Pneumorrhachis and pneumothorax with pneumocephalus following gunshot wound to the chest in a 45-year-old male: a case report.

BACKGROUND

This report presents a rare case of pneumorrhachis, pneumothorax, and pneumocephalus in a patient with multiple traumatic injuries following a gunshot wound to the chest. Pneumorrhachis, the presence of air within the spinal canal, can arise from iatrogenic, nontraumatic, or traumatic causes and is classified as extradural or intradural, the latter often linked to severe trauma. Pneumothorax, air in the pleural space, may impair ventilation and presents as simple, communicating, or tension types, with causes including trauma, iatrogenesis, or spontaneous events. Pneumocephalus, an accumulation of gas within the neurocranium, typically resolves spontaneously but rarely occurs in combination with pneumothorax after thoracic gunshot trauma. This report aims to elucidate the potential pathophysiological mechanisms of air migration and highlight the multidisciplinary management challenges inherent in this rare traumatic triad.

CASE PRESENTATION: A 45-year-old Syrian male presented with multiple traumatic injuries following a gunshot wound to the chest. Initial assessment revealed respiratory distress, hemodynamic instability, and decreased oxygen saturation. Clinical evaluation and imaging confirmed a tension pneumothorax, which was treated with an emergent chest tube placement. Subsequent computed tomography scans showed extensive pneumocephalus, with air pockets in the intracranial cavity, and pneumorrhachis, with air tracking along the spinal canal. Both findings were attributed to the high-pressure air leakage through fascial planes and anatomical pathways caused by the penetrating trauma. The patient was managed with supplemental oxygen, careful neurological monitoring, and supportive care. Despite the severe injuries, his condition stabilized, and no surgical intervention was required for the pneumorrhachis or pneumocephalus, which resolved spontaneously over time. However, the patient's clinical course was complicated by persistent infection and respiratory failure, and he ultimately succumbed to his injuries 3 months after admission.

CONCLUSION

The coexistence of pneumorrhachis, pneumothorax, and pneumocephalus following chest gunshot trauma is exceedingly rare. This case underscores the importance of early recognition, prompt imaging, and multidisciplinary care in managing such complex injuries, contributing valuable insights to the limited literature on these conditions.