SHM Converge Scientific Abstract ePoster Gallery-Air on the Brain: The Hospitalist's Role in Complex Care Coordination for a Rare Complication

Pdf Summary

This case describes a 38-year-old woman with prior cervical spine giant cell tumor, in remission, who was admitted for dysphagia and found to have invasive esophageal squamous cell carcinoma. During hospitalization, she developed fever, and CT imaging showed a retro-esophageal fluid collection near spinal hardware. A drain was placed via video-assisted thoracoscopic surgery (VATS), and cultures grew E. coli.<br /><br />She later developed vomiting and headache. CT revealed pneumocephalus, and lumbar puncture confirmed E. coli meningitis. After multidisciplinary review, the pneumocephalus was thought to be iatrogenic, likely introduced through the retro-esophageal drain in the setting of prior spinal surgery/hardware. The drain was removed, and repeat CT showed significant improvement in the intracranial air. A CT gastrografin study found no esophageal leak, allowing chemotherapy and radiation to begin. The patient remained clinically stable without neurologic deficits.<br /><br />The report emphasizes that pneumocephalus is air within the cranial vault, most often caused by trauma or surgery, but in hospitalized patients rare iatrogenic causes should also be considered. Hospitalist involvement was important for coordination among specialties, diagnostic clarification, and management. Careful neurologic monitoring is essential because tension pneumocephalus can be life-threatening.

Asset Subtitle

Michelle Perkons

Meta Tag

Author List Michelle Perkons, Samuel Hofacker

Category Clinical Vignettes

Concept Pneumocephalus

Concept Complication

Concept Subarachnoid Space

Concept Cranial Vault

Concept Multidisciplinary Coordination

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Michelle Perkons

Track Adult

Keywords

pneumocephalus

E. coli meningitis

esophageal squamous cell carcinoma

retro-esophageal fluid collection

video-assisted thoracoscopic surgery

iatrogenic complication

spinal hardware

lumbar puncture

hospitalist coordination

neurologic monitoring

Pneumocephalus

Complication

Subarachnoid Space

Cranial Vault

Multidisciplinary Coordination