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Klin Padiatr
DOI: 10.1055/a-2041-2914
Short Communication

Massive Air Leak Syndrome During High Flow Oxygen Therapy and a Rare Complication: Pneumorrhachis

Massive-Air-Leak-Syndrom während der High-Flow-Sauerstofftherapie und eine seltene Komplikation: Pneumorrhachis
Aytaç Göktuğ
1   Department of Pediatric Emergency Medicine, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
,
Songül Sönmez
2   Department of Pediatrics, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
,
Dinçel Eren
2   Department of Pediatrics, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
,
Özgür Çağlar
3   Department of Pediatric Surgery, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
,
Yasemin Tasci Yildiz
4   Pediatric Radiology, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Altindağ, Turkey
,
Mutlu Uysal Yazici
5   Pediatric Intensive Care, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
,
Nilden Tuygun
6   Department of Pediatric Emergency Medicine, SBU Ankara Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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Introduction

Pulmonary air leak syndrome is the escape of air from the lungs into the extra alveolar spaces in which it is not normally present. The most common causes of air leakage are acute asthma exacerbations, Valsalva maneuvers (e. g., lifting heavy objects, blowing balloons, straining), sudden and severe coughing attacks, crying, screaming, vomiting, diabetic ketoacidosis (hyperpnea), and foreign body aspiration (Mumford AD et al., BMJ 1996; 313: 1619, Forshaw MJ et al., Surg today. 2007; 37: 888–892, Wong KS et al., Pediatr Emerg Care. 2013; 29: 988–991), and the symptoms and signs vary according to where the air accumulates.

Air leakage begins with the rupture of overstretched alveoli (Chernick V, & Avery ME. J Pediatr. 1963; 32: 816–824). Excessive strain can be caused by air trapping or uneven distribution of gas. Air escaping from the alveoli may pass from the perivascular connective tissue sheath to the hilum, leading into the pneumomediastinum and then into the pleural space, causing pneumothorax or trapped in the perivascular tissues of the lung, which can cause pulmonary interstitial emphysema (PIE) (Macklin C. Arch Intern Med. 1939; 64: 913–926). Less frequently, air may diffuse into the pericardial space, subcutaneous tissue, or peritoneal space, causing pneumopericardium, subcutaneous emphysema, and pneumoperitoneum, respectively, while diffusion into the spinal canal, called pneumorrhachis, is very rare (Fugo JR et al., Curr Surg. 2006; 5: 351–353). Computed tomography (CT) is the gold standard method for diagnosing pneumorrhachis and determining the extent of air leaks.

Here, we report a girl with severe bronchopneumonia associated with human bocavirus (HBoV), who developed a massive air leak in the second hour of oxygen therapy with a heated, humidified, high flow nasal cannula (HFNC).



Publication History

Article published online:
11 July 2023

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