid muscle, presenting as subcutaneous emphysema at the neck. We made a 4-cm incision lateral to the right sternocleidomastoid muscle. After incising the platysma muscle, the dorsal side of the sternocleidomastoid muscle was easily stripped off due to the presence of air, allowing placement of a 14-Fr Nelaton catheter. Subcutaneous emphysema as well as pneumopericardium on X-rays improved and disappeared by 3 days after starting drainage. Positive end-expiratory pressure (PEEP) was titrated in a stepwise manner from 6 to 10 cmH(2)O, with no re-appearance of subcutaneous emphysema. The Nelaton catheter at the neck was removed and the skin was sutured using 3-0 Nylon monofilament. CONCLUSIONS: We propose this approach from the neck to release air and prevent deterioration of pneumomediastinum communicating with subcutaneous emphysema at the neck. AME Publishing Company 2023-02-01 2023-03-15 /pmc/articles/PMC10061455/ /pubmed/37007542 http://dx.doi.org/10.21037/atm-22-5054 Text en 2023 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Case Report
Oka, Naoki
Kuriyama, Akira
An approach from the neck to drain expanding pneumomediastinum: a case report
title An approach from the neck to drain expanding pneumomediastinum: a case report
title_full An approach from the neck to drain expanding pneumomediastinum: a case report
title_fullStr An approach from the neck to drain expanding pneumomediastinum: a case report
title_full_unstemmed An approach from the neck to drain expanding pneumomediastinum: a case report
title_short An approach from the neck to drain expanding pneumomediastinum: a case report
title_sort approach from the neck to drain expanding pneumomediastinum: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10061455/
https://www.ncbi.nlm.nih.gov/pubmed/37007542
http://dx.doi.org/10.21037/atm-22-5054
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