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Air All in the Wrong Places: A Case of Pneumorrhachis Secondary to Chronic Vomiting
Nicholas R Rotsching1, Jay Mathias1, Marc Gutierrez1,2
1Internal Medicine, Wright State University, Dayton, USA.
Abstract:
Pneumorrhachis (PR) is a rare phenomenon in which air is present in the spinal canal. PR can be stratified into different categories based on etiology, with spontaneous PR being the least common. In this report, we describe the case of a 33-year-old male with a four-year history of emesis secondary to chronic gastroparesis who presented with pleuritic chest pain radiating to the neck. A CT scan of the chest showed pneumomediastinum, with air extending into the soft tissues of the neck and the spinal canal. A literature review found a trend between maneuvers that increase intrathoracic pressure, such as emesis or coughing, and the incidence of spontaneous pneumomediastinum, in which air may freely communicate with the epidural space of the spinal canal. Currently, there are no guidelines for the management of patients with PR. From our experience, conservative management of asymptomatic PR is an appropriate approach for these patients.
Insights
Pneumorrhachis, or air in the spinal canal, is rare. Spontaneous pneumorrhachis can occur after increased intrathoracic pressure events like vomiting, suggesting conservative management for asymptomatic cases.
Area of Science:
- Medical Case Reports
- Thoracic Surgery
- Spinal Imaging
Background:
- Pneumorrhachis (PR) is a rare condition characterized by air within the spinal canal.
- Spontaneous PR, often linked to increased intrathoracic pressure, is the least common form.
- No established management guidelines exist for PR.
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