Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

Abstract

Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST) was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

Cocaine-Induced Cervical Emphysema and Pneumomediastinum

“…The most common symptoms of pneumomediastinum include dyspnea (75% of patients), chest pain (50% of patients), and dysphagia [1]. By far, the most common cause of pneumomediastinum is blunt trauma leading to direct injury at various levels of the airway [6]. The condition may also arise as a spontaneous pneumomediastinum, as detailed by Macklin.…”

“…Other causes include perforation of hollow abdominal organs or injury to the esophagus, larynx, or tracheobronchial tree. Injury to the neck or face can also lead to air tracking down the fascial planes [2,6,8,9].…”

“…Cervical emphysema and pneumomediastinum refer to the presence of gas in the tissues of the neck and the mediastinum, respectively. The most common causes include injury to the tracheobronchial tree, alveoli, and the upper GI tract [4,6]. More distant injuries, such as to the face or hollow organs of the abdomen, can potentially lead to air tracking into the tissues of the neck and mediastinum [9,11].…”

“…More distant injuries, such as to the face or hollow organs of the abdomen, can potentially lead to air tracking into the tissues of the neck and mediastinum [9,11]. Previously reported activities that drive air into the tissue include air-driven dental tools, positive pressure ventilation, and Valsalva maneuvers related to actions such as weight lifting, childbirth, coughing, and singing [6,10,11].…”

Facial Oedema Is Not Always Angioedema: A Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema during COPD Exacerbation

“…A facial, neck and chest CT scan then revealed a pneumomediastinum associated with severe subcutaneous emphysema, which was probably secondary to rupture of an emphysematous lung bulla during a coughing paroxysm [1] . In light of the absence of mediastinal organ injury, we adopted a conservative approach [2,3] . We administered antibiotics and oxygen, and prescribed rest, antitussives and laxatives in order to prevent any movement that could increase the intrathoracic pressure.…”