Finding the bubble: atypical and unusual extrapulmonary air in the chest

Our plain-English summary of Finding the bubble: atypical and unusual extrapulmonary air in the chest, by D. Varona Porres, O. Persiva, A.L. Sánchez, et al (Radiología, 2021).

The study

• Authors: D. Varona Porres, O. Persiva, A.L. Sánchez, L. Cabanzo, E. Pallisa, J. Andreu
• Journal: Radiología
• Published: 2021;63(4):358-369
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.

Conclusion: In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

Copyright © 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

In plain English

This article was a pictorial review from the radiology department of Hospital Vall de Hebron in Barcelona, Spain. The authors used a series of cases from their own center to show X-ray and CT images of air found in the chest outside the lungs. They grouped the causes by location: the mediastinum, the pericardium, the heart and blood vessels, the pleura, and the chest wall. The article did not say how many cases were collected or over what period. One case was a 69-year-old man with worsening breathlessness and chest pain. His chest X-ray showed air and fluid filling the right side of the chest (hydropneumothorax). CT showed nodular thickening of the pleura, and a biopsy was positive for pleural mesothelioma. Other cases included a man with squamous cell carcinoma of the lung whose tumour had spread to the pericardium, causing air there. The article did not mention asbestos or any patient's exposure history. The authors concluded that correct diagnosis of the many atypical causes of such air can affect treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Pictorial review ("Radiology through images") illustrated with cases collected at the authors' center; no statistics
• Who was studied: Individual patients from the authors' hospital (Hospital Vall de Hebron, Barcelona, Spain), each described in a figure; total number and time period not stated
• Exposure: No asbestos or other exposure was studied; the article concerns imaging of air outside the lungs in the chest from various causes
• Main results:
  • A 69-year-old man with progressive dyspnoea and chest pain had a right hydropneumothorax on chest X-ray
  • In the same man, CT showed nodular pleural thickening involving the mediastinal pleura, and a biopsy of pleural nodules was positive for pleural mesothelioma
  • A 53-year-old man with squamous cell carcinoma of the lung had pneumopericardium (air around the heart) caused by direct extension of the tumour to the pericardium
  • A 57-year-old man with a disseminated lung neoplasm and a right hydropneumothorax died within a few days
• The authors' conclusion: The authors concluded that there are many atypical and infrequent causes of air outside the lungs in the chest, and that correct diagnosis can affect treatment

Topics

Medical terms in this study, explained in our Lexicon: Thorax, Mediastinum, Lung Transplant, Pericardium, Pleura, Pneumothorax, Pleural Mesothelioma, Bilateral.

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