Pneumomediastinum and Subcutaneous Emphysema Complicating Acute Exacerbation of Bronchial Asthma

Akinyemi RO1, Ogah OS1, Akisanya CO2, Timeyin AO1, Akande KO1, Durodola A1, Ogundipe RF1, Osinfade JK1. 

  1. Dept. of Medicine
  2. Dept. of Radiology (FMC, Abeokuta)

Introduction

Pneumomediastinum otherwise known as mediastinal emphysema refers to the presence of air within the mediastinum while subcutaneous emphysema refers to the presence of air in the subcutaneous tissue and this may involve the face, neck or trunk[1]. The term, pneumomediastinum, was introduced into medical literature by Hamman in 1939[2]. Both conditions are relatively uncommon but important complications of bronchial asthma. The first definitive case of asthma complicated by subcutaneous emphysema was reported in a child in 1850 even though Laennec, as early as 1819, had recognized symptoms and signs of subcutaneous emphysema[3]. Extravasations of air in extra-pulmonary tissues may also manifest as pneumopericardium or pneumothorax and may as well complicate, apart from asthma, perforation or rupture of oesophagus (Boerhaaves syndrome), rupture of trachea or main bronchi, or conditions resulting in raised intrathoracic pressure [valsalva manouvre as in vaginal delivery, weight lifting, vomiting, strenuous exercise], following paraquat intoxication, dental procedures, blunt or penetrating trauma or soft tissue infection. It may also complicate gastrointestinal instrumentation such as endoscopy, colonoscopy and laparoscopic surgery[4].

We present an index case of pneumomediastinum and subcutaneous emphysema complicating an acute exacerbation of asthma in a young male Nigerian in order to sensitize clinicians about the occurrence of this rare complication of bronchial asthma in our environment. The pathophysiologic mechanisms and treatment approach are also reviewed in the light of current literature.

Case Report

A 21 year old male Nigerian student and a known asthmatic presented to the Emergency Department of Federal Medical Centre, Abeokuta, south-western Nigeria with a 10 hour history of cough productive of whitish sputum, increasing difficulty with breathing, wheezing and neck pain. He was diagnosed asthmatic at the age of eleven and had been admitted on a few occasions for acute exacerbations in the prior ten years. He had salbutamol tablets regularly.

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