Clinical Manifestations of Spontaneous Pneumomediastinum

Abstract

BackgroundSpontaneous pneumomediastinum (SPM) is an uncommon disorder with only a few reported clinical studies. The goals of this study were to investigate the clinical manifestations and the natural course of SPM, as well as examine the current available treatment options for SPM.MethodsWe retrospectively reviewed 91 patients diagnosed with SPM between January 2008 and June 2015.ResultsThe mean age of the patients was 22.7±13.2 years, and 67 (73.6%) were male. Chest pain (58, 37.2%) was the predominant symptom. The most frequent precipitating factor before developing SPM was a cough (15.4%), but the majority of patients (51, 56.0%) had no precipitating factors. Chest X-ray was diagnostic in 44 patients (48.4%), and chest computed tomography (CT) showed mediastinal air in all cases. Esophagography (10, 11.0%), esophagoduodenoscopy (1, 1.1%), and bronchoscopy (5, 5.5%) were performed selectively due to clinical suspicion, but no abnormal findings that implicated organ injury were documented. Twelve patients (13.2%) were discharged after a visit to the emergency room, and the others were admitted and received conservative treatment. The mean length of hospital stay was 3.0±1.6 days. There were no complications related to SPM except for recurrence in 2 patients (2.2%).ConclusionSPM responds well to conservative treatment and follows a benign natural course. Hospitalization and aggressive treatment can be performed in selective cases.

Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia

“…Furthermore, the patient developed a pronounced cough, which may also induce alveolar rupture. Mediastinal emphysema results from a sudden increase in the alveolar pressure, causing alveolar rupture and air leakage with interstitial emphysema (7); this can be observed in the severe acute respiratory syndrome (8). In addition to the giant bulla, chest CT also revealed multiple bullae in the subpleural lung zones (arrowheads; Fig.…”

Neumomediastino espontáneo y enfisema subcutáneo asociado con broncoespasmo en una mujer sin antecedente de asma

“…En un estudio realizado en Corea, que analizó la información correspondiente a 91 pacientes, se observó que los factores más frecuentes fueron el tabaquismo activo, la infección respiratoria y el asma. 5 En otro estudio elaborado en Portugal, que incluyó 18 pacientes, se identificaron los mismos factores.…”

“…5 Aparentemente, en nuestro caso el factor predisponente fue la infección del tracto respiratorio acompañada de broncoespasmo, debido a la falta de antecedentes personales de asma y de síntomas compatibles con rinitis alérgica.…”

“…3,4 Cabe mencionar que en esas mismas investigaciones en 11 a 34 % de los casos no se logró identificar el factor desencadenante. 3,5,6 En la paciente descrita al parecer fue la tos paroxística asociada con broncoespasmo.…”

“…4 Los eventos desencadenantes del NME de mayor relevancia son tos, vómito, problemas de alimentación, actividad física y uso de drogas inhaladas. 3,4,5,6 Los síntomas habituales del NME son disnea, dolor torácico, tos, dolor en cuello, disfagia y odinofagia; 3,4,5,6 que habitualmente están acompañados de enfisema subcutáneo en la región torácica, el cual que puede extenderse hasta la región del cuello. 6 El signo de Hamman, considerado patognomó-nico, que consiste en ruido sincrónico con los latidos del corazón, 7 se identifica en aproximadamente 6 a 14 % de los pacientes con NME.…”