PDF(Pubmed)
Abstract：
Hamman syndrome is defined as dissection of air in mediastinum and skin fascia usually due to increased intrathoracic pressure. The air leak tends to make its way into pleural and pericardial layers; however, in rare instances air can also dissect into epidural spaces, regarded as pneumorrhachis. We present a case of a young male with a history of polysubstance abuse and e-vaping, who presented with symptoms of altered mental status. Given the concerning physical examination, a computed tomography of the chest was undertaken, which showed pneumothorax, pneumomediastinum and pneumorrhachis. The patient was closely monitored in the intensive care unit and improved after symptomatic management. The symptoms of pneumorrhachis depend on the volume and location of air in intracranial and intraspinal space. Although asymptomatic in our case, it is crucial for clinicians to be aware that pneumorrhachis with Hamman syndrome can potentially cause neurological deficits and cardiopulmonary arrest in severe cases due to increased intraspinal and intracranial hypertension, emphasising the need for close monitoring.
CONCLUSIONS: Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.
CONCLUSIONS: Elevated intrathoracic pressure generated by deep inhalation of an aerosolised product is one of the triggers of air dissection in pleural, pericardial, and mediastinal regions. In rare instances, air can also translocate into intracranial and intraspinal spaces, which is referred to as pneumorrhachis.Mostly asymptomatic, pneumorrhachis has the potential to develop acute neurological deficits due to increased intracranial and intraspinal pressure, validating the need for acute monitoring.Most cases of pneumorrhachis are managed conservatively. However, severe cases warrant decompression or high concentrations of oxygen administration to facilitate air absorption.
摘要：
Hamman综合征被定义为纵隔和皮肤筋膜中的空气夹层，通常是由于胸内压升高。漏气倾向于进入胸膜层和心包层；然而，在极少数情况下，空气也可以解剖进入硬膜外腔，被认为是肺出血。我们介绍了一个年轻男性的案例，有多物质滥用和电子烟的历史，出现精神状态改变的症状.考虑到体检，对胸部进行了计算机断层扫描，显示气胸，纵隔肺炎和肺出血。在重症监护病房密切监测患者，并在对症处理后好转。肺出血的症状取决于颅内和椎管内空气的体积和位置。虽然在我们的案例中没有症状,对于临床医生来说，至关重要的是要意识到，在严重的情况下，由于椎管内和颅内高压增加，合并哈曼综合征的肺出血可能会导致神经功能缺损和心肺骤停。强调密切监测的必要性。
结论：深度吸入雾化产品产生的胸内压升高是胸膜空气夹层的触发因素之一，心包,和纵隔区域。在极少数情况下,空气也可以转移到颅内和椎管内，这就是所谓的肺出血。大部分无症状，由于颅内和椎管内压力升高，肺出血有可能发展为急性神经功能缺损，验证急性监测的必要性。大多数肺出血病例都是保守治疗。然而,严重病例需要减压或高浓度氧气，以促进空气吸收。
结论：深度吸入雾化产品产生的胸内压升高是胸膜空气夹层的触发因素之一，心包,和纵隔区域。在极少数情况下,空气也可以转移到颅内和椎管内，这就是所谓的肺出血。大部分无症状，由于颅内和椎管内压力升高，肺出血有可能发展为急性神经功能缺损，验证急性监测的必要性。大多数肺出血病例都是保守治疗。然而,严重病例需要减压或高浓度氧气，以促进空气吸收。
