Epidural pneumatosis: a benign entity in trauma patients.

Air may be visualized in the spinal epidural space in a variety of settings. Pathologic collections of air from herniated vacuum disk and epidural abscess have been described [1, 2]. Iatrogenic air may result from epidural anesthesia or unsuccessful lumbar puncture. Intraspinal air (pneumorrhachis) after trauma has been considered a rare occurrence; only three cases have been reported in the literature. In one case, air was found in the thoracic spine after a fracture dislocation of L2 with jejunal perforation [3); in the second case, air was seen in the cervical spine in association with a pneumothorax [4]. In the third case, subarachnoid air extended from a traumatic pneumocephalus [5]. In other instances, pneumorrhachis would suggest an open or penetrating spinal injury. Epidural air directly resulting from a pneumomediastinum has not been reported before. Three cases are described here.