title: Three Simultaneous Cases of Spontaneous Pneumomediastinum With Epidural Pneumatosis During Vocal Training.
abstract: OBJECTIVE
  The aim of this study was to describe a case series of three simultaneous cases of spontaneous pneumomediastinum (SPM) with epidural pneumatosis during vocal training.
  
  
  METHODS
  A report of three cases with chart review was performed. Literature review was carried out using PubMed.
  
  
  RESULTS
  This was an extremely rare case series where at least three of the 20 participants of a vocal training in a self-development seminar developed SPM, epidural pneumatosis, pneumothorax, and subcutaneous emphysema. All cases improved with bed rest. Simultaneous cases of SPM have been reported in the past. However, the cause of simultaneous occurrence has not been explained clearly. In our cases, continuous excessive vocal training may have caused intrathoracic pressure to rise, causing SPM at a high prevalence. Epidural pneumatosis is a rare finding. Studies on epidural pneumatosis complicating SPM are limited. Air is said to easily pass through the cervical region owing to the close proximity between the mediastinum and the upper spine, resulting in epidural pneumatosis. Elevated intrathoracic pressure while the glottis is closed may worsen the risk for epidural pneumatosis. In this seminar, continuous effortful vocal training at full pitch with few pauses for breath may have contributed to this simultaneous occurrence.
  
  
  CONCLUSIONS
  We report three simultaneous cases of SPM and epidural pneumatosis due to demanding vocal training. Further research on this subject is desired to identify risk factors.
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.. Electronic address: yukitsukihana0105@gmail.com.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshimatsu
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Yamairi
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Nakasone
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Michiru
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Saori
authors.initials: S
authors.lastname: Terai
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Maruyama
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Yae
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Munetake
authors.initials: M
authors.lastname: Takata
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Iwae
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Otani
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kamimori
authors.affiliation: Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D004824:Epidural Space; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology*; D012307:Risk Factors; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014834:Voice Training; D055815:Young Adult
keywords: epidural pneumatosis; pneumothorax; spontaneous pneumomediastinum; subcutaneous emphysema; vocal training