{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:30:07Z","timestamp":1769632207255,"version":"3.49.0"},"reference-count":14,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,29]],"date-time":"2024-09-29T00:00:00Z","timestamp":1727568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"institutional academic funds"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Bronchial-subarachnoid fistulas are rare occurrences, which are not well defined in the literature. This uncommon clinical phenomenon may result in symptomatic pneumorrhachis and presents unique clinical challenges. This report details a case of a 53-year-old female whose treatment for recurrent chondrosarcoma of the thoracic spine included multiple surgeries and radiotherapy. Two weeks after her most recent debulking surgery, she experienced a rapid onset of unusual symptoms, including headache, back and neck spasms, bladder incontinence, and confusion. The source of her symptoms was found to be secondary to pneumorrhachis from a pre-existing bronchial-pleural fistula that had fistulized to the subarachnoid space discovered on computed tomography (CT) and confirmed intraoperatively. The patient was treated successfully with high-flow oxygen therapy and bed rest, followed by surgical correction of both a pleural air leak and a dural defect with muscular flaps. The patient was discharged home in stable condition and remained clinically free of recurrent bronchial-subarachnoid fistula six months after surgical repair. This case contributes to the existing literature by providing detailed clinical insights into the diagnosis and successful management of a bronchial-subarachnoid fistula leading to pneumorrhachis, thereby highlighting the importance of early recognition and intervention and underscoring the need for further research in this area.<\/jats:p>","DOI":"10.3390\/diagnostics14192170","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T04:00:04Z","timestamp":1727668804000},"page":"2170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptomatic Pneumorrhachis from Bronchial-Subarachnoid Fistula"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8803-3143","authenticated-orcid":false,"given":"Alexander W.","family":"Lipinski","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Arizona Campus, Mayo Clinic College of Medicine and Science, Scottsdale, AZ 85259, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathew V.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric J.","family":"Wannamaker","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent M.","family":"Timpone","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1007\/s00586-006-0160-6","article-title":"Pathogenesis, diagnosis and management of pneumorrhachis","volume":"15","author":"Oertel","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.injury.2019.10.075","article-title":"Traumatic pneumorrhachis","volume":"51","author":"Pfeifle","year":"2020","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/ppul.26305","article-title":"Spontaneous pneumorrhachis with pneumomediastinum, scrotal emphysema, and extensive subcutaneous emphysema in a patient with pneumonia: A case report and literature review","volume":"58","author":"Zhuang","year":"2023","journal-title":"Pediatr. Pulmonol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e12137","DOI":"10.1002\/anr3.12137","article-title":"Pneumorrhachis following cervical spine surgery","volume":"9","author":"Bautista","year":"2021","journal-title":"Anaesth. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.radcr.2016.06.001","article-title":"An unusual cause of acute headache: Subarachnoid free air secondary to spontaneous bronchopleurodurosubarachnoid fistula from a Pancoast tumor","volume":"11","author":"Kazimirko","year":"2016","journal-title":"Radiol. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"164","DOI":"10.14245\/kjs.2016.13.3.164","article-title":"Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery","volume":"13","author":"Lee","year":"2016","journal-title":"Korean J. Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1259\/bjr.73.867.10817052","article-title":"Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula","volume":"73","author":"Lin","year":"2000","journal-title":"Br. J. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3340\/jkns.2011.50.1.64","article-title":"A case of broncho-paraspinal fistula induced by metallic devices: Delayed complication of thoracic spinal surgery","volume":"50","author":"Son","year":"2011","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1038\/s41394-019-0235-3","article-title":"A rare case of concomitant pneumocephalus and pneumorachis after lumbar spine surgery with late presenting dural leak","volume":"5","author":"Gupta","year":"2019","journal-title":"Spinal Cord Ser. Cases"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"405","DOI":"10.2176\/nmc.cr2013-0118","article-title":"Pneumocephalus and pneumorrhachis after spinal surgery: Case report and review of the literature","volume":"54","author":"Karavelioglu","year":"2014","journal-title":"Neurol. Med.-Chir."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s10143-020-01300-8","article-title":"Traumatic pneumorrhachis: Systematic review and an illustrative case","volume":"44","author":"Osunronbi","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s10143-023-02261-4","article-title":"Use of oxygen therapy for pneumocephalus: A systematic review","volume":"47","author":"Kim","year":"2024","journal-title":"Neurosurg. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3171\/spi.2006.5.2.165","article-title":"Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery: Case report","volume":"5","author":"Rovlias","year":"2006","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"861.e1","DOI":"10.1016\/j.ajem.2014.12.040","article-title":"Traumatic pneumorrhachis: 2 cases and review of the literature","volume":"33","author":"Kara","year":"2015","journal-title":"Am. J. Emerg. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/19\/2170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:06:21Z","timestamp":1760112381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/19\/2170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,29]]},"references-count":14,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["diagnostics14192170"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14192170","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,29]]}}}