The spontaneous pneumopyopericardium simultaneously masquerading as acute myocardial infarction and surgical abdomen: a case report Weiping Zhang, Xiaojun Bai, Xiaolin Xue
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.012
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: June 13 2014
x Pneumopyopericardium is a rare disease, presenting clinically as a spectrum of acute myocardial infarction or severe surgical abdomen, which includes various symptoms and changes in cardiac enzymes and electrocardiogram. Here, we report a case of pneumopyopericardium in a 61-year-old male farmer in China. An early diagnosis of pneumopyopericardium was difficult due to his acute myocardial infarction– and severe surgical abdomen–like symptoms and signs. The electrocardiogram, esophagogram, and chest computed tomographic scan commonly revealed pericardial fluid and air and excluded a gastrointestinal perforation in late stage of severe inflammation.
Luxatio cordis—surgical treatment followed by venovenous extracorporal membrane oxygenation F. Rademacher, J. Reichert, T.A. Schildhauer, J. Swol
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.008
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x We report about a 54-year-old male patient who was involved in a motorcycle accident. On day 15 after trauma, a tension pneumothorax was suspected based on radiography because of the right-side shift of the heart. A computer tomographic scan detected a pneumothorax on the left side and pneumopericardium. A chest drain was inserted on the left side. The postinterventional radiograph showed a further dislocation of the heart to the right side. The diagnosis of luxatio cordis was suspected. The patient was taken into the operating theater in a hemodynamic stable state.
Esophageal rupture diagnosed with bedside ultrasound Charlotte Derr, Jessica Maloney Drake
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.036
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 2 2012
x A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows suggested a diagnosis of pneumopericardium. Based upon the patient's presenting symptoms and ultrasound findings, an esophageal perforation was suspected.
Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain David M. Drossner, Daniel A. Hirsh, Jesse J. Sturm, William T. Mahle, David J. Goo, Robert Massey, Harold K. Simon
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.011
The American Journal of Emergency Medicine , Vol. 29 , Issue 6 ,
Published online: July 14 2010
x Chest pain is a frequent chief complaint among the pediatric population. To date, limited data exist on the full spectrum of emergent cardiac disease among such patients; and existing data have been limited to relatively small cohorts.
Sonographic evidence of spontaneous pneumomediastinum Lorraine Ng, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Spontaneous pneumomediastinum (SPM) is defined as a non-traumatic air leak from alveolar, bronchial or esophageal rupture along vascular sheaths and tissue planes into the mediastinum due to increased pressure in the trachea, bronchi, alveoli or esophagus [1]. SPM is rare in children, with a bimodal incidence peaking in children less than 7 years of age and then again in adolescence [1]. Historically, the diagnosis of SPM is made with physical examination findings and chest radiography.
Pneumomediastinum caused by isolated oral-facial trauma Gerard DeMers, Jacob L. Camp, Donald Bennett
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.022
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: August 16 2010
x Pneumomediastinum from isolated blunt or penetrating oral-facial trauma is a rare occurrence, which can be associated with facial fractures or may be iatrogenic. We present two cases caused by high-pressure-induced facial injuries that had very different management and outcomes. The first patient had asymptomatic pneumomediastinum and an uncomplicated recovery, whereas the second had a complicated clinical course requiring extensive surgical debridement. Neither patient developed mediastinitis as a complication of pneumomediastinum.
Posttraumatic tension pneumopericardium L Hernández-Luyando, E.González De Las Heras, J Calvo, C López, H De La Puente
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90186-8
The American Journal of Emergency Medicine , Vol. 15 , Issue 7 ,
Published in issue: November 1997
Simple pneumopericardium due to blunt trauma progressing to tension pneumopericardium during transportation Sho Nachi, Hideshi Okada, Hisaaki Kato, Kodai Suzuki, Shiho Nakano, Takahiro Yoshida, Shozo Yoshida, Hiroaki Ushikoshi, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.028
The American Journal of Emergency Medicine , Vol. 34 , Issue 5 ,
Published online: September 19 2015
x Patients with simple pneumopericardium due to blunt thoracic trauma occasionally progressed to tension pneumopericardium, although pneumopericardium is believed to be benign in general. A 65-year-old man had both arms caught in a grinding machine and his face struck hard at work. He was diagnosed with bilateral degloving injuries of both arms and mediastinal emphysema on computed tomography. He required transfer to an advanced emergency medical service center for treatment. Although he was hemodynamically stable then, the patient's condition deteriorated during transportation.
Pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents Roland Ladurner, Lars M. Qvick, Felix Hohenbleicher, Klaus K. Hallfeldt, Wolf Mutschler, Thomas Mussack
DOI: http://dx.doi.org/10.1016/j.ajem.2004.01.003
The American Journal of Emergency Medicine , Vol. 23 , Issue 1 ,
Published in issue: January 2005
x Pneumopericardium is the presence of air in the pericardial space. In adults, it may be seen in the context with severe blunt chest trauma, pneumothorax, pneumoperitoneum, or other causes of pneumomediastinum. The diagnosis is made by computed tomography scan of the thorax and abdomen that allows the additional detection of concomitant injuries. Possible causes of the pneumopericardium such as tracheobronchial or oesophageal tears have to be excluded by bronchoscopy or esophagogastroduodenoscopy.
Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection Mark K. Markarian, David A. MacIntyre, Benjamin J. Cousins, Alexander Malone, John J. Fildes
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.008
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
x A 15 year old male was an unrestrained passenger in a high speed motor vehicle crash followed by ejection. The patient was noted to have evidence of bilateral pneumothorax upon arrival in the Emergency Department. Bilateral chest tubes were placed under sterile conditions; however, the left pneumothorax remained, and a second left chest tube was placed. Repeat chest radiographs revealed extensive subcutaneous emphysema, pneumomediastinum, and pneumopericardium. Needle aspiration of the pericardium returned significant quantities of air, an immediate improvement in blood pressures followed.
Spontaneous pyopneumopericardium Emile N El-Shammaa, Daniel R Martin
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90116-X
The American Journal of Emergency Medicine , Vol. 17 , Issue 3 ,
Published in issue: May 1999
x A previously healthy 42-year-old man presented to the emergency department with progressive weakness, lightheadedness, nausea, and lower extremity edema. Evaluation revealed hypotension, pulsus paradoxus, leukocytosis, hepatic and renal dysfunction, and an air-fluid level in the mediastinum. Emergency department ultrasound confirmed the presence of a large pericardial fluid collection. The patient was admitted to the medical intensive care unit with a diagnosis of pyopneumopericardium for emergent pericardiocentesis.
Fifty-year-old female with facial subcutaneous emphysema: a case report Gerald W. Beltran, Mark D. Lopez
DOI: http://dx.doi.org/10.1016/j.ajem.2007.11.002
The American Journal of Emergency Medicine , Vol. 26 , Issue 6 ,
Published in issue: July 2008
x Subcutaneous emphysema in itself is a benign condition. However, when present secondary to trauma, it may indicate a more serious problem. We report a patient with subcutaneous emphysema secondary to trauma sustained during a generalized seizure. It is believed that the source of the air in the tissue was from a minor laceration below and into the patient's nose without any fracture of the underlying bones or sinus involvement.
Transdiaphragmatic repositioning of the heart in the setting of emergency laparotomy after blunt trauma Rainer Gumpert, Sylvia Archan, Veronika Matzi, Freyja-Maria Smolle-Jüttner
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.033
The American Journal of Emergency Medicine , Vol. 27 , Issue 8 ,
Published in issue: October 2009
x Cardiac luxation after blunt trauma is a rare condition that carries a high mortality rate. We report a case of a left pericardial rupture with partial dislocation of the heart into the left pleural cavity and cardiac strangulation in a polytraumatized patient after a severe motor vehicle accident. This case is of special interest because the patient not only had cardiovascular compromise but was also actually in cardiac arrest and being resuscitated when an emergency repositioning of the heart through the diaphragm in the setting of damage control laparotomy restored circulation.
TOC
DOI: http://dx.doi.org/10.1016/S0735-6757(04)00403-6
The American Journal of Emergency Medicine , Vol. 23 , Issue 1 ,
Published in issue: January 2005
Disposition of spontaneous pneumomediastinum Brent A. Smith, Douglas B. Ferguson
DOI: http://dx.doi.org/10.1016/0735-6757(91)90090-7
The American Journal of Emergency Medicine , Vol. 9 , Issue 3 ,
Published in issue: May 1991
x In the evaluation of spontaneous pneumomediastinum, it is important to exclude pathological causes of pneumomediastinum, including Boerhaave's syndrome, which carries a high mortality rate. The literature varies greatly as to the care of patients with presumed spontaneous pneumomediastinum. The authors present an illustrative case of spontaneous pneumomediastinum treated with intravenous antibiotics and intensive care unit (ICU) admission despite a normal esophagram. Spontaneous pneumomediastinum is a benign entity that may not require observation in an ICU, and patients may do as well with close outpatient follow-up.
Pneumomediastinum and pneumoretroperitoneum Robert S Crausman, Eaine M Klinge, Charles Irvin
DOI: http://dx.doi.org/10.1016/0735-6757(95)90207-4
The American Journal of Emergency Medicine , Vol. 13 , Issue 3 ,
Published in issue: May 1995
x A 23-year-old man presented to the emergency department with extensive subcutaneous emphysema and severe dehydration after a prolonged self-imposed religious fast. Chest radiographs showed marked pneumomediastinum and pneumoretroperitoneum without pneumothorax. Patients are often admitted to the hospital for close observation when these findings are recognized, but this caution is generally unwarranted. This case illustrates the common occurrence of the usually benign entity of pneumomediastinum without pneumothorax.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00170-8
The American Journal of Emergency Medicine , Vol. 26 , Issue 4 ,
Published in issue: May 2008
Tracheal rupture complicating emergent endotracheal intubation Chieh-Min Fan, Patrick Chow-In Ko, Kuang-Chao Tsai, Wen-Chun Chiang, Yun-Chung Chang, Wen-Jone Chen, Ang Yuan
DOI: http://dx.doi.org/10.1016/j.ajem.2004.04.012
The American Journal of Emergency Medicine , Vol. 22 , Issue 4 ,
Published in issue: July 2004
x Tracheal rupture is rare in clinical practice. We present 2 female patients with tracheal rupture after emergent endotracheal intubation from different injury mechanisms; penetrating injury of using stylet during intubation in one case and overinflation of cuff of the endotracheal tube under rapid sequence intubation in another. The lesions of rupture could be detected by bronchoscopy and reconstructive 3-dimensional computed tomography. Both cases received surgical repair without complication. In our report, reconstructive 3-dimensional computed tomography scrupulously detected the rupture sites and provided the noninvasive modality for diagnosis.
Acute gastrointestinal manifestations associated with use of crack Antonio E. Muñiz, Timothy Evans
DOI: http://dx.doi.org/10.1053/ajem.2001.20010
The American Journal of Emergency Medicine , Vol. 19 , Issue 1 ,
Published in issue: January 2001
x Crack, the free-base form of cocaine, causes pulmonary, cardiac, obstetric, neurologic, muskuloskeletal, and gastrointestinal complications. As the popularity for crack use increases, it follows that the number of cocaine-related emergency department (ED) visits, hospitalizations, and deaths should increase. We report 3 cases of patients arriving to the ED with acute onset of abdominal pain after smoking crack. These patients required surgical correction of their intestinal perforations. Although the exact pathophysiology of intestinal ischemia is not known, cocaine blocks the reuptake of norepinephrine, which leads to mesenteric vasoconstriction and focal tissue ischemia that may lead to perforation.
Pneumoperitoneum secondary to fallopian coelomic fistula Richard M Sobel, Robert Fulton, Matthew Simons
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90134-1
The American Journal of Emergency Medicine , Vol. 17 , Issue 3 ,
Published in issue: May 1999
