Journal of Emergency Practice and Trauma

Base of skull fracture leading to pneumomediastinum and pneumo-retroperitoneum: a case report with review of literature

Document Type : Case Report

Authors

Garima Sharma
Sanya Vermani
Anjum Syed

Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India

https://doi.org/10.34172/jept.2021.25
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.
Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.
Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.

Keywords

Trauma
Pneumomediastinum
Pneumo-retroperitoneum
Subjects
1. Frias Vilaça A, Reis AM, Vidal IM. The anatomical compartments and their connections as demonstrated
by ectopic air. Insights Imaging 2013; 4(6): 759-72. doi:10.1007/s13244-013-0278-0.
2. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and
management. Arch Intern Med 1984; 144(7): 1447-53.
3. Roncati L, Pusiol T, Scialpi M. The endothoracic fascia: an anatomic site in which primary liposarcoma may arise.
Lung 2015; 193(6): 1055-6. doi: 10.1007/s00408-015-9798-3.
4. Kleinman PK, Brill PW, Whalen JP. Anterior pathway for transdiaphragmatic extension of pneumomediastinum.
AJR Am J Roentgenol 1978; 131(2): 271-5. doi: 10.2214/ajr.131.2.271.
5. Lidid L, Valenzuela J, Villarroel C, Alegria J. Crossing the barrier: when the diaphragm is not a limit. AJR Am J
Roentgenol 2013; 200(1): W62-70. doi: 10.2214/ajr.11.8264.
6. Allard E, Selim J, Veber B. Pneumocephalus and pneumorachis after blunt chest trauma without spinal
fractures: a case report. J Med Case Rep 2019; 13(1): 317.doi: 10.1186/s13256-019-2208-3.
7. Anbarasu A, Khajanchi M. Pneumocephalus following thoracic trauma: a rare entity along the carotid sheath. ANZ
J Surg 2018; 88(4): 382-3. doi: 10.1111/ans.13388.
Journal of Emergency Practice and Trauma
Volume 8, Issue 1
January 2022
Pages 77-79

  • Receive Date 03 July 2021
  • Revise Date 31 August 2021
  • Accept Date 13 September 2021

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