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SPONTANIOUS PNEUMOMEDIASTENIUM AFTER SEVERE COUGHING; CASE REPORT.

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Introduction: Pneumomediastinum, the mediastinal localization of the air after perforation in the respiratory or gastrointestinal system organs, is rarely seen in children. Most common symptom is chest pain. Typical sign of this condition is Hamman sign which is synchronized crackle sound at auscultation with the hearth beat. Although many underlying disorders caused increased intrathoracic pressure can lead to pneumomediastinum, it can be occurred without any reason. Treatment is directed at the cause, if necessary surgical treatment is performed. In this article, we present a child with severe cough and spontaneous pneumomediastinum due to tracheitis.

Case report: A 4-year-old girl was admitted with severe cough and shortness of breath. Her cough started four days ago and progressed, shortness of breath has just begun. On admission, her vital signs were within normal range. Oxygen saturation measured by pulse oximetry (SpO2) was at 93 % in room air. On her physical examination, bilateral coarse crackles on chest and crepitations on both anterolateral sides of neck were detected. No pathology was detected in laboratory tests. AP and lateral chest X-ray showed intense subcutaneous air bronchograms on the neck which was compatible with pneumomediastinum. Chest CT detected free air particles around the clavicle and sternum, in cervical region, between muscles, at subcutaneous tissue, in peritracheal and esophageal region, at superior mediastinum and anterior thymus, at retrosternal localization, around of arcus aorta and its branches, in mediastinal and deeper neck fascia's without any positive findings of intestinal perforation. Patient was diagnosed as spontaneous pneumomediastinum secondary to severe cough. Antibiotic treatment for the upper respiratory tract infection, hydration support and symptomatic treatment for cough was given. After 2 days, patient's crepitation on the neck was disappeared. At the 5th day of treatment, chest X-Ray was normal and she was discharged from hospital with a good condition.

Conclusion: Although it is rare disease, spontaneous pneumomediastinum should be thought in children with severe cough as a differential diagnosis.

Taha Cinar (1), Elif Unver Korgali (1), Gulsah Unsal (1), Pinar Burucu (1), Mahmut Ekici (1), Kayhan Karakus (2)

(1) Department of Pediatrics, Cumhuriyet University School of Medicine, Sivas, Turkey

(2) Department of Pediatric Radiology, Cumhuriyet University School of Medicine, Sivas, Turkey

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Title Annotation:Poster Presentation Abstracts
Author:Cinar, Taha; Korgali, Elif Unver; Unsal, Gulsah; Burucu, Pinar; Ekici, Mahmut; Karakus, Kayhan
Publication:Erciyes Medical Journal
Article Type:Case study
Date:Mar 1, 2017
Words:361
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