ISSN - 0973-0958

Pediatric Oncall Journal

An Unusual Life Saving Measure 01/09/2014 00:00:00

An Unusual Life Saving Measure

Vinayak Deshmukh, Jayant Wagha, Bhavana Lakhkar.
Department of Pediatrics, JNMC, Sawangi Meghe, Wardha, India.

Dr. Bhavana Lakhkar, Head and Professor of Pediatric department, J.N.M.C. quarters, Sawangi Meghe. Wardha.
Spontaneous pneumopericardium, pneumomediastinum and surgical emphysema are unusual complications of bronchial asthma. We present a case report where we could save life by decompressing cardiac tamponade by wide bore puncture through epigastric approach.
Spontaneous pneumomediastinum, pneumopericardium, surgical emphysema.
Spontaneous pneumomediastinum is rare in children. Most of the literature available is in the form of single case reports. Few retrospective studies on small number of patients are also available.
Case Report
A 4 years old girl came with sudden attack of breathlessness and noisy breathing. She was known asthmatic and was admitted previously for the similar complaints. On examination she had palpable surgical emphysema on the neck and axillary region. Wheezing and respiratory distress was severe. Her heart sounds were feeble on auscultation. Considering the possibility of spontaneous pneumomediastinum and pneumopericardium, x-ray chest was taken immediately which classically showed pneumopericardium and spontaneous pneumomediastinum. After returning from radiology department child suddenly deteriorated, became cyanosed, her pulse were not palpable and heart sounds were not audible. Considering cardiac tamponade, an 18-gauge needle was inserted into the pericardium through epigastric approach. A gush of air came out with little fluid and blood. Her heart sounds immediately became audible and pulse became palpable. Continuous nebulization with adrenaline, steroids and salbutamol; subcutaneous adrenaline, terbutaline along with intravenous aminophylline drip and steroids were immediately administered. Half an hour later her bronchospasm decreased remarkably, respiratory distress reduced and her heart sounds were better audible. So we removed the 18 bore needle and sealed the puncture site with tincture benzoin. Patient was under observation for next 3 to 4 days and remained stable.
Spontaneous pneumomediastinum mainly affects male adolescents. Most common cause of spontaneous pneumomediastinum is bronchial asthma, which leads to alveolar rupture followed by dissection of gas towards the hilum and mediastinum (1). Clinical diagnosis is based on symptom triad of chest pain, dyspnoea, and surgical emphysema. The diagnosis has to be confirmed by chest radiography. (2) The main differential diagnosis is esophageal perforation by foreign body, which requires contrast radiography. Spontaneous pneumomediastinum resolves usually spontaneously within few days. (2-4) In this case report it has resolved spontaneously over next three days. However needle insertion for relief of cardiac tamponade was life saving.
Compliance with Ethical Standards
Funding None
Conflict of Interest None
  1. Chiu CY, Wong KS, Yao TC, Huang JL. Asthmatic versus non-asthmatic spontaneous pneumomediastinum in Children. Asian Pac J Allergy Immunol. 2005 Mar; 23: 19-22.  [PubMed]
  2. Chalumeau M, Le Clainche L, Sayeg N, Sannier N, Michel JL, Marianowski R, Jouvet P, Scheinmann P. Spontaneous pneumomediastinum in children. Pediatr. Pulmonol. 2001; 31: 67-75.  [CrossRef]
  3. Ameh V, Jenner R, Jilani L, Bradbury A. Spontaneous pneumopericardium, pneumomediastinum and subcutaneous emphysema: unusual complications of asthma in a 2-year-old boy. Emerg Med J. 2006: 23: 466-7.  [CrossRef]
  4. Kucukosmanoglu O, Karakoc GB, Altintas D, Gunser Kendirli S. Pneumomediastinium and pneumopericardium: Unusual and rare complications of asthma in a four-year-old girl. Allergol Immunopathol. 2001; 29: 28-30.  [CrossRef]

Cite this article as:
Deshmukh V, Wagha J, Lakhkar B. An Unusual Life Saving Measure. Pediatr Oncall J. 2008;5: 105.
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