Abstract
A 23.4-week premature and extremely low birth weight neonate was transferred to the Neonatal Intensive Care Unit for management of respiratory failure and retrocardiac pneumomediastinum, suspected to be the result of a low tracheal injury during intubation. Initial conservative management failed and chest radiographs demonstrated worsening retrocardiac pneumomediastinum. Due to the patient’s extreme low birth weight and location of the pneumomediastinum, surgery was deemed to be very high risk and potentially fatal. We report the successful definitive percutaneous management of retrocardiac tension pneumomediastinum with a minimally invasive bedside method using an intercostal paraspinal approach under the guidance of ultrasound and plain radiography.
Similar content being viewed by others
References
Rosenfeld DL, Cordell CE, Jadeja N (1990) Retrocardiac pneumomediastinum: radiographic finding and clinical implications. Pediatrics 85:92–97
Amodio JB, Berdon WE, Abramson SJ et al (1986) Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations. Pediatr Radiol 16:380–383
Kyle A, Veldtman G, Stanton M et al (2012) Barotrauma-associated posterior tension pneumomediastinum, a rare cause of cardiac tamponade in a ventilated neonate: a case report and review of the literature. Acta Paediatr Int J Paediatr 101:e142–e144
Cunningham LC, Jatana KR, Grischkan JM (2013) Conservative management of iatrogenic membranous tracheal wall injury: a discussion of 2 successful pediatric cases. JAMA Otolaryngol Head Neck Surg 139:405–410
Baird CW, Watts LT, Lessaris KJ (2009) Nonoperative management of an extensive tracheal injury in an 860-g preterm neonate. J Thorac Cardiovasc Surg 137:787–788
Bowen A 3rd, Quattromani FL (1980) Infraazygous pneumomediastinum in the newborn. AJR Am J Roentgenol 135:1017–1021
Morrison SC, Fletcher BD (1985) Infra-azygous pneumomediastinum versus pulmonary ligament air collection: CT evaluation. Pediatr Radiol 15:129–130
Beckstrom AC, Ricca RL, Gow KW, McAdams RM (2012) Persistent posterior pneumomediastinum in a neonate. Pediatr Int 54:441–442
Acknowledgments
The authors acknowledge the Interventional Radiology Team at Children’s National Hospital.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ponkowski, M.J., Yadav, B., Meagher, E. et al. Minimally invasive treatment of retrocardiac tension pneumomediastinum in an extremely low birth weight infant. Pediatr Radiol 50, 1624–1628 (2020). https://doi.org/10.1007/s00247-020-04712-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-020-04712-2