A 12-year-old girl presented with midepigastric and right-upper-quadrant abdominal pain of 4 weeks' duration. Often, pain was present in the morning and persisted all day. Occasionally it awakened her at night. Antacids provided temporary relief of pain, but when symptoms persisted, she was referred to a gastroenterologist. There was no nausea, vomiting, hematemesis, or diarrhea. Results of physical examination were normal. However, a small amount of stool that tested positive for occult blood was found on rectal examination. Her hematocrit was 0.35, and results of a complete blood count were within normal limits. An upper gastrointestinal series with air contrast showed thickened gastric folds (Fig 1). Endoscopy of the upper gastrointestinal tract showed diffuse erythema of the gastric mucosa and small petechial hemorrhages in the body of the stomach. The antrum demonstrated fine nodules, and the duodenum was erythematous, with two small ulcerations. Endoscopic biopsy specimens were taken (Figs 2

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=peds&articleId=516281&pdfFileName=archpedi_146_8_029.pdf

Radiological Cases of the Month

Pneumoperitoneum as a result of pneumomediastinum has been described already. Amongst the causes pneumoperitoneum due to a complication of adenotonsillectomy, has not previously been described. We describe a five-year-old girl with tension pneumoperitoneum with respiratory and circulatory insufficiency half an hour after adenotonsillectomy. Removal of the intra-abdominal air with a 14 gauge needle restored normal respiration and circulation.

Tension pneumoperitoneum as an early complication after adenotonsillectomy

Tension mediastinal emphysema: emergency percutaneous drainage with CT guidance.

Chapter 10 – Focal Bacterial Infections

UNLABELLED Ventilation-associated neonatal barotrauma comprises a spectrum of conditions including pneumothorax, pulmonary interstitial emphysema, pneumopericardium and pneumomediastinum. Whilst pneumothorax is common, mediastinal and particularly posterior mediastinal air collections are rare. We report the case of a neonate, presenting with life threatening pericardial tamponade secondary to posterior tension pneumomediastinum. The infant was successfully resuscitated with an emergency left lateral thoracotomy and chest drain insertion. We believe this to be the first such case reported in the literature. We discuss aspects of pathophysiology, diagnosis and management relating to posterior pneumomediastinum. CONCLUSION Posterior pneumomediastinum is rare, but can potentially cause fatal tamponade. Such cases must be managed in a tertiary centre where cardiology and surgical expertize are available.

Barotrauma‐associated posterior tension pneumomediastinum, a rare cause of cardiac tamponade in a ventilated neonate: a case report and review of the literature

Fourteen neonates with posterior mediastinal air collections (retrocardiac pneumomediastinum) are described. In the majority of the infants (13 of 14), the mediastinal air developed as a complication of assisted ventilation. It is suggested that the retrocardiac pneumomediastinum represents air trapped in a potential space in the mediastinum posterior to the heart and not within the pulmonary ligament. The collections have a variable shape and size and rarely may produce a tension phenomenon elevating the posterior, inferior portion of the heart off of the diaphragm. There was a strong association of retrocardiac pneumomediastinum with other manifestations of extraalveolar air, including pulmonary interstitial emphysema (13 of 14 infants), pneumothorax (10 of 14 infants), dissection of air into the soft tissues of the neck (10 of 14 infants), and pneumoperitoneum (5 of 14 infants).

Retrocardiac Pneumomediastinum: Radiographic Finding and Clinical Implications

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Retrocardiac Pneumomediastinum: Radiographic Finding and Clinical Implications