Thoraco-abdominal pneumorrhachis following pneumomediastinum, pneumoretroperitoneum, cervical, thoracic and abdominal wall subcutaneous emphysema after retroduodenal perforation: Case report of a rare radiologic finding

Pneumorrhachis (PR) is an under-diagnosed phenomenon delineating existence of intraspinal air. We report a case in which extradural PR developed along with pneumoretroperitoneum, pneumomediastinum, cervical, thoracic and abdominal wall subcutaneous emphysema after retroduodenal perforation following ERCP. ERCP was done to evaluate obstructive jaundice in a 62-year-old male following which patient developed abdominal pain and crepitus in the body wall. Computerized tomography scan revealed extradural pneumorrhachis of thoraco-abdominal spinal canal with presence of air in the body cavities. The patient remained however neurologically asymptomatic and recovered with conservative management over the next few days. We have also studied the available literature and presented a pathway of air dissection from the body cavities to the epidural space.