Resolution
This is an interesting case.
An x-ray of his chest noted subcutaneous air over his left shoulder (as marked by the yellow arrows). On review with our radiologist, it was also noted that there was a medical pneumothorax (red arrows).
The patient was sent to the ED, given the unusual history and findings. He was observed and discharged the following day.
It is important to note that spontaneous subcutaneous emphysema, pneumothorax and/or pnumomediastinum in the presence of active ulcerative colitis is likely caused by migration of retroperitoneal gas. This should alert the provider to the probability of intestinal perforation. Emergent consultation is indicated.1
Reference
- Cohen ME. Pneumomediastinum during relapse of ulcerative colitis. Am J Gastroenterol. 1997; 92(12): 2306-2307.
Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM, TEREM Immediate Medical Care, Jerusalem, Israel.
