&lt;p&gt;Analysing the Clinical Features of Pneumomediastinum Associated with Diabetic Ketoacidosis in 79 Cases&lt;/p&gt;

Zhang, Weidong; Chen, Jingfang; Wu, Xinying; Chen, Luyu; Wei, Jinxin; Xue, Mingqiang; Liang, Qingzheng

doi:10.2147/dmso.s230799

Cited by 10 publications

(12 citation statements)

References 32 publications

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“…Pathophysiologically, the condition is thought to result from pressure changes leading to alveolar rupture followed by tracking of air along the bronchovascular tissue plane, a process known as the Macklin effect (3). Cases have attributed PSPM to other Valsalva events, such as child-birth (4), diabetic ketoacidosis (5), fellatio (6) and cannabinoid hyperemesis syndrome (7). However, PSPM patients may present without any clear inciting event or predisposing factors (8,9).…”

Section: Review Articlementioning

confidence: 99%

A narrative review of primary spontaneous pneumomediastinum: a poorly understood and resource-intensive problem

Morgan¹,

Maloney²,

DeCamp³

et al. 2021

J Thorac Dis

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Primary spontaneous pneumomediastinum (PSPM) is a benign self-limited condition that can be difficult to discriminate from esophageal perforation. This may trigger costly work-up, transfers and hospital admissions. To better understand this diagnostic dilemma and current management, we undertook the most comprehensive and up to date review of PSPM. The PubMed database was searched using the MeSH term "Mediastinal Emphysema" [Mesh], to identify randomized controlled trials, meta-analyses and case series (including 10 or more patients) relevant to the clinical presentation and management of patients with PSPM. There were no relevant randomized controlled trials or meta-analyses. Nineteen case series met our criteria, including a total of 535 patients. The average mean age was 23 years with a 3:1 male predominance. Chest pain was the most common symptom, found in 70.9% of the patients. Dyspnea and neck pain were the second and third most common symptoms, found in 43.4% and 32% of the patients, respectively.Subcutaneous emphysema was the most common sign (54.2%). Common histories included smoking (29.6%), cough (27.7%), asthma (25.9%), physical exertion (21.1%) and recent retching or emesis (13%). Nearly all patients (96.9%) underwent chest X-ray (CXR). Other diagnostic studies included computed tomography (65%) and esophagram (35.6%). Invasive studies were common, with 13% of patients undergoing esophagogastroduodenoscopy and 14.6% undergoing bronchoscopy. The rate of hospital admission was 86.5%, with an average length of stay of 4.4 days. No deaths were reported. Notably, we identified a dearth of information regarding the vitals, laboratory values and imaging findings specific to patients presenting with PSPM. We conclude that PSPM is a benign clinical entity that continues to present a resource-intensive diagnostic challenge and that data on the vitals, labs, and imaging findings specific to PSPM patients is scant.An improved understanding of these factors may lead to more efficient diagnosis and management of these patients.

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Section: Review Articlementioning

confidence: 99%

A narrative review of primary spontaneous pneumomediastinum: a poorly understood and resource-intensive problem

Morgan¹,

Maloney²,

DeCamp³

et al. 2021

J Thorac Dis

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“…In the majority of 79 reported cases, after correction of acidosis and vomiting, pathological collections of air were gradually reabsorbed. 1 The benign, self-limiting course of Hamman's syndrome is a reason we infer that many cases remain undiagnosed, a theory proposed in other literature. 3 Two fatal cases have been described due to worsening pneumomediastinum and another due to pulmonary infection.…”

Section: Discussionmentioning

confidence: 84%

“…In DKA, alveolar rupture causes the movement of air down the pressure gradient into the mediastinal space. [1][2][3][4] Alveolar rupture in DKA is thought to be precipitated by Kussmaul breathing and severe vomiting. 1 The most common symptoms are chest pain and dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

Images of the month: An incidental finding of spontaneous pneumomediastinum (Hamman's syndrome) secondary to diabetic ketoacidosis during the coronavirus pandemic

2020

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“…As with much of the current literature, there are many confounding factors present within our data. A subset of our patients presented with a separate disease process associated with PMD, such as asthma ( 25 ) and diabetic ketoacidosis ( 26 ), which could have contributed to lab and vital sign abnormalities unrelated to the presence of PMD. Concurrent use of recreational drugs and tobacco, which are known to have deleterious effects on the lung ( 27 , 28 ), was present in many of our THC and CON patients.…”

Section: Discussionmentioning

confidence: 99%

Dedicated esophageal imaging may be unnecessary in marijuana-associated spontaneous pneumomediastinum: Findings from a retrospective cohort study

Tung²,

Dugan³

et al. 2023

Front. Surg.

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BackgroundMarijuana use has become more common since its legalization, as have reports of marijuana-associated spontaneous pneumomediastinum. Non-spontaneous causes such as esophageal perforation are often ruled out on presentation due to the severe consequences of untreated disease. Here we seek to characterize the presentation of marijuana-associated spontaneous pneumomediastinum and explore whether esophageal imaging is necessary in the setting of an often benign course and rising healthcare costs.Materials and MethodsRetrospective review was performed for all 18–55 year old patients evaluated at a tertiary care hospital between 1/1/2008 and 12/31/2018 for pneumomediastinum. Iatrogenic and traumatic causes were excluded. Patients were divided into marijuana and control groups.Results30 patients met criteria, with 13 patients in the marijuana group. The most common presenting symptoms were chest pain/discomfort and shortness of breath. Other symptoms included neck/throat pain, wheezing, and back pain. Emesis was more common in the control group but cough was equally prevalent. Leukocytosis was present in most patients. Four out of eight of computed tomography esophagarams in the control group showed a leak requiring intervention, while only one out of five in the marijuana group showed even a possible subtle extravasation of contrast but this patient ultimately was managed conservatively given the clinical picture. All standard esophagrams were negative. All marijuana patients were managed without intervention.DiscussionMarijuana-associated spontaneous pneumomediastinum appears to have a more benign clinical course compared to non-spontaneous pneumomediastinum. Esophageal imaging did not change management for any marijuana cases. Perhaps such imaging could be deferred if clinical presentation of pneumomediastinum in the setting of marijuana use is not suggestive of esophageal perforation. Further research into this area is certainly worth pursuing.

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<p>Analysing the Clinical Features of Pneumomediastinum Associated with Diabetic Ketoacidosis in 79 Cases</p>

Cited by 10 publications

References 32 publications

A narrative review of primary spontaneous pneumomediastinum: a poorly understood and resource-intensive problem

A narrative review of primary spontaneous pneumomediastinum: a poorly understood and resource-intensive problem

Images of the month: An incidental finding of spontaneous pneumomediastinum (Hamman's syndrome) secondary to diabetic ketoacidosis during the coronavirus pandemic

Dedicated esophageal imaging may be unnecessary in marijuana-associated spontaneous pneumomediastinum: Findings from a retrospective cohort study

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