Open AccessMediastinal emphysema after long‐distance flight with ketoacidosis and underlying diabetes mellitus type 1
Author(s) -
Ardila Pardo Gracia Lana,
Kübler Wolfgang Michael,
Witzenrath Martin,
Oestmann JörgWilhelm
Publication year - 2019
Publication title -
respirology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.304
H-Index - 9
ISSN - 2051-3380
DOI - 10.1002/rcr2.423
Subject(s) - medicine , diabetic ketoacidosis , type 1 diabetes , type 2 diabetes mellitus , ketoacidosis , diabetes mellitus , intensive care medicine , pediatrics , endocrinology
A 21‐year old female with diabetes mellitus type 1 presented to our hospital's emergency department having suffered from shortness of breath, mild chest pain, and vomiting following her arrival after a long‐distance flight two days earlier. Symptoms had since subsided and physical examination was normal. Blood analysis revealed increased D‐dimers and diabetic ketoacidosis. Computed tomography (CT) examination excluded pulmonary embolism but demonstrated significant mediastinal emphysema. After conservative treatment including nasal oxygen and adjustment of insulin therapy, follow‐up low‐dose CT after four days confirmed full regression of the emphysema. The patient was discharged feeling well, with a recommendation for improved diabetes treatment. Spontaneous pneumomediastinum is a rare condition occurring in younger patients without trauma or pulmonary disease. Over‐inflation and/or pulmonary vasoconstriction have been proposed as major physiological contributors and were likely evoked in the present case by increased respiratory drive due to ketoacidosis and hypoxic vasoconstriction during long distance flight.