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Infectious Diseases

A Man in His 60s With Pneumonia and Multiple Reintubation Attempts

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To identify the key insights or developments described in this article

1 Credit CME

JAMA Cardiology

Published Online: March 9, 2022

Cardiovascular Images

Article Information and Disclosures

Meng-Ko Tsai, MD^1,2,3;

Chao-Hung Lai, MD, PhD¹;

Li-Chien Chang, MD^1,2,4

Author Affiliations

¹Department of Internal Medicine, Armed Forces Taichung General Hospital, Taichung City, Taiwan
²Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
³Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan
⁴Department of Nutrition, Chung Shan Medical University, Taichung City, Taiwan

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A man in his 60s was admitted because of pneumonia with respiratory failure. He was intubated on day 3 and extubated on day 7. On day 9, respiratory acidosis was noted. However, reintubation of the patient was difficult; a total of 3 intubation attempts were made. After successful reintubation, through written communication, the patient reported symptoms of dyspnea, chest pain, and neck pain during periods of daily sedation interruption. Physical examination demonstrated upper trunk tissue distention and crepitus on palpitation. Chest computed tomography revealed pneumopericardium, subcutaneous emphysema, pneumothorax, and pneumoperitoneum (Figure).

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Article Information

Corresponding Author: Li-Chien Chang, MD, Department of Internal Medicine, Armed Forces Taichung General Hospital, No. 348, Section 2, Zhongshan Road, Taiping District, Taichung City 411, Taiwan (corrauthor098@gmail.com).

Conflict of Interest Disclosures: Drs Tsai, Lai, and Chang reported receiving processing and editing fee assistance from the Department of Medical Education and Research, Taichung Armed Forces General Hospital. No other disclosures were reported.

Additional Contributions: We thank Chun-Wen Chen, MD, Department of Radiology, Taichung Armed Forces General Hospital, and Mr Hsin-Yi Pan, Department of Optometry, Asia University, for their assistance with image review and processing, respectively. They were not financially compensated for their contributions.

References

Brander L , Ramsay D , Dreier D , Peter M , Graeni R . Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review. Heart. 2002;88(4):e5. doi:10.1136/heart.88.4.e5 PubMed Google Scholar

Gould JC , Schurr MA . Tension pneumopericardium after blunt chest trauma. Ann Thorac Surg. 2001;72(5):1728-1730. doi:10.1016/S0003-4975(01)02647-9 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.