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Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report
BACKGROUND: Pneumomediastinum is an abnormal accumulation of air within the mediastinum. Herein, we report a rare case in which a patient initially developed pneumomediastinum and extensive subcutaneous emphysema after bronchoscopic bronchioloalveolar lavage (BAL). The condition then progressed to a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811029/ https://www.ncbi.nlm.nih.gov/pubmed/33489748 http://dx.doi.org/10.1016/j.rmcr.2021.101341 |
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author | Po, Pien-Lung Bai, Hsueh-Fen Lin, Chia-Heng Lin, Chen-Chun |
author_facet | Po, Pien-Lung Bai, Hsueh-Fen Lin, Chia-Heng Lin, Chen-Chun |
author_sort | Po, Pien-Lung |
collection | PubMed |
description | BACKGROUND: Pneumomediastinum is an abnormal accumulation of air within the mediastinum. Herein, we report a rare case in which a patient initially developed pneumomediastinum and extensive subcutaneous emphysema after bronchoscopic bronchioloalveolar lavage (BAL). The condition then progressed to abdominal compartment syndrome leading to death. CASE PRESENTATION: An 80-year-old man with acute respiratory failure caused by severe pneumonia and septic shock, was admitted to our intensive care unit. Bronchoscopic BAL was performed for microbiological specimen collection. The patient developed subcutaneous emphysema after the procedure, and pneumomediastinum was identified on subsequent chest radiography. The patient initially received supportive care. However, he experienced persistent hypotension, which did not respond to vigorous fluid replacement and high dose vasopressor treatment. Physical examination revealed distended, tense abdomen with diffuse tympanic sound upon percussion. Computer tomography scan showed extensive subcutaneous emphysema, massive air accumulation in the retroperitoneal cavity, near total collapse of the inferior vena cava, and left sided shifting of intra-abdominal organs. The impression was tension pneumoperitoneum with abdominal compartment syndrome. The patient eventually died of refractory hypotension. CONCLUSIONS: Iatrogenic injury is a rare condition. The common complications include hypoxia, bleeding, infection, arrhythmia, subcutaneous emphysema, and pneumomediastinum, and these can be managed conservatively. However, more complex and life-threatening conditions can be caused by tracheal perforation or alveolar rupture, and can lead to pneumothorax, pneumoperitoneum, or even abdominal compartment syndrome. A high level of suspicion is needed for early detection, and immediate decompression is required to prevent death. |
format | Online Article Text |
id | pubmed-7811029 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-78110292021-01-22 Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report Po, Pien-Lung Bai, Hsueh-Fen Lin, Chia-Heng Lin, Chen-Chun Respir Med Case Rep Case Report BACKGROUND: Pneumomediastinum is an abnormal accumulation of air within the mediastinum. Herein, we report a rare case in which a patient initially developed pneumomediastinum and extensive subcutaneous emphysema after bronchoscopic bronchioloalveolar lavage (BAL). The condition then progressed to abdominal compartment syndrome leading to death. CASE PRESENTATION: An 80-year-old man with acute respiratory failure caused by severe pneumonia and septic shock, was admitted to our intensive care unit. Bronchoscopic BAL was performed for microbiological specimen collection. The patient developed subcutaneous emphysema after the procedure, and pneumomediastinum was identified on subsequent chest radiography. The patient initially received supportive care. However, he experienced persistent hypotension, which did not respond to vigorous fluid replacement and high dose vasopressor treatment. Physical examination revealed distended, tense abdomen with diffuse tympanic sound upon percussion. Computer tomography scan showed extensive subcutaneous emphysema, massive air accumulation in the retroperitoneal cavity, near total collapse of the inferior vena cava, and left sided shifting of intra-abdominal organs. The impression was tension pneumoperitoneum with abdominal compartment syndrome. The patient eventually died of refractory hypotension. CONCLUSIONS: Iatrogenic injury is a rare condition. The common complications include hypoxia, bleeding, infection, arrhythmia, subcutaneous emphysema, and pneumomediastinum, and these can be managed conservatively. However, more complex and life-threatening conditions can be caused by tracheal perforation or alveolar rupture, and can lead to pneumothorax, pneumoperitoneum, or even abdominal compartment syndrome. A high level of suspicion is needed for early detection, and immediate decompression is required to prevent death. Elsevier 2021-01-07 /pmc/articles/PMC7811029/ /pubmed/33489748 http://dx.doi.org/10.1016/j.rmcr.2021.101341 Text en © 2021 The Authors. Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Case Report Po, Pien-Lung Bai, Hsueh-Fen Lin, Chia-Heng Lin, Chen-Chun Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title | Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title_full | Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title_fullStr | Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title_full_unstemmed | Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title_short | Pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: A case report |
title_sort | pneumomediastinum that progression to tension pneumoperitoneum after bronchioloalveolar lavage: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811029/ https://www.ncbi.nlm.nih.gov/pubmed/33489748 http://dx.doi.org/10.1016/j.rmcr.2021.101341 |
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