Subcutaneous emphysema, pneumomediastinum and epidural emphysema in a child due to foreign body aspiration mimicking croup syndrome

Summary 

Epidural emphysema (pneumorachis) is a rare condition and usually accompanies subcutaneous emphysema or pneumomediastinum. We present a 18-month-old boy with pneumomediastinum, subcutaneous emphysema and epidural emphysema due to foreign body aspiration mimicking croup syndrome. He was admitted to emergency unit with the complaint of respiratory distress and noisy breathing. Physical examinations revealed inspiratory stridor and tachypnea. His clinical status has been worsened in spite of supportive treatment. Computerized thorax tomography showed pneumomediastinum, subcutaneous emphysema at the cervical region and epidural emphysema. A plastic part of toy was removed through a bronchoscope from the trachea and his respiratory distress was completely resolved after bronchoscopy. Children with foreign body aspiration may be admitted to emergency unit with different clinical findings mimicking asthma or respiratory infections. Foreign body aspiration should be considered in children with pneumomediastinum, subcutaneous emphysema or epidural emphysema and diagnostic and also therapeutic bronchoscopy should be done immediately.

Keywords: Epidural emphysema, Subcutaneous emphysema, Pneumomediastinum, Children, Foreign body aspiration, Pneumorachis