A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature.
Abscess ; Adolescent ; Cough ; Eating ; Emergency Service, Hospital ; Emphysema ; Female ; Foreign Bodies ; Head ; Humans ; Laryngoscopy ; Mediastinal Emphysema* ; Mediastinitis ; Mediastinum ; Neck ; Oxygen ; Palpation ; Pharyngitis ; Physical Examination ; Subcutaneous Emphysema ; Substance-Related Disorders ; Vocal Cords ; Voice

BACKGROUNDThe exaggerated surge in morning blood pressure (BP) that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications. However, no previous studies have evaluated the rate of this surge independently of the evening period. It remains unclear whether the rate of increase experienced during the surge is a significant or independent determinant of cardiovascular events.

METHODSWe randomly selected 340 ambulatory BP monitoring (ABPM) patients. All subjects without type 2 diabetes mellitus were divided into two groups: hypertensive group (n = 170) and normotensive group (n = 170). We analyzed ambulatory blood pressure recordings using a double logistic curve-fitting procedure to determine whether the magnitude of the surge in BP and heart rate (HR) in the morning is related to the level of BP in hypertensive individuals. We evaluated the association between the rate of the morning surge in systolic BP (SBP) and the incidence of myocardial infarction and stroke in normotensive and hypertensive subjects.

RESULTSComparisons between hypertensive and normotensive subjects showed that the rates of the morning surges in SBP, mean BP (MBP), and diastolic BP (DBP) were greater in the hypertensive group (P < 0.05) than in the normotensive group. The rate of morning surge in BP was found to be correlated with the daytime SBP (r = 0.236, P < 0.01), the difference between the day and night plateau (r = 0.249, P < 0.01), and the night SBP (r = -0.160, P < 0.05), respectively. After controlling for age, sex, and mean systolic pressure within 24 hours (24 h SBP), the rate of morning surge in SBP was closely correlated with daytime SBP (r = 0.463, P < 0.001), night SBP (r = -0.173, P < 0.05), and the difference between the day and night plateau (r = 0.267, P < 0.001). Logistic regression analysis revealed that the rate of morning surge in SBP was an independent determinant of myocardial infarction (OR = 1.266, 95% CI = 1.153 - 1.389, P < 0.001) and stroke (OR = 1.367, 95% CI = 1.174 - 1.591, P < 0.001).

CONCLUSIONSThe rate of the morning surge in BP is greater in hypertensive subjects than in normotensive subjects. Daytime SBP may be the best predictor of the rate of morning surge in SBP. The rate of the morning surge in BP is associated with cardiovascular and stroke events.

Adult ; Aged ; Blood Pressure ; physiology ; Blood Pressure Monitoring, Ambulatory ; Circadian Rhythm ; physiology ; Female ; Heart Rate ; radiation effects ; Humans ; Hypertension ; physiopathology ; Male ; Middle Aged ; Stroke ; physiopathology