Pneumoperitoneum and Pneumomediastinum Caused by Pulmonary Fibrosis

Abstract

An 80-year-old man was diagnosed as having malignant lymphoma in 2011 and underwent chemotherapy, which led to complete remission (CR). After achieving CR, he had been treated with steroid for pulmonary fibrosis since 2015. On the most recent occasion he crashed, recurrence of the malignant lymphoma brain metastasis was found and he was hospitalized. Radiotherapy was performed for malignant lymphoma metastatic brain tumor. On the 30th day after hospitalization, he suddenly exhibited difficulty breathing, mediastinal emphysema and intraperitoneal free gas was detected in the upper abdomen by radiological imaging. In the absence of findings of perforation of the gastrointestinal tract, mediastinal emphysema and pneumoperitoneum related to pulmonary fibrosis were diagnosed. There are few case reports of pneumoperitoneum complicated with respiratory disease. Radiotherapy was administered with the diagnosis of malignant lymphoma metastatic brain tumor. Dyspnea appeared, mediastinal emphysema and intraperitoneal gas were confirmed by image examination, and pneumoperitoneum and pneumoperitoneum were diagnosed.