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Massive subcutaneous emphysema, pneumomediastinum, and pneumopericardium in children

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Abstract

Massive subcutaneous emphysema (SE), pneumomediastinum (PM), and pneumopericardium (PP) are rare conditions in the pediatric population. Air leak syndrome is a constellation of disorders that include SE, PM, PP, and pulmonary interstitial emphysema. In children, SE, PM, and PP are associated with obstructive airway disease most often in the case of asthma. Management may be conservative or involve invasive procedures that require surgical intervention. Here, we describe a case of massive SE, PM, and PP in a 10-year-old child after placement of a peripherally inserted central line and review the literature.

Section snippets

Case report

A 10-year-old female was referred to our service for resection of an abdominal tumor in the setting of multiple systemic and constitutional symptoms. She initially presented with a 7-month history of shortness of breath and malaise. On initial physical examination, there was a Cushingoid appearance, ulceration of the buccal mucosa, blistering of the lips, respiratory crackles, and of the fingernails. Chest x-ray showed bilateral hyperinflation of her lungs. Computed tomographic (CT) angiography

Discussion

Subcutaneous emphysema associated with PM and PP is a rare condition in pediatric medicine. There is a peak of incidence within the first 3 to 4 years of life because of respiratory tract infections. The incidence has been reported to be variable, around 1 in 20,000 patients presenting to the emergency department with an asthma attack. Obstructive pulmonary disease is associated with SE in 35% of the cases.

These disorders can be classified as acquired or spontaneous. Acquired SE is the direct

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