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Pneumomediastinum and pneumoretroperitoneum
R S Crausman1, E M Klinge, C Irvin
1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, USA.
The American Journal of Emergency Medicine
|May 1, 1995
Summary
Prolonged fasting can cause extensive subcutaneous emphysema and severe dehydration. However, findings like pneumomediastinum without pneumothorax are usually benign and do not warrant hospitalization.
Area of Science:
- Internal Medicine
- Radiology
- Gastroenterology
Background:
- Prolonged fasting, often for religious reasons, can lead to severe dehydration and electrolyte imbalances.
- Subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum are potential complications that may arise.
- These radiological findings can be alarming and necessitate careful evaluation.
Observation:
- A 23-year-old male presented with extensive subcutaneous emphysema and severe dehydration following a prolonged religious fast.
- Chest radiography revealed significant pneumomediastinum and pneumoretroperitoneum.
- Importantly, no pneumothorax was identified on imaging.
Findings:
- The case highlights pneumomediastinum as a common finding in patients presenting with severe dehydration after fasting.
- Pneumoretroperitoneum was also noted, suggesting air dissection along fascial planes.
- The absence of pneumothorax is a critical distinguishing feature.
Implications:
- Recognition of these findings in the context of fasting-induced dehydration is crucial for appropriate patient management.
- Hospital admission for close observation may not always be necessary for pneumomediastinum without pneumothorax.
- This case underscores the generally benign nature of spontaneous pneumomediastinum in this clinical scenario.