Rapid disappearance of pneumorrhachis after chest tube placement

Introduction:We present a rare case of traumatic pneumorrhachis with the combination of hemothorax which resolved rapidly after insertion of a chest tube.Case presentation:A 55 year old male was admitted to our emergency department after falling from a ladder. His general condition was well, GCS was 15 with nomotor deficits. On his spinal CT a fracture on multiple ribs leading to right sided hemothorax was observed with air in the T6-T8 spinal canal. A chest tube was placedand as he did not have any neurological deficits surgical intervention to the pneumorrhachis was not considered. On the next day's a follow-up CT the air in the spinalcanal was reduced and on the 5th day resolved completely.Conclusion:Traumatic pneumorrhachis is a rare phenomenon and is not fully understood how the air from the posterior mediastinal wall can spread to the epiduralor subarachnoid space. One hypothesis for subarachnoid air is that the high pressure air from a pneumothorax or pneumomediastinum pushes in a one-valvemechanism through the fascial layers of the posterior mediastinum through the neural foramina into the spinal canal. In our case, after the insertion of the chest tubethe air in the subarachnoid space resolved and the patient's tingling sensation on his legs disappeared. We believe that the negative pressure of the chest tube did asomehow reverse effect of the air flow back from the spinal canal into the chest tube which has not been reported in the literature before.