Pneumomediastinum in blunt trauma: If aerodigestive injury is not seen on CT, invasive workup is not indicated

Matthees, Nicholas; Mankin, James A.; Trahan, Amy; Israr, Sharjeel; Jones, Michael David; Dameworth, Jonathan L; Petersen, Scott R.; Weinberg, Jordan A.

doi:10.1016/j.amjsurg.2018.11.002

Cited by 4 publications

(8 citation statements)

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“…The most prevalent mechanism of thoracic trauma in this study was RTA, accounting for more than half of the total cases (63.6%) and 94% of the blunt chest trauma, this is in accordance with the international standard for the unilateral chest trauma [ 11 , [13] , [14] , [15] , [16] ]. Rib fracture is a frequent manifestation of blunt chest trauma.…”

Section: Discussionsupporting

confidence: 85%

Bilateral thoracic trauma; presentation and management, a case series

Baram

Kakamad

2019

Annals of Medicine and Surgery

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Introduction Unilateral chest trauma has been perfectly described in the literature while bilateral chest trauma has never been specifically probed, the aim of this study is to highlight the specificities, presentations, the difference in the therapeutic algorithm and outcome of patients with bilateral thoracic trauma. Patients and methods A single center, prospective study was carried out in four years. The data were taken directly from the patients, patient's relatives and the medical records. All patients presenting with bilateral chest trauma, admitted to the hospital overnight, were included in this study. The patients were managed according to the Advanced Trauma Life Support (ATLS) protocol which consists of primary and secondary surveys. For those patients who diagnosed to have either haemo or pneumothorax or both, thoracostomy tube was inserted. Descriptive and analytical analyses were calculated. Results The study included 107 patients. Bilateral blunt trauma was found in 72 (67.3%) cases while bilateral penetrating trauma was found in 35 (32.7%) patients. The most common mechanism of trauma was road traffic accidents (RTA) accounting for 68 (63.6%) victims. Overall 30-day mortality was 14.9%. In blunt trauma, 3 or more rib fracture, pulmonary contusion, intubation, and intensive care unit admission were among the predictors of increased risk of mortality. Conclusion Bilateral thoracic trauma has comparable patterns of presentation, choices of investigation, strategies of management, predictors of the outcome, morbidity and mortality with unilateral chest trauma.

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Section: Discussionsupporting

confidence: 85%

Bilateral thoracic trauma; presentation and management, a case series

Baram

Kakamad

2019

Annals of Medicine and Surgery

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“…En el contexto de trauma contuso, la presencia de neumomediastino parece ser un hallazgo que en la mayoría de los casos es benigno y rara vez constituye la evidencia de una lesión aerodigestiva subyacente. En esta cohorte de pacientes solo se presentaron tres lesiones aerodigestivas, en dos pacientes, con una incidencia de 4,8 % para lesión de vía aérea y de 2,4 % para lesión de esófago, que concuerda con lo reportado en estudios retrospectivos similares 2,5,9,11 . La baja incidencia de este tipo de lesiones se debe probablemente al tamaño pequeño de las estructuras en comparación con los demás órganos intratorácicos, la posición relativamente protegida y a la alta tasa de mortalidad prehospitalaria cuando este tipo de lesiones están presentes o en asociación con lesiones de estructuras vasculares principales.…”

Section: Discussionunclassified

“…Las actuales imágenes tomográficas de alta resolución y el uso rutinario de reconstrucciones multiplanares de alta calidad han permitido una detección confiable de las lesiones aerodigestivas, llevando a que se reconozca la presencia de neumomediastino en los estudios tomográficos de los pacientes con trauma contuso como un mal predictor de lesión aerodigestiva 13 , confirmando la baja incidencia de estas lesiones y la precisión diagnóstica de las imágenes avanzadas de la TCMD al compararla con la fibrobroncoscopia y la EDS, por lo que resulta innecesario seguir utilizando los estudios endoscópicos de forma rutinaria en la evaluación del neumomediastino secundario a un trauma contuso cuando la TCMD es negativa y sin hallazgos sospechosos 5,9,11 .…”

Section: Discussionunclassified

“…Las disrupciones focales o irregularidades de la pared traqueal o bronquial son altamente sugestivas de lesión de vía aérea, al igual que los patrones específicos de distribución del aire mediastinal, el cual suele estar distribuido de forma asimétrica, con mayor cantidad de aire del lado de la lesión y rodeándola. Los hallazgos tomográficos sugestivos de lesión esofágica son la presencia de aire extraluminal periesofágico, el derrame pleural izquierdo, el colapso del lóbulo pulmonar inferior izquierdo, la presencia de aire en el espacio prevertebral y la presencia de líquido en el compartimiento mediastinal visceral 2,5,15 .…”

Section: Discussionunclassified

“…Clásicamente se ha considerado que el hallazgo en los estudios de imagen de neumomediastino puede deberse a una lesión aerodigestiva subyacente, lo que genera preocupación en el cirujano de trauma, debido a las implicaciones clínicas que estas lesiones podrían acarrear 3 . Esto ha llevado a que se recomiende la realización de procedimientos diagnósticos invasivos de forma sistemática, como la fibrobroncoscopia y la endoscopia digestiva superior (EDS), para descartar este tipo de lesiones, para evitar su morbimortalidad, cuando están presentes 4,5 . Sin embargo, las lesiones de la vía aérea y del esófago secundarias a trauma contuso son excepcionalmente raras, lo que cuestiona el valor diagnóstico de estos estudios en este contexto clínico 4,6 .…”

Section: Introductionunclassified

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Neumomediastino en trauma contuso: ¿son siempre necesarios los estudios invasivos para descartar lesión aerodigestiva?

et al. 2022

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Introducción. La presencia de neumomediastino secundario a un trauma contuso es un hallazgo común, especialmente con el uso rutinario de la tomografía computarizada. Aunque en la mayoría de los casos es secundario a una causa benigna, la posibilidad de una lesión aerodigestiva subyacente ha llevado a que se recomiende el uso rutinario de estudios endoscópicos para descartarla. El propósito de este estudio fue determinar la incidencia de neumomediastino secundario a trauma contuso y de lesiones aerodigestivas asociadas y establecer la utilidad de la tomografía computarizada multidetector en el diagnóstico de las lesiones aerodigestivas. Métodos. Mediante tomografía computarizada multidetector se identificaron los pacientes con diagnóstico de neumomediastino secundario a un trauma contuso en un periodo de 4 años en un Centro de Trauma Nivel I. Resultados. Fueron incluidos en el estudio 41 pacientes con diagnóstico de neumomediastino secundario a un trauma contuso. Se documentaron en total tres lesiones aerodigestivas, dos lesiones traqueales y una esofágica. Dos de estas fueron sospechadas en tomografía computarizada multidetector y confirmadas mediante fibrobroncoscopia y endoscopia digestiva superior, respectivamente, y otra fue diagnosticada en cirugía. Conclusión. El uso rutinario de estudios endoscópicos en los pacientes con neumomediastino secundario a trauma contuso no está indicado cuando los hallazgos clínicos y tomográficos son poco sugestivos de lesión aerodigestiva.

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Evaluating emergency department visits for spontaneous and traumatic pneumomediastinum: a retrospective analysis

İshak Işık

2024

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Pneumomediastinum signifies the accumulation of air within the mediastinum. This condition can develop spontaneously or as a secondary condition due to trauma or iatrogenic causes. Although rare, it is part of a wide differential diagnosis scale due to its most common presenting symptoms: chest pain and shortness of breath. METHODS: Our study is a retrospective, observational, and cohort investigation. It included patients who presented to the emergency department and were diagnosed with pneumomediastinum through computed tomography. The study evaluated patients’ sociodemographic features, methods of presentation, chest tube insertion, other surgical procedures, outcomes, and patient dispositions. The primary outcome of the study focused on the results of traumatic and spontaneous pneumomediastinum: hospital admission, the necessity for thoracostomy tube insertion, requirement for surgical procedures, and mortality. The secondary aim was to determine the relationship between other clinical features and laboratory parameters and their impact on the outcomes. RESULTS: The study comprised 67 cases. The average age of the cases was 44.89±2.41 years. Of the cases, 67.2% (n=45) were male. In terms of development, 40.3% (n=27) of cases were classified as spontaneous, and 59.7% (n=40) were post-trauma pneumomediastinum diagnoses. Among symptoms, 50.7% (n=34) of patients experienced dyspnea, and 49.3% (n=33) presented with chest pain, while symptoms like cough, fever, nausea, vomiting, and swallowing difficulty were reported in varying proportions. Among the patients, 9.0% (n=6) had lung disease, 29.9% (n=20) had comorbidities, 3.0% (n=2) had a history of substance use, 14.9% (n=10) underwent thoracostomy tube insertion, and 20.9% (n=14) required surgical procedures. While 35.8% (n=24) of the patients were admitted to the intensive care unit, 13.4% (n=9) died. The mean total hospital stay was calculated as 8.68±1.12 days. No statistically significant relationship was found between the development of pneumomediastinum and hospital admission (p=0.507). CONCLUSION: Upon examining the causes of pneumomediastinum cases, it was observed that patients with a history of trauma required thoracostomy tube insertion and surgical intervention more frequently. However, when classified as spontaneous or traumatic, both groups exhibited similar clinical courses and outcomes. Both groups demonstrated favorable clinical outcomes.

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Pneumomediastinum in blunt trauma: If aerodigestive injury is not seen on CT, invasive workup is not indicated

Cited by 4 publications

References 13 publications

Bilateral thoracic trauma; presentation and management, a case series

Bilateral thoracic trauma; presentation and management, a case series

Neumomediastino en trauma contuso: ¿son siempre necesarios los estudios invasivos para descartar lesión aerodigestiva?

Evaluating emergency department visits for spontaneous and traumatic pneumomediastinum: a retrospective analysis

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