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J Pediatr Intensive Care 2022; 11(02): 168-176
DOI: 10.1055/s-0040-1716857
Case Report

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

Adam Bajinting‡   *
1   Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, United States
,
Adam Lee‡   *
1   Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, United States
,
Abby Lunneen
2   Section of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, United States
,
Colleen M. Fitzpatrick
1   Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, United States
2   Section of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, United States
,
Gustavo A. Villalona
1   Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, United States
2   Section of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri, United States
› Author Affiliations Funding None.
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Abstract

Reports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Keywords

emergency - pneumomediastinum - non-accidental trauma

* Both authors contributed equally.




Publication History

Received: 20 April 2020

Accepted: 16 August 2020

Article published online:
23 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 McHugh TP. Pneumomediastinum following penetrating oral trauma. Pediatr Emerg Care 1997; 13 (03) 211-213
    CrossrefPubMedGoogle Scholar
  • 2 Ostwani W, Novis S, Brady A, Brown DJ, Mohr BA. Case report: neonate with stridor and subcutaneous emphysema as the only signs of physical abuse. Pediatrics 2015; 136 (02) e523-e526
    CrossrefPubMedGoogle Scholar
  • 3 Paul AR, Adamo MA. Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment. Transl Pediatr 2014; 3 (03) 195-207
    PubMedGoogle Scholar
  • 4 Corsini I, Dani C. Clinical management of the neonatal pneumomediastinum. Acta Biomed 2014; 85 (01) 39-41
    PubMedGoogle Scholar
  • 5 Raissaki M, Modatsou E, Hatzidaki E. Spontaneous pneumomediastinum in a term newborn: atypical radiographic and CT appearances. BJR Case Rep 2019; 5 (04) 20180081
    PubMedGoogle Scholar
  • 6 Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr 2008; 167 (04) 415-418
    CrossrefPubMedGoogle Scholar
  • 7 Versteegh FG, Broeders IA. Spontaneous pneumomediastinum in children. Eur J Pediatr 1991; 150 (05) 304-307
    CrossrefPubMedGoogle Scholar
  • 8 Zylak CM, Standen JR, Barnes GR, Zylak CJ. Pneumomediastinum revisited. Radiographics 2000; 20 (04) 1043-1057
    CrossrefPubMedGoogle Scholar
  • 9 Vanden Berghe S, Devlies F, Seynaeve P. The spinnaker-sail sign: neonatal pneumomediastinum. J Belg Soc Radiol 2018; 102 (01) 51
    CrossrefPubMedGoogle Scholar
  • 10 Monteiro R, Paulos L, Agro Jd, Winckler L. Neonatal spontaneous pneumomediastinum and the spinnaker-sail sign. Einstein (Sao Paulo) 2015; 13 (04) 642-643
    CrossrefPubMedGoogle Scholar
  • 11 Rentea RM, St Peter SD. Neonatal and pediatric esophageal perforation. Semin Pediatr Surg 2017; 26 (02) 87-94
    CrossrefPubMedGoogle Scholar
  • 12 Kouritas VK, Papagiannopoulos K, Lazaridis G. et al. Pneumomediastinum. J Thorac Dis 2015; 7 (Suppl. 01) S44-S49
    CrossrefPubMedGoogle Scholar
  • 13 Garey CL, Laituri CA, Kaye AJ. et al. Esophageal perforation in children: a review of one institution's experience. J Surg Res 2010; 164 (01) 13-17
    CrossrefPubMedGoogle Scholar
  • 14 Miller JW, Hart CK, Statile CJ. Oesophageal perforation in a neonate during transoesophageal echocardiography for cardiac surgery. Cardiol Young 2015; 25 (05) 1015-1018
    CrossrefPubMedGoogle Scholar
  • 15 Wennervaldt K, Melchiors J. Risk of perforation using rigid oesophagoscopy in the distal part of oesophagus. Dan Med J 2012; 59 (11) A4528
    PubMedGoogle Scholar
  • 16 Bansal BC, Abramo TJ. Subcutaneous emphysema as an uncommon presentation of child abuse. Am J Emerg Med 1997; 15 (06) 573-575
    CrossrefPubMedGoogle Scholar
  • 17 Ramnarayan P, Qayyum A, Tolley N, Nadel S. Subcutaneous emphysema of the neck in infancy: under-recognized presentation of child abuse. J Laryngol Otol 2004; 118 (06) 468-470
    CrossrefPubMedGoogle Scholar
  • 18 Barrett TG, Debelle GD. Near-fatal aspiration of a child's dummy: design fault or deliberate injury?. J Accid Emerg Med 1995; 12 (02) 154-155
    CrossrefPubMedGoogle Scholar
  • 19 Dolgin SR, Wykoff TW, Kumar NR, Maniglia AJ. Conservative medical management of traumatic pharyngoesophageal perforations. Ann Otol Rhinol Laryngol 1992; 101 (03) 209-215
    CrossrefPubMedGoogle Scholar
  • 20 McDowell HP, Fielding DW. Traumatic perforation of the hypopharynx--an unusual form of abuse. Arch Dis Child 1984; 59 (09) 888-889
    CrossrefPubMedGoogle Scholar