Eur J Pediatr Surg 2013; 23(03): 249-250
DOI: 10.1055/s-0032-1313341
Case Gallery
Georg Thieme Verlag KG Stuttgart · New York

Epidural Air in Child with Spontaneous Pneumomediastinum

Sandra Tomita
1   Department of Surgery, New York University Medical Center, New York, New York, United States
,
Rafael Rivera
2   Department of Radiology, New York University Medical Center, New York, New York, United States
,
Keith Kuenzler
2   Department of Radiology, New York University Medical Center, New York, New York, United States
,
Howard Ginsburg
2   Department of Radiology, New York University Medical Center, New York, New York, United States
› Author Affiliations
Further Information

Publication History

20 December 2011

13 March 2012

Publication Date:
30 May 2012 (online)

Case Report

A 3-year-old boy was seen in the emergency room after his mother noted neck swelling, drooling, and dysphonia. This occurred after a brief coughing episode and one episode of vomiting. Although he was never diagnosed with asthma, the patient had a history of severe paroxysms of coughing. On examination, he had palpable subcutaneous emphysema of the neck, upper chest, and upper back. There were bilateral rhonchi (low pitched, snore-like sounds) on lung examination. He had no neurologic deficits. A chest X-ray showed significant subcutaneous emphysema of the soft tissues of the neck and chest. A neck and chest computed tomography (CT) scan ([Figs. 1] and [2]) showed severe pneumomediastinum with extensive subcutaneous emphysema tracking along the fascial planes of the neck, supraclavicular regions, right upper extremity, anterior chest wall, and epidural space. He underwent an esophagram which was negative for perforation. He was observed in the hospital for a day and discharged to home the next day. During this hospitalization he was diagnosed with asthma and is currently being treated for such.

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Fig. 1 Computed tomography scan (transverse view) at level of upper chest showing subcutaneous air, pneumomediastinum, and epidural air (arrow).
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Fig. 2 Computed tomography scan of chest and neck (sagittal view) showing epidural air (arrow).
 
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