Category of the manuscript: Clinical Images
Title: Pneumoretroperitoneum secondary to pneumomediastinum in a child
with coronavirus disease-2019
Masashi Taniguchi, M.D.1, Masanori Nishikawa, M.D.
PhD2, Yu Inata, M.D.1, Noboru
Matsumoto, M.D.3, Wakako Ichida,
M.D.2, Tomoki Nishikido, M.D.3, and
Muneyuki Takeuchi, M.D. PhD1
- Department of Intensive Care Medicine, Osaka Women’s and Children’s
Hospital, Osaka, Japan.
- Department of Radiology, Osaka Women’s and Children’s Hospital, Osaka,
Japan.
- Department of Pediatric Pulmonology and Allergy, Osaka Women’s and
Children’s Hospital, Osaka, Japan.
Corresponding Author: Masashi Taniguchi, M.D
Department of Intensive Care Medicine, Osaka Women’s and Children’s
Hospital,
840, Murodo-cho, Izumi, Osaka, Japan
Email: masatani@wch.opho.jp
Telephone number: +81-725-56-1220
Fax number: +81-725-56-5682
Funding: None of the authors received an honorarium, grant, or other
forms of payment to produce this manuscript.
Conflicts of Interest: The authors declare no conflicts of interest.
Key Clinical Message
Pneumomediastinum is a known complication of mechanical ventilation.
Pneumoretroperitoneum secondary to pneumomediastinum is rare but could
occur in mechanically ventilated patients.
Abstract
Pneumomediastinum is a known complication of mechanical ventilation.
Infrequently, it secondarily arises from pneumoperitoneum or
pneumoretroperitoneum, when air travels along the fascial planes to
enter the mediastinum. Conversely, pneumoretroperitoneum secondary to
pneumomediastinum is even rare but could occur in mechanically
ventilated patients.
1 Case Presentation
A 3-year-old boy with metatropic dysplasia under home ventilation via
tracheostomy was admitted to the pediatric intensive care unit for
severe coronavirus disease-2019 pneumonia. He underwent mechanical
ventilation in the lateral decubitus position due to severe
kyphoscoliosis and a narrow thorax. On day 10, pneumonia exacerbation
was documented by computed tomography scan findings of diffuse
ground-glass opacities. A follow-up computed tomography scan on day 14
showed continuous pneumoretroperitoneum (Fig. 1) from the
pneumomediastinum (Fig. 2). There were no pathological findings in the
abdomen that explained the presence of air in the retroperitoneal space.
Air travels through the anatomical fascial surface to other
compartments. Several rare cases of pneumomediastinum secondary to
pneumoperitoneum or pneumoretroperitoneum have been reported1. Pneumoretroperitoneum attributed to
pneumomediastinum is less frequently observed 2. This
is the first report of pneumoretroperitoneum arising from
pneumomediastinum in a patient with coronavirus disease-2019. In this
case, postural changes and positive pressure ventilation likely
contributed to the movement of air from the mediastinum into the
retroperitoneal space.
Author Contributions
Masashi Taniguchi: wrote the first draft of the manuscript. Each author
listed on the manuscript: has seen and approved the submission of this
version of the manuscript and takes full responsibility for the
manuscript.
References
[1] Elmoheen A, Haddad M, Bashir K, Salem WA. Subcutaneous
emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum after
upper gastrointestinal endoscopy. BMJ Case Rep. 2020;13:e236369.
[2] Kim JB, Jung HJ, Lee JM, Im KS, Kim DJ. Barotrauma developed
during intra-hospital transfer -a case report-. Korean J
Anesthesiol. 2010; 59 (Suppl.):S218–21.