Thyroid cartilage fracture following sneezing as a cause of spontaneous pneumomediastinum

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OBJECTIVE

To evaluate the possible etiological factors of spontaneous pneumomediastinum and to describe a case that was unusual in its etiology: a thyroid cartilage fracture as a result of sneezing.

MATERIAL AND METHODS

Six patients (four male, two female, aged 16—82 years) were hospitalized with spontaneous pneumomediastinum diagnosed with a chest X-ray in five patients and 100% with computed tomography. Treatment was symptomatic.

RESULTS

The commonest symptoms (cough, shortness of breath, hoarseness) were in four patients. Spontaneous pneumomediastinum developed in three cases as a result of bronchospasm during an attack of bronchial asthma, in one patient after exercise, in one after fibrogastroscopy, in one after sneezing. We report a 30-year-old man who presenting subcutaneous emphysema on the neck, hoarseness, pain when swallowing, hemoptysis developed after sneezing. His computed tomography revealed a pneumomediastinum due to fistula of the fracture of the thyroid cartilage following sneezing while simultaneously obstructing both nostrils. At laryngoscopy, there was a linear hematoma in the resolution stage on the anterior wall of the larynx. He was treated conservatively and recovered rapidly. There are no previous published reports of spontaneous pneumomediastinum following fracture of the thyroid cartilage.

CONCLUSION

Fracture of the thyroid cartilage as a result of a sharp rapid increase in airway pressure during a sneeze with blocked nasal passages can be one of the rare causes of spontaneous pneumomediastinum. Avoid closing both nostrils at the same time when sneezing.

Keywords:

spontaneous pneumomediastinum

spontaneous mediastinal emphysema

computed tomography

thyroid cartilage fracture

sneezing

Authors:

Plaksin S.A.

Vagner Perm State Medical University

ORCID: 0000-0001-8108-1655

Petrov M.E.

Perm Krai Clinical hospital

ORCID: 0009-0004-5212-5005

Received:

02.09.2023

Accepted:

22.10.2023

List of references:

Pogodina AN, Voskresensky OV, Nikolaeva EB, Barmina TG, Parshin VV. Modern approaches to the treatment of spontaneous pneumothorax and spontaneous mediastinal emphysema. Atmosphere. Pulmonology and Allergology. 2011;1:45-51. (In Russ.).
Polyantsev AA, Panin SI, Polyantsev (Jr) AA, Kotrunov VV. Pneumomediastinum in patients with coronavirus infection (COVID-19). Khirurgiya. Zhurnal im. N.I. Pirogova. 2021;5:20-24. (In Russ.). https://doi.org/10.17116/hirurgia202105120
Abakumov MM, Shamba HL. Spontaneous mediastinal emphysema (clinic, diagnosis, treatment). Practical guide. M.: Research Institute of Emergency Medicine named after N.V. Sklifosovsky; 2015. (In Russ.).
Erel F, Güngör C, Sarıoğlu N, Aksu GD, Turan G, Demirpolat G. Spontaneous pneumomediastinum and subcutaneous emphysema secondary to pulmonary alveolar microlithiasis. Tüberküloz ve Toraks. 2021;69(3):416-420. https://doi.org/10.5578/tt.20219716
Kobashi Y, Okimoto N, Matsushima T, Soejima R. Comparative study of mediastinal emphysema as determined by etiology. Internal Medicine. 2002;41(4):277-282. https://doi.org/10.2169/internalmedicine.41.277
Alemu BN, Yeheyis ET, Tiruneh AG. Spontaneous primary pneumomediastinum: is it always benign? BMJ Medical Case Reports. 2021;15(1):157. https://doi.org/10.1186/s13256-021-02701-z
Law ST, Wong KC, Tse CF. Cervical subcutaneous emphysema and pneumomediastinum after sneezing. Hong Kong Medical Journal. 2013;19(2):188.e3-4.
Romanov MD, Kireeva EM, Levina TM. Features of the diagnosis of spontaneous mediastinal emphysema. Tuberculosis and lung diseases. 2021;99(6):49-53. (In Russ.). https://doi.org/10.21292/2075-1230-2021-99-6-49-53
Semkovych Ya, Semkovych M, Synoverska O, Vovk Z, Kuzenko O. A case of spontaneous pneumomediastinum and tension pneumothorax in a pediatric patient after elective dental procedure. Pediatrics. Eastern Europe. 2022;10(1):168-174.
Gasser CR, Pellaton R, Rochat CP. Pediatric spontaneous Pneumomediastinum: Narrative Literature Review. Pediatric Emergency Care. 2017;33(5):370-374. https://doi.org/10.1097/PEC.0000000000000625
Pimenta I, Varudo R, Lança S, Gonzalez FA. Exuberant spontaneous pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema in COVID-19 pneumonia. BMJ Case Reports. 2021;14(5):e243861. https://doi.org/10.1136/bcr-2021-243861
Mangel TP, Madden BP. Acute tracheal tear — A potential cause of spontaneous pneumomediastinum in patients with COVID-19. Monaldi Archives for Chest Disease. 2021;91(2). https://doi.org/10.4081/monaldi.2021.1852
Akkas M, Tiambeng C, Aksu NM, Onur R. Tracheal rupture as a result of coughing. The American Journal of Emergency Medicine. 2018;36(11):2133.e1-2133.e3. https://doi.org/10.1016/j.ajem.2018.08.027
Weissberg D, Weissberg D. Spontaneous mediastinal emphisema. European Journal of Cardio-Thoracic Surgery. 2004;26(5):885-888. https://doi.org/10.1016/j.ejcts.2004.05.050
Chidambaram A, Donekal S. Spontaneous pneumomediastinum and subcutaneous emphysema in a child with unknown aetiology. BMJ Case Reports. 2019;12(2):e226805. https://doi.org/10.1136/bcr-2018-226805
Kelly S, Hughes S, Nixon S, Paterson-Brown S. Spontaneuos pneumomediastinum (Hamman’s syndrome). Surgeon. 2010;8(2):63-66. https://doi.org/10.1016/j.surge.2009.10.007
Dougherty D, Meyer KM, Thompson AR, Speck KE. Pediatric pneumomediastinum: Symptom-based management. Journal of Pediatric Surgery. 2023;58(3):427-431. https://doi.org/10.1016/j.jpedsurg.2022.10.016
Takada K, Matsumoto S, Hiramatsu T, Kojima E, Shizu M, Okachi S, Ninomiya K, Morioka H. Spontaneous pneumomediastinum: an algorithm for diagnosis and management. Therapeutic Advances in Respiratory Disease. 2009;3(6):301-307. https://doi.org/10.1177/1753465809350888
Deshmukh A, Archana MP, Baalamurugan KT, Venugopal DR, Suresh MK. Pneumopericardium, pneumomediastinum and surgical emphysema emphysema in spontaneous pneumothorax. The National Medical Journal of India. 2022;35(1):17-18. https://doi.org/10.25259/NMJI_363_19
Kyung SK, Heurtebise F, Godon A, Rivière MF, Coatrieux A. Head-neck and mediastinal emphysema caused by playing a wind instrument. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2010;127(6):221-223. https://doi.org/10.1016/j.anorl.2010.10.002
Morvan JB, Veyrières JB, Mimouni O, Maugey N, Cathelinaud O, Verdalle P. Perforation of the piriform sinus after sneezing with cervical subcutaneous emphysema and pneumomediastinum. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2011;128(3):147-149. https://doi.org/10.1016/j.anorl.2010.12.006

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