Hypoxemia in an adolescent: when the cause is between the lines

Authors

  • Tatiana Pereira Department of Pediatrics and Neonatology, Centro Hospitalar Entre o Douro e Vouga
  • Graça Loureiro Department of Pediatrics and Neonatology, Centro Hospitalar Entre o Douro e Vouga
  • Sandra Pereira Department of Pediatrics, Hospital Integrado de Pediatria, Centro Hospitalar Universitário de São João
  • Cristina Rocha Department of Pediatrics and Neonatology, Centro Hospitalar Entre o Douro e Vouga
  • Paulo Guimarães Department of Pediatrics and Neonatology, Centro Hospitalar Entre o Douro e Vouga
  • Sara Oliveira Department of Pediatrics and Neonatology, Centro Hospitalar Entre o Douro e Vouga

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v29.i4.14106

Keywords:

chest pain, mycoplasma infection, multifactorial etiology, spontaneous pneumomediastinum, subcutaneous emphysema

Abstract

Spontaneous pneumomediastinum is a rare entity in pediatric age, with multifactorial etiology.
A 16-year-old male with multiple allergies (mites, dogs, cats, and grasses), daily smoker (one pack/day for one year), and regular cannabis, cocaine, and amphetamine consumer went to the Emergency Department of the local hospital with cough, dyspnea, chest pain, and fever with 12 hours of evolution. On physical examination, the boy presented facies complaints, polypnea, shortness of breath, extensive subcutaneous emphysema in the cervical region and right hemithorax, and diminished vesicular murmur bilaterally with expiratory wheezing. Chest x-ray was performed, revealing alterations compatible with pneumomediastinum and subcutaneous emphysema in the cervical region. Urine test was positive for tetrahydrocannabinoids. Atopy (IgE levels) study was performed, with positive result, and serological testing was performed for Mycoplasma pneumoniae, showing IgM of 33U/mL and IgG of 25U/mL.
In this clinical case, multiple pneumomediastinum triggering/predisposing factors can be identified, including marked smoking habits, acute mycoplasma infection, and inhaled and smoked drug consumption.
The aim of this study was to review the pathophysiology/semiology of pneumomediastinum and emphasize the importance of clinical suspicion.

References

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Pereira A, Faria C, Carvalho S, Pontes T, Antunes A, Antunes H. Pneumomediastino espontâneo como apresentação de infeção por Mycoplasma pneumoniae, Nascer e Crescer. 2015; 24:174-8.

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Mohseni M. Spontaneous Pneumomediastinum. Int J Emerg Med. 2008; 1:229–30.

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Published

2020-11-27

How to Cite

Pereira, T., Loureiro, G., Pereira, S., Rocha, C., Guimarães, P., & Oliveira, S. (2020). Hypoxemia in an adolescent: when the cause is between the lines. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 29(4), 196–199. https://doi.org/10.25753/BirthGrowthMJ.v29.i4.14106

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Section

Case Reports

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