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Massive Pneumomediastinum and Subcutaneous Emphysema Secondary to Foreign Body Aspiration

  • Dvir Gatt
    Correspondence
    Reprint Address: Dvir Gatt, md, Department of Pediatrics, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, PO Box 151, Beer Sheva, Israel
    Affiliations
    Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel

    Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel

    Faculty of Health Sciences, Ben-Gurion, University of the Negev, Beer Sheva, Israel
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  • Inbal Golan-Tripto
    Affiliations
    Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel

    Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel

    Faculty of Health Sciences, Ben-Gurion, University of the Negev, Beer Sheva, Israel
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  • Aviv Goldbart
    Affiliations
    Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel

    Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel

    Faculty of Health Sciences, Ben-Gurion, University of the Negev, Beer Sheva, Israel
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  • Micha Aviram
    Affiliations
    Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel

    Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel

    Faculty of Health Sciences, Ben-Gurion, University of the Negev, Beer Sheva, Israel
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      Abstract

      Background

      Spontaneous pneumomediastinum (SPM) occurs in cases of mediastinal leaks that are not caused by trauma, mechanical ventilation, or other surgical procedures. In most cases, in the pediatric population a trigger can be identified, most commonly asthma. SPM caused by foreign body aspiration is not a common entity. It is usually a benign condition that generally resolves without severe sequela, but in some cases, severe morbidity and mortality have been documented. Treatment is usually conservative and includes rest, analgesics, and treatment of any underlying pathologies.

      Case Report

      We report a case of a 19-month-old boy who presented to the emergency department with acute facial swelling and wheezing with no history of foreign body aspiration. This misleading presentation led the medical staff in the emergency department to initially treat the patient for anaphylaxis. The diagnosis was made only after imaging modalities demonstrated SPM with a suspected foreign body in the right main stem bronchus.

      Why Should an Emergency Physician Be Aware of This?

      Providers should consider SPM from an aspirated foreign body in young children with respiratory distress and acute facial swelling, especially when crepitus is present. © 2021 Elsevier Inc.

      Keywords

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