Diagnostic and therapy of a cervical emphysema

Abstract

Introduction: Emphysema of the neck represents a crucial symptom of swallowing/respiratory pathways injuries or rarely passes to the neck area from diff erent locations. The clinical image can develop dramatically in the fi rst hours after onset and frequently the etiology remains unclear. Dyspnoea, dysphagia, retrosternal or interscapular pain usually follows. In the diff erential dia gnosis, not only traumatic etiology but also other acute conditions must be considered – e. g. acute coronary syndrome etc. The size of emphysema varies, also head and chest area can also be aff ected. Pneumomediastinum or partial pneumothorax are also often presented. The primarily aim of this paper is to discuss a dia gnostic and therapeutic possibilities, not to determine the incidence of emphysema. Methodology: This is a retrospective multicenter study involving patients from three regional ENT departments – Pardubice Hospital, Hradec Králové University Hospital and Liberec Hospital over a period of 15 years (2005–2020). Only clinically signifi cant emphysema, emphysema of unclear origin and emphysema requiring intensive care were in-rolled. Results: In a group of 15 patients, there are the following causes of cervical emphysema – 3 laryngeal injuries, 3 Hamman’s syndromes, 2 tracheal intubations, 2 traumas of swallowing pathways, 2 in COVID-19 disease, 1 tonsillectomy, 1 urgent tracheostomy and 1 sneezing. Etiologically, the Valsalva maneuver is an important (co)factor, dominating especially in adolescents and young adults (53%, 8 patients). Traumatic etiology occurred at the age of 17–53 years (33%, 5 patients). Iatrogenic involvement is more common over the age of 55 years. Pneumomediastinum occurred in 47% and partial pneumothorax in 40% of patients. Four of those initially unclear cases are discussed in detail. Conclusion: Imaging methods and endoscopic examination are indicated in a patient with cervical emphysema of unclear origin. Prophylactic use of broad-spectrum antibio tics, observation and interdisciplinary cooperation are always necessary. Key words emphysema – Hamman’s syndrome – pneumothorax – pneumomediastinum – covid lung injury