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Clinical Note |

Spontaneous Cervical Emphysema With Nasopharyngeal Fistula

Han Sung Ko, MD; Kyung Yuhl Han, MD; Jin Ho Kim, MD; Jong Yang Kim, MD; Byoung Soo Shim, MD; Yong Jin Song, MD
Arch Otolaryngol Head Neck Surg. 2010;136(4):404-406. doi:10.1001/archoto.2010.37.
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Cervical subcutaneous emphysema is typically caused by air in the upper aerodigestive tract expanding into the retropharyngeal space and the mediastinum. Among such cases, spontaneous subcutaneous emphysema is a rare disease that can occur without clear external injuries and often does not require medical or surgical intervention. Predisposing factors include repeated coughing and vomiting. The condition is presumed to be caused by an increase in intrathoracic and pulmonary alveolar pressure.1 However, we report herein the first case, to our knowledge, of cervical subcutaneous emphysema in the context of an anatomic deficit in the nasopharynx diagnosed by nasal endoscopy and a review of the literature.

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Figure 1.

Radiography of the neck shows extensive free air within the retropharyngeal space (arrowhead).

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Figure 2.

Simple chest radiograph demonstrates a thin radiolucent line at the left edge of the heart (arrowhead).

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Figure 3.

Axial computed tomography shows retropharyngeal free air space and a nasopharyngeal fistula (arrow).

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Figure 4.

Nasal endoscopy shows the nasopharyngeal fistula orifice (arrowhead), torus tubarius (small arrow), and eustachian tube orifice (large arrow).

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