asthma
Barotrauma in a Patient with Status Asthmaticus
Submitted by GPH on Fri, 2010-03-05 11:54
This patient initially presented with Status Asthmaticus. Despite aggressive medical management, her condition failed to improve and she was intubated for mechanical ventilation. While on the ventilator, the patient developed significant auto-PEEP (PEEP – positive end expiratory pressure or pressure remaining in the lungs after an exhalation) as a result of air trapping. This lead to barotrauma with a left sided pneumothorax and an extensive SQ emphysema (white arrow on the image above).
Status Asthmaticus
Submitted by GPH on Thu, 2010-03-04 12:17
24 year old female with a history of asthma and tobacco abuse presented with a progressively worsening shortness of breath and coughing. Her exam revealed extensive wheezing. She was admitted for further treatment of her asthma.
On the chest XR above, note hyperinflated lungs with depressed diaphragms on both sides. The hallmark of asthma is airway narrowing due to inflammation and airway muscle constriction. The patients are unable to fully exhale due to the narrowed airway. This causes air trapping leading to hyperinflation of both lungs.
Sponteneous pneumomediastinum in patient with asthma.
Submitted by GPH on Thu, 2009-10-08 14:49
I want to talk about one interesting finding on CXR that I came across while rounding in ICU. How often do we see a spontaneous pneumomediastinum (SPM) with SQ emphysema? The patient was a young female admitted earlier with asthma exacerbation. The patient reported coughing and shortness of breath on admission. No significant chest pain was reported. On hospital day 2 she developed some chest discomfort. Portable CXR revealed evidence of the spontaneous pneumomediastinum and SQ emphysema (see image above with arrows pointing to subcutaneous air). Literature search came up with a review paper from CHEST. The mechanism of SPM is terminal alveolar rupture with dissection of air into hilum, then mediastinum and later into the tissues of the neck along the fascial planes. Very interesting! It could even happen while straining, sneezing or inflating party balloons. Many of those patients do, though, have some precipitating conditions like Asthma. Illicit drug users (specifically inhalational drugs) are at higher risk as well. The most common presentation is chest pain and shortness of breath.
The patient in ICU did fine and went home several days later.
