Spontaneous Pneumomediastinum: Time for Consensus

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Abstract

Pneumomediastinum (PM) is defined as the presence of free air in the mediastinal cavity. It is often regarded as a revealing sign of a more serious medical condition. PM is broken down into two categories, one, with an instigating event, referred to as secondary PM. The other is when free air is discovered in the mediastinal cavity without a clear etiology, referred to as spontaneous pneumomediastinum (SPM). Often misdiagnosed due to the vague nature of presenting symptoms, SPM must be part of the differential diagnosis of a chest pain patient to expedite discovery and if necessary, management. A MedLine/PubMED search was performed identifying all relevant articles with “SPM” in the title. Six case series were reviewed to determine what clinical scenario constitutes a possible case of SPM. Results showed that almost all patients with SPM exhibited some chest pain, but Hamman’s crunch was present in only one-fifth of patients. Patients with certain pre-existing pulmonary diseases showed a greater propensity for the presence of free air in the mediastinal cavity. SPM must be diagnosed and managed promptly due to rare, but serious complications and any chest pain with an unknown etiology should contain SPM in the differential diagnosis.

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Most cited references 20

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Spontaneous pneumomediastinum: 41 cases.

Ivan Macia, Juan A. Moya, Ricard Ramos … (2007)

Spontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any apparent precipitating factor. The purpose of this study is to review and discuss our experience with this condition. A descriptive, retrospective study of 41 cases--34 men (83%) and 7 women (17%)--treated at our hospital for spontaneous pneumomediastinum from January 1990 through June 2006. The mean age of the patients was 21 years (range, 14-35 years). Notably, 22% of patients had a prior history of asthma. No precipitating factor was identified in 51% of cases while onset was associated with physical effort in 12%. Chest pain (85%) and dyspnea (49%) were the most common symptoms. Subcutaneous emphysema, which presented in 71% of patients, was the most common sign. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In certain cases, a computed tomography scan of the chest, contrast-enhanced swallow, or bronchoscopy was performed. All patients were admitted to the hospital with good progress and no instances of morbidity or mortality. Treatment included analgesia, rest, and/or initial oxygen therapy. The mean length of hospital stay was 5 days (range, 1-9 days) with only one case of early recurrence, which was resolved satisfactorily. Spontaneous pneumomediastinum is a benign process primarily affecting young men. Despite its low incidence, spontaneous pneumomediastinum should be considered in the differential diagnosis of acute chest pain because it requires a high index of suspicion. Patients with spontaneous pneumomediastinum respond well to medical treatment, with no recurrence in the great majority of cases.

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Spontaneous pneumomediastinum: a comparative study and review of the literature.

Manuel Caceres, Syed Z. Ali, Rebecca Braud … (2008)

Spontaneous pneumomediastinum (SPM) is an unusual occurrence with few cases reported. It is seen after intrathoracic pressure changes leading to alveolar rupture and dissection of air along the tracheobronchial tree. This study was undertaken to provide a thorough clinical and radiologic analysis of this patient population. A retrospective comparative analysis was performed on patients with SPM over 12 years. Patient demographics, clinical presentation, and radiographic and diagnostic studies were recorded. A clinical and radiologic comparison was performed with secondary pneumomediastinum. Seventy-four patients were identified with a diagnosis of pneumomediastinum. A total of 28 patients with SPM were identified. The major initial complaints were chest pain (54%), shortness of breath (39%), and subcutaneous emphysema (32%). The main triggering events were emesis (36%) and asthma flare-ups (21%). No apparent triggering event was noted in 21% of patients. Chest radiograph was diagnostic in 69%; computed tomography was required in 31%. Esophagram, esophagoscopy, and bronchoscopy were performed on an individual basis and were invariably negative. When compared with secondary pneumomediastinum, SPM is more likely to be discovered by chest radiography, has a lower incidence of pneumothorax and pleural effusion, requires a shorter hospital stay, and has no associated mortality. Spontaneous pneumomediastinum is a benign condition that often presents with chest pain or dyspnea. It can develop without a triggering event and with no findings on chest radiography. Treatment is expectant and recurrence is low. Secondary causes must be ruled out to avoid an unfavorable outcome.

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Spontaneous pneumomediastinum: a benign curiosity or a significant problem?

Peter J C Clarke, Andrew Newcomb (2005)

To identify the significance of spontaneous pneumomediastinum (SPM) and to optimize its management. A retrospective analysis was undertaken of all patients presenting with SPM over a 5-year period. Eighteen patients were identified, and information on their presentations, initial diagnoses, comorbidities, investigations, clinical courses, length of hospital stays, and outcomes were collated. The emergency department referrals of two major Melbourne teaching hospitals. SPM is an uncommon condition presenting in approximately 1 in 30,000 emergency department referrals. The typical patient identified from this study is a young man who is likely to have a history of asthma, and who is also likely to smoke or to use illicit drugs. The most common presentation is nonspecific pleuritic chest pain with dyspnea. Complications are rare, and the clinical course benign, but the possibility of a ruptured viscus or an initial misdiagnosis often leads to a great number of investigations. A proposed algorithm of management is given. Other serious and potentially life-threatening conditions, such as Boerhaave syndrome need to be excluded.

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Author and article information

Journal

Journal ID (nlm-ta): N Am J Med Sci

Journal ID (iso-abbrev): N Am J Med Sci

Journal ID (publisher-id): NAJMS

Title: North American Journal of Medical Sciences

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2250-1541

ISSN (Electronic): 1947-2714

Publication date (Print): August 2013

Volume: 5

Issue: 8

Pages: 460-464

Affiliations

[1]Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New Hyde Park, NY 11040, US

[1 ]School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY 10522, US

[2 ]Department of Medicine, Touro College of Osteopathic Medicine, Harlem, NY 10010, US

Author notes

Address for correspondence: Dr. Arunabh Talwar, Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New Hyde Park, NY 11040, US. E-mail: arunabh@ 123456nshs.edu

Article

Publisher ID: NAJMS-5-460

DOI: 10.4103/1947-2714.117296

PMC ID: 3784922

PubMed ID: 24083220

SO-VID: 949297a7-aca2-4697-99ea-b21723c3ceb6

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Spontaneous Pneumomediastinum: Time for Consensus

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Abstract

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Sex and gender-sensitive medicine

Most cited references 20

Spontaneous pneumomediastinum: 41 cases.

Spontaneous pneumomediastinum: a comparative study and review of the literature.

Spontaneous pneumomediastinum: a benign curiosity or a significant problem?

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