Clin Exp Otorhinolaryngol.  2016 Jun;9(2):178-181. 10.21053/ceo.2014.01543.

Spontaneous Retropharyngeal and Mediastinal Emphysema

Affiliations
  • 1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
  • 2Division of Otolaryngology-Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA. Kimberly.Shepard@hhs.sccgov.org

Abstract

A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature.

Keyword

Mediastinal Emphysema; Subcutaneous Emphysema; Mediastinitis

MeSH Terms

Abscess
Adolescent
Cough
Eating
Emergency Service, Hospital
Emphysema
Female
Foreign Bodies
Head
Humans
Laryngoscopy
Mediastinal Emphysema*
Mediastinitis
Mediastinum
Neck
Oxygen
Palpation
Pharyngitis
Physical Examination
Subcutaneous Emphysema
Substance-Related Disorders
Vocal Cords
Voice
Oxygen

Figure

  • Fig. 1. Lateral radiography of neck demonstrated a linear air-column (arrow) in the retropharyngeal space. Note the metal shadow between C1 and C2 spine is patient’s ear ring.

  • Fig. 2. Computed tomography confirmed extensive cervical emphysema involving the retropharyngeal space (A: arrow) and mediastinum (B: arrows) with no evidence of fluid collection or abscess formation. (A) Axial image at the level of hypopharynx. (B) Axial image at the level of mediastinum.

  • Fig. 3. Near-complete resolution of linear air column (arrow) in the retropharyngeal space was confirmed with radiography of lateral neck on the second hospital day.


Reference

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