SHM Converge Scientific Abstract ePoster Gallery-Nutritional Emphysema

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This case describes a 58-year-old man with severe self-neglect and profound malnutrition after his mother’s death. For about a year, he avoided solid food and survived mostly on liquids, leading to a 200-pound weight loss. He arrived cachectic, weak, and covered in urine and feces, with edema and marked wasting. Imaging showed extensive pneumomediastinum, a tiny pneumothorax, pneumoperitoneum, and bowel wall thickening, but vascular studies showed patent mesenteric vessels and no thrombosis. An esophagram ruled out perforation, and surgeons found no need for operative treatment. He was started on parenteral nutrition, later transitioned toward enteral feeds, and improved radiographically by day 4 before discharge to a skilled nursing facility.<br /><br />The discussion highlights that spontaneous pneumomediastinum, pneumothorax, and pneumoperitoneum without typical triggers such as vomiting, barotrauma, infection, or chronic lung disease are rare. Severe malnutrition has long been suspected to cause emphysema-like lung changes. Prior studies in patients with anorexia nervosa found reduced lung density on CT, lower gas volume relative to lung tissue, declining diffusion capacity, and weakened respiratory muscles. Proposed mechanisms include surfactant deficiency and depleted glycogen stores, though these have not been definitively proven. Animal studies suggest these changes may improve with nutritional rehabilitation.<br /><br />The authors conclude that severe starvation can cause reversible structural lung abnormalities and even air-leak syndromes. Management requires aggressive nutritional support, careful monitoring for refeeding syndrome, arrhythmias, and skin breakdown, and evaluation of the underlying psychiatric cause of starvation.

Asset Subtitle

Gina Khraish

Meta Tag

Author List Andreea S. Xavier, Gina Khraish

Category Clinical Vignettes

Concept Severe Malnutrition

Concept Emphysema

Concept Nutritional Rehabilitation

Concept Self-Neglect

Concept Pneumomediastinum

Distinguished Non-Finalist

Presenter Organization McGovern Medical School

Presenting Author Gina Khraish

Track Adult

Keywords

severe malnutrition

self-neglect

pneumomediastinum

pneumothorax

pneumoperitoneum

starvation

anorexia nervosa

parenteral nutrition

refeeding syndrome

air-leak syndrome

Severe Malnutrition

Emphysema

Nutritional Rehabilitation

Self-Neglect

Pneumomediastinum