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Epidural Pneumatosis of the Cervicothoracic Spine Associated With Transient Upper Motor Neuron Findings Complicating Haemophilus influenzae Pharyngitis, Bronchitis, and Mediastinitis

Harrod, Christopher C. MD*; Boykin, Robert E. MD*; Kim, Young J. MD, PhD

Journal of Pediatric Orthopaedics: July-August 2010 - Volume 30 - Issue 5 - p 455-459
doi: 10.1097/BPO.0b013e3181df44b6

Background Epidural pneumatosis and pneumomediastinum are rare findings. Reports in children are exceedingly rare. Abnormal neurologic findings have yet to be reported.

Methods We report on the case of a 7-year-old girl who was diagnosed with epidural pneumatosis with signs of neurologic compression in the setting of Haemophilus influenzae upper and lower respiratory infection. After urgent direct laryngoscopy, bronchoscopy, esophagoscopy, and pharyngeal biopsy was carried out, CT scan of the chest revealed extensive pneumomediastinum tracking along vessels throughout the neck and chest in addition to epidural pneumatosis from C6 to T5. Upper motor neuron findings were present. Broad spectrum antibiotics were administered, and interval neurologic examination and repeat CT scans showed resolution of abnormal neurologic exam in addition to epidural pneumatosis dissipation.

Results Rapid clinical improvement was noted on broad spectrum intravenous antibiotics with extubation on postoperative day one. She was discharged home on oral augmentin on postoperative day 4 with intact neurologic examination. At 11 month follow-up, she remained symptom-free with normal neurologic examination and unremarkable cervical and thoracic spine radiographs.

Conclusion Resolution of clinical and radiographic findings is possible with conservative treatment.

Level of Evidence IV.

*Orthopaedics, Massachusetts General Hospital

Department of Orthopedic Surgery, Children's Hospital Boston, Boston, MA

Disclaimer: None of the subjects received any financial assistance or will receive from a commercial party related directly or indirectly to the subject of this article.

Reprints: Young J. Kim, MD, PhD, The Department of Orthopedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Fegan Bldg 2nd floor Boston, MA 02115. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.