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Pneumorrhachis of the entire spinal canal
  1. M F Oertel,
  2. M C Korinth,
  3. M H T Reinges,
  4. J M Gilsbach
  1. Department of Neurosurgery, University Hospital, Aachen University, Aachen, Germany
  1. Correspondence to:
 Dr M F Oertel
 Department of Neurosurgery, University Hospital, School of Medicine, Aachen University, Pauwelsstrasse 30, 52057 Aachen, Germany; mfoertelukaachen.de

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Pneumorrhachis (PR)—the curious phenomenon of intraspinal air—is an exceptional radiographic finding. In this report the first case of PR of the entire spine is presented.

A 19 year old man with a history of diabetes mellitus and bronchial asthma was admitted because of cough, fever, nausea, and vomiting for 3 days. Physical examination and laboratory studies showed cervical subcutaneous emphysema, infection signs, and ketoacidotic decompensated diabetes mellitus with hyperglycaemia.

Subsequent computed tomography (CT) (fig 1) revealed pneumomediastinum, pneumoretroperitoneum, cervical and thoracic subcutaneous emphysema, external pneumocephalus, and PR of the entire spinal canal.

Figure 1

 Left panel: sagittal reconstruction of contrast enhanced spinal CT scan demonstrating intraspinal epidural air collection accompanied by subcutaneous emphysema and pneumomediastinum. Transaxial contrast enhanced axial spinal CT images of the cervical (upper right panel), thoracic (middle right panel), and lumbar region (lower right panel) revealing extradural PR of the entire spine associated with distinctive cervical and thoracic subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. Note air dissection via the neural foramina into the vertebral canal.

The patient underwent otorhinolaryngological exploration for presumptive diagnosis of nasopharyngeal abscess but no evidence of an infectious process was found.

With intravenous antibiotics for gastrointestinal infection and antibechic medication the symptoms resolved and the PR reabsorbed completely. The patient was discharged home asymptomatically after 12 days.

In this case, PR was secondary to tracheobronchial microinjury resulting from violent coughing. The air dissected from the upper respiratory tract into the paraspinal soft tissues of the neck, entered the spinal canal via the neural foramina, and extended epidurally throughout the entire vertebral canal (fig 1).

Only one similar case with air distribution in the cervical and lumbar spine,1 and in the thoracic and lumbar region,2 and three cases with both cervical and thoracic PR were previously described.2–4

The current case serves to highlight the importance of PR as a rare and usually asymptomatic but eminent epiphenomenon of associated, frequently concealed, severe pathologies, so as to enable adequate patient management.

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