Disseminated Head and Neck Emphysema with Pneumocephalus due to air compressor injury to orbit

Abstract

Disseminated Head and Neck Emphysema with Pneumocephalus due to air compressor injury to orbit Jin Hyuck Lee, Hyuk Joong Choi, Bo Seung Kang, Tai Ho Im Dept. of Emergency medicine, Hanyang University Guri Hospital Introduction Since the first report at 1970, air compressor injuries with orbital facial emphysema have been reported in 11 English literatures. This is one of the most severe cases with head and neck emphysema following air compressor injury, which we reported to the government`s labor department for rare serious injury. Case 4 year Old Girl C/C Right periorbital swelling P/I A healthy 4-year-old girl was struck in the right eye with compressed air gun by brother, while she was playing at auto repair shop, with the result that a high-pressure air stream at 75 lbs per square inch was directed towards her right eye from close range. She complained of severe pain and swelling of the both eyelids. She presented to the ED immediately. V/S 36.8℃-100-22 BP 110/70 mmHg Reference P/Ex Mentation: Alert HEENT: pupil examination revealed both round pupil of size 0.3/0.3. No commotio retinae on dilated fundoscopy. Extensive edema and ecchymosis in the both eyelids, Crepitus was present over the upper and lower eyelids of both eyes and extended into the nose, cheek, scalp, lower jaw, and temporomandibular joint on both sides. Chest: CBS without rale RHB without murmur Progress HD#1: Admission, given systemic and topical antibiotics HD#2: Visual acuity was 6/6 RE, 6/6 LE HD#10: The emphysema had improved gradually, with full resolution evident on repeated computed tomography Fig 3. Fig 4. Fig 1 . Fig 2. Fig 1. Plain skull x-ray shows massive emphysematous change on the face, ranging from parietotemporal area to submandibular area on both sides Fig 2. Pneumocephalus in the anterior frontal area and extensive emphysema within frontoparietal scalp on both sides Fig 3. In the right orbit, accumulation of air beneath the Tenon fascia, around the optic nerve, and through the optic canal into the subarachnoid space. In both periorbital area, large airfilled chemosis seen. Fig 4. Emphysema extends along the deep cervical fascia, to both parapharyngeal and retropharyngeal space 1. Hitchings R, McGill JI . Compressed air injury of the eye. Br J Ophthalmol 1970 ;54(9):634-5. 2. Yildiz A, Duce MN, Ozer C, et al. Disseminated pneumocephalus secondary to an unusual facial trauma. Eur J Radiol 2002 ;42(1):65-8. 3. Williams TR, Frankel N. Intracerebral air caused by conjunctival laceration with air hose. Arch Ophthalmol. 1999;117(8):1090-1.