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Published on: November 29, 2024
Mediastinal emphysema complicating diabetic ketoacidosis: plea for conservative diagnostic approach
R G Pauw1, T S van der Werf, H M van Dullemen
1Department of Internal Medicine, Division of Pulmonary Medicine & Tuberculosis, University Medical Centre Groningen, University of Groningen, the Netherlands.
Background:
Spontaneous pneumomediastinum has been infrequently reported as a complication of diabetic ketoacidosis. Evidence-based guidelines are currently not available to help in choosing the best diagnostic approach.
Methods:
We conducted a systematic review of the literature and looked for diagnostic clues that might indicate the need for a work-up to rule out oesophageal perforation.
Results:
In all 56 published cases of spontaneous pneumomediastinum associated with diabetic ketoacidosis, the condition was self-limiting. We report one additional case of a 31-year-old female who presented with a spontaneous pneumomediastinum and also epidural pneumatosis, complicating diabetic ketoacidosis.
Conclusion:
Important pathology, such as oesophageal rupture, was not detected in any of the reported cases, and we suggest a restrictive diagnostic work-up.
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