Home | Business News | Browse by Publication | J | Journal of Respiratory Diseases

What caused this woman's pneumomediastinum?

Article Excerpt
A 35-year-old woman presented to the emergency department (ED) with vague abdominal complaints. The patient had a complex medical history that included diverticulosis and relapsing polychondritis. Initially, her polychondritis was limited to involvement of the ears and nose. Within the past few years, however, her polychondritis flares had been associated with progressive dyspnea, which prompted intermittent and then long-term use of high-dose oral corticosteroids.

Despite the addition of methotrexate and cyclosporine, the patient continued to experience progressive dyspnea and hoarseness. This prompted a formal chest CT evaluation to assess for airway involvement, which was done shortly before her presentation to the ED.

Although there was no evidence of airway involvement associated with relapsing polychondritis, the CT scan demonstrated pneumomediastinum, an unsuspected finding of uncertain etiology (Figure 1).

[FIGURE 1 OMITTED]

The patient was discharged home with scheduled short-term follow-up in the pulmonary outpatient clinic for further assessment. At that visit, she reported left flank and abdominal pain, for which she had been taking oral narcotics several times a day with only partial relief. She also reported night sweats, presyncope, nausea, anorexia, and subjective fevers, as well as slightly darker and more foul-smelling stools. She had no rectal bleeding.

Because of her progressive abdominal symptoms, the patient was immediately referred to the ED. On physical examination, her blood pressure was 110/80 mm Hg and her heart rate and respiration rate...

View this article FREE - Now for a Limited Time, try Goliath Business News
Free for 3 Days!