Post-traumatic pneumorrhachis associated with surgical emphysema of the neck and pneumomediastinum

Case contributed by Essam G Ghonaim
Diagnosis certain


A patient presented to the ER with painful neck and upper back after blunt trauma. Studies show at the time of presentation and after three weeks follow-up.

Patient Data

Age: 45 years
Gender: Male

CT evidence of subcutaneous and inter-fascial air density is seen on both sides of the lower neck, the anterior chest wall, the axilla, and the mediastinum as well as within the thoracic spinal canal.   

Follow-up after 3 weeks showed remarkable resolution of the surgical emphysema and pneumomediastinum as well as almost total resolution of pneumorrhachis.

Case Discussion

Pneumorrhachis (PR) is defined as air within the spinal canal (either intra- or extra-dural). It is usually an imaging diagnosis, caused by numerous – mainly traumatic and iatrogenic – etiologies, and is usually associated with other pathologies and numerous air entry pathways. CT is the diagnostic modality of choice. PR is usually asymptomatic, is reabsorbed spontaneously and is usually managed conservatively. Prophylactic management with antibiotics is not recommended. In case general anesthesia is required, the use inhalational nitrous oxide is avoided because it causes expansion of intra-cavitary air.

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