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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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CASE REPORT
Year : 2006  |  Volume : 11  |  Issue : 4  |  Page : 248-249
 

Intraspinal air after blunt thoracic trauma


Neurosurgery Clinic, General Hospital of Chania Creta, Greece

Correspondence Address:
A Krasoudakis
15 K. Voulgaridi Street, Chania - 73133
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.29612

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   Abstract 

Presence of intraspinal air (pneomorachis) is usually iatrogenic after epidural injections or spinal manipulations. It may also be associated with degenerative disc disease, epidural abscess and synovial cysts. Presented herein is a case of a child with pneomorachis following blunt thoracic trauma.


Keywords: Intraspinal air, pneumorachis, thoracic trauma


How to cite this article:
Krasoudakis A, Marathianos S, Tsiminikakis N, Chavredakis E, Arhontakis G. Intraspinal air after blunt thoracic trauma. J Indian Assoc Pediatr Surg 2006;11:248-9

How to cite this URL:
Krasoudakis A, Marathianos S, Tsiminikakis N, Chavredakis E, Arhontakis G. Intraspinal air after blunt thoracic trauma. J Indian Assoc Pediatr Surg [serial online] 2006 [cited 2019 Oct 16];11:248-9. Available from: http://www.jiaps.com/text.asp?2006/11/4/248/29612



   Introduction Top


The presence of air in intraspinal (pneumorachis) is usually iatrogenic after epidural injections.

We report a case of pneumorachis after blunt thoracic trauma.


   Case report Top


We present a case of a 7 years old boy, who suffered a closed thoracic trauma. The child was hidden inside of an abandoned hut in school. It seems that the wall collapsed on its thorax. The boy was transferred to the Emergency Department. The initial blood pressure was 100/60 mmHg, GCS:15/15, SpO 2 : 93% and tachycardia (110 p/min) and no neurological deficit. He was complaining of severe pain of the right chest and paraspinal muscles of the back at the level of T1-T2, rest of the examinations were normal.

Chest X-ray did not reveal pneumothorax or rib fractures and abdomen U/S did not show any intraperitoneal collections or injuries. The boy underwent computed tomography (CT) examination of cervical spine thorax and abdomen and pulmonary lacerations of lungs were revealed.

The interesting finding was the presence of air bubbles inside the spinal canal on the epidural space of levels C6-C7-T1-T2 with no evidence of spinal fracture [Figure - 1][Figure - 2]. The boy was admitted in the surgical department for observation.

Repeated CT, a few days later revealed complete absorption of intraspinal air. The patient discharged one week after hospitalization in very good condition.


   Discussion Top


In most cases, intraspinal air is associated with degenerative disc disease, epidural abscess or synovial cyst or as a follow of iatrogenic manipulation. The presence of epidural air (pneumorachis) is reported rarely in the literature in particular in association with closed thoracic trauma.

Pneumorachis is usually asymptomatic although sometimes radiculitis or myelopathy symptoms can occur depending of air quantity. As a possible pathogenetic mechanism, the rupture of alveoli after hyperpressure of the thorax with the glottis closed (Valsava manoeuvre) is reported.[1]

The augmentation after sudden intrapleural compression may lead to rupture of lung alveoles. The air is possible to spread next by pneumodissection through vascular sheath and accumulate in the mediastinum, the pericardium and retroperitoneum and more rarely into the spinal canal.[2]

Also unsuspected pneumothorax due to rib fracture (not revealed by simple X-ray evaluation) is reported as a causative factor.[3] In our case, repeated control with CT did not reveal pneumothorax and the absorption of intraspinal air [Figure - 3][Figure - 4] confirmed the diagnosis. So no further rule out was needed.

Since the air inside the canal did not produce any neurological deficit by pressure of the notochord there was no reason of any treating procedure.

This observation suggests a wider indication for CT scans of thorax in blunt chest trauma and in addition, whenever intraspinal air is found in the diagnostic assessment of a traumatized patient, a possible pneumothorax should be suspected.

We think that repeated evaluation with CT of chest and spine is necessary for observation of these patients and in most cases conservative treatment is enough with no further manipulations for the absorption of air. If there is an evidence of pressure due to air bubbles causing neurologic deficit a percutaneus CT-guided treatment could be considered.

 
   References Top

1.Delval O, Fossati P, Tailboux L, Mouillet B, Tallon JB, Vandermarcq P. Epidural air after closed thoracic trauma. J Radiol 1998;79:566-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Marckin CC Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum. Arch Intern Med 1939;64:913-26.  Back to cited text no. 2    
3.Khodadadyan C, Hoffman R, Neumann K, Sudkamp NP. Unrecognized pneumothorax as a cause of intraspinal air. Spine 1995;20:838-40.  Back to cited text no. 3    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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  2005 - Journal of Indian Association of Pediatric Surgeons | Published by Wolters Kluwer - Medknow 

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