Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomed...Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past <span>histories. He abruptly had cough, fever, and eruption on the abdomen.</span> Computed tomography and echocardiography revealed pneumomediastinum and <span>pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated</span> the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema.</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">The infant</span></span></span><span><span><span style="font-family:"">’</span></span></span><span><span><span style="font-family:"">s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy</span></span></span><span><span><span style="font-family:"">.展开更多
Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can ...Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can lead to devastating injuries.Patient's concern:A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus.There was diffuse subcutaneous emphysema over the neck,chest,abdomen,and extremities,and he presented with hemodynamic instability and respiratory failure.Diagnosis:Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum,pneumomediastinum,pneumothorax,and extensive subcutaneous emphysema.Intervention:In view of tension pneumoperitoneum,urgent percutaneous needle decompression was performed using 16 G needle,5 cm superomedial to the anterior superior iliac spine.The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics.Outcome:The patient succumbed two days later due to septic shock.Lessons:This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.展开更多
Background:Due to airway remodeling and emphysematous destruction in the lung,the two classical clinical phenotypes of chronic obstructive pulmonary disease(COPD)are emphysema and bronchiolitis.The present study was d...Background:Due to airway remodeling and emphysematous destruction in the lung,the two classical clinical phenotypes of chronic obstructive pulmonary disease(COPD)are emphysema and bronchiolitis.The present study was designed to investigate the levels of small airway immunoglobulin A(IgA)in COPD with“emphysema phenotype.”The study also evaluated the associations between the small airway IgA levels and the severity of disease by the extent of emphysema versus airflow limitation.Methods:Thirty patients(20 with COPD and ten healthy smokers)undergoing lung resection surgery for a solitary peripheral nodule were included.The study was conducted from January 2015 to December 2018 in the Shanxi Dayi Hospital.The presence of small airway IgA expression was determined in the lung by immunohistochemistry.In vivo,Wistar rats were exposed to silica by intratracheal instillation.Rats were sacrificed at 15 and 30 days after exposure of silica(n=10 for each group).We also evaluated airway IgA from rats.Results:Small airway secretory IgA(sIgA),dimeric IgA(dIgA),and dIgA/sIgA of Global Initiative for Chronic Obstructive Lung Disease grade 1–2 COPD patients showed no difference compared with smoking control subjects(5.15±1.53 vs.6.03±0.85;1.94±0.66 vs.1.67±0.04;41.69±21.02 vs.28.44±9.45,all P>0.05).dIgA/sIgA level in the lung of COPD patients with emphysema showed higher levels than that of COPD patients without emphysema(51.89±24.81 vs.31.49±9.28,P=0.03).The percentage of low-attenuation area below 950 Hounsfield units was positively correlated with dIgA/sIgA levels(r=0.45,P=0.047),but not associated with the severity of disease by spirometric measurements(forced expiratory volume in the first second%pred,P>0.05).Likewise,in the rat study,significant differences in sIgA,dIgA,dIgA/sIgA,mean linear intercept,mean alveoli number,and mean airwaythickness of bronchioles(VVairway,allP<0.01)were only observed between control rats and those exposed for 30 days.However,in the group exposed for 15 days,although theVVairwaywas 展开更多
文摘Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past <span>histories. He abruptly had cough, fever, and eruption on the abdomen.</span> Computed tomography and echocardiography revealed pneumomediastinum and <span>pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated</span> the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema.</span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">The infant</span></span></span><span><span><span style="font-family:"">’</span></span></span><span><span><span style="font-family:"">s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy</span></span></span><span><span><span style="font-family:"">.
文摘Rationale:Colonic barotrauma induced by high-pressure air compressors has been reported more frequently these days due to the widespread use of air compressors in industries.Such enormous pressure into the rectum can lead to devastating injuries.Patient's concern:A 35-year-old male was referred to our emergency department with an alleged history of directing high pressure compressed air jet towards the anus.There was diffuse subcutaneous emphysema over the neck,chest,abdomen,and extremities,and he presented with hemodynamic instability and respiratory failure.Diagnosis:Rectosigmoid perforation due to exposure to high-pressure air jet causing tension pneumoperitoneum,pneumomediastinum,pneumothorax,and extensive subcutaneous emphysema.Intervention:In view of tension pneumoperitoneum,urgent percutaneous needle decompression was performed using 16 G needle,5 cm superomedial to the anterior superior iliac spine.The gush of air was released along with reduction in abdominal distension and improvement in hemodynamics.Outcome:The patient succumbed two days later due to septic shock.Lessons:This case highlighted the importance of promoting education about work safety among industrial workers especially in developing countries like India.
文摘Background:Due to airway remodeling and emphysematous destruction in the lung,the two classical clinical phenotypes of chronic obstructive pulmonary disease(COPD)are emphysema and bronchiolitis.The present study was designed to investigate the levels of small airway immunoglobulin A(IgA)in COPD with“emphysema phenotype.”The study also evaluated the associations between the small airway IgA levels and the severity of disease by the extent of emphysema versus airflow limitation.Methods:Thirty patients(20 with COPD and ten healthy smokers)undergoing lung resection surgery for a solitary peripheral nodule were included.The study was conducted from January 2015 to December 2018 in the Shanxi Dayi Hospital.The presence of small airway IgA expression was determined in the lung by immunohistochemistry.In vivo,Wistar rats were exposed to silica by intratracheal instillation.Rats were sacrificed at 15 and 30 days after exposure of silica(n=10 for each group).We also evaluated airway IgA from rats.Results:Small airway secretory IgA(sIgA),dimeric IgA(dIgA),and dIgA/sIgA of Global Initiative for Chronic Obstructive Lung Disease grade 1–2 COPD patients showed no difference compared with smoking control subjects(5.15±1.53 vs.6.03±0.85;1.94±0.66 vs.1.67±0.04;41.69±21.02 vs.28.44±9.45,all P>0.05).dIgA/sIgA level in the lung of COPD patients with emphysema showed higher levels than that of COPD patients without emphysema(51.89±24.81 vs.31.49±9.28,P=0.03).The percentage of low-attenuation area below 950 Hounsfield units was positively correlated with dIgA/sIgA levels(r=0.45,P=0.047),but not associated with the severity of disease by spirometric measurements(forced expiratory volume in the first second%pred,P>0.05).Likewise,in the rat study,significant differences in sIgA,dIgA,dIgA/sIgA,mean linear intercept,mean alveoli number,and mean airwaythickness of bronchioles(VVairway,allP<0.01)were only observed between control rats and those exposed for 30 days.However,in the group exposed for 15 days,although theVVairwaywas