key: cord-0028459-j94n46nv
authors: Gonçalves, Tatiana Almeida; Parente, Daniella Braz; Barreto, Miriam Menna
title: Pneumomediastinum and pneumorrhachis as complications of dermatomyositis
date: 2021-11-25
journal: nan
DOI: 10.36416/1806-3756/e20210352
sha: b46535aa7805883c16475903a0a08600254d15d8
doc_id: 28459
cord_uid: j94n46nv

nan

1. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil. 2. Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro (RJ), Brasil.

A 45-year-old woman diagnosed with dermatomyositis was admitted with swelling of the neck and anterior chest wall and dysphonia for 3 days. Subcutaneous crackles were palpated on the anterior chest wall. Her hands exhibited signs of dermatomyositis (Gottron's papules, mechanic's hands, and Raynaud's phenomenon) ( Figure  1A ). Chest CT scan showed extensive subcutaneous emphysema dissecting the muscular planes in the neck and chest wall, pneumomediastinum, right pneumothorax, and pneumorrhachis. Interstitial lung disease was also observed ( Figures 1B and 1C ). Oral contrast excluded esophageal rupture. A chest CT scan performed 9 months earlier revealed a subpleural bleb in the left upper lobe and interstitial alterations ( Figure 1D ). The patient was treated conservatively and discharged to follow-up.

Spontaneous pneumomediastinum is an uncommon complication of dermatomyositis. Rupture of subpleural blebs or subpleural infarctions resulting from vasculitis are possible mechanisms. (1, 2) In the case reported herein, the rupture of the subpleural bleb observed previously was considered the cause of the pneumomediastinum and the pneumothorax. In rare situations, air can dissect through the fascial planes from the posterior mediastinum or retropharyngeal space through the neural foramina into the epidural space, causing pneumorrhachis. This condition is usually self-limiting and conservatively managed. 

Pulmonary manifestations of polymyositis/dermatomyositis

Spontaneous Pneumomediastinum in Dermatomyositis

Pneumorrhachis: an uncommon finding in patients with COVID-19