Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Po, Pien-Lung, Bai, Hsueh-Fen, Lin, Chia-Heng, Lin, Chen-Chun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
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
_version_ 1783637424537075712
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
work_keys_str_mv AT popienlung pneumomediastinumthatprogressiontotensionpneumoperitoneumafterbronchioloalveolarlavageacasereport
AT baihsuehfen pneumomediastinumthatprogressiontotensionpneumoperitoneumafterbronchioloalveolarlavageacasereport
AT linchiaheng pneumomediastinumthatprogressiontotensionpneumoperitoneumafterbronchioloalveolarlavageacasereport
AT linchenchun pneumomediastinumthatprogressiontotensionpneumoperitoneumafterbronchioloalveolarlavageacasereport