Pneumorrhachis

Case contributed by Kamil Bekalarek

Presentation

Status post-MVA two days ago. Follow-up examination.

Patient Data

Age: 20 years
Gender: Male

Follow-up CT of the cervical spine

CT

A moderate amount of air within the spinal canal is noted concentrated at the periphery of the canal – extradural location; the air is seen along the cervical and upper thoracic spine.

Air locules are also seen tracking along with the exiting nerve roots at the C7-T1 level on both sides and within the soft tissue of the lower neck on the left side at the same level.

Fluid in the left pleural space.

NG tube; PICC on the right side.

Intitial CT of the cervical spine - 2 days before

CT

At the initial CT of the cervical spine, performed a few hours after the accident, the air within the spinal canal and soft tissue were not present.

Small right pneumothorax on the right side.

Case Discussion

The extradural air within the spinal canal is consistent with pneumorrhachis.

There is also air tracking along with nerve roots and soft tissue emphysema in the left lower neck and fluid in left pleural space. This is consistent with a prior unsuccessful attempt of PICC insertion on the left side in the interval between presented examinations.

Pneumorrhachis is most likely iatrogenic in this case. 

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