Spontaneous pneumomediastinum: an algorithm for diagnosis and management

Abstract

Spontaneous pneumomediastinum (SPM) is a rare disorder most often affecting young males which is generally self-limiting. Despite the benign prognosis with few complications and little morbidity, it frequently confuses clinicians in primary settings, who may have difficulty differentiating SPM from other serious organ ruptures, especially oesophageal rupture (the so-called Boerhaave syndrome), which may lead to mediastinitis and may be fatal, even with appropriate interventions. An overview of adult SPM is provided, reviewing 17 studies (414 patients), including our clinical experience, and finally an algorithm for diagnosis and management of SPM is proposed, based on the characteristics of SPM.

Diagnosis and treatment of spontaneous pneumomediastinum is not complicated

“…There is no specifically treatment of SPM either on adults or children [10][11][12][13]. After diagnostic studies, hospitalization is necessary, oxygen support, bed rest, pain control and/or antibiotic administration is essential.…”

Spontaneous pneumomediastinum following exposure to metal paint spray: a first time report

“…The prevalence of SPM remains underestimated due to its self-limiting nature and underdiagnosis. This is predominantly a disease of young males between 18 and 25 years old [Takada et al 2009]. Unlike spontaneous pneumothorax, no specific somatotype or smoking habits has been consistently associated with SPM [Takada et al 2009;Koullias et al 2004;Abolnik et al 1991].…”

“…This air leak is usually of small quantity as the trigger events are of very short duration, making SPM a benign self-limited disease. However, no trigger events may be found in 40% cases [Takada et al 2009]. …”

“…It is an uncommon, self-limiting, typically benign disorder, affecting mostly young males with or without an apparent precipitating factor. The usual trigger events for SPM are strong physical exertions, contact sports, acute asthma attack, violent cough related to acute respiratory infections, severe vomiting, Valsalva maneuver, inhalation of illicit drugs, forced defecation, labor, pulmonary function test, diabetic ketoacidosis and bromine inhalation [Takada et al 2009;Koullias et al 2004;Abolnik et al 1991;Lossos et al 1990]. As the presenting symptoms of SPM mimic those of other common disorders it can be misdiagnosed and underreporting is common due to its self-limiting nature.…”

“…Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum that is not preceded by trauma, surgery or other medical procedures [Takada et al 2009;Iyer et al 2009]. It is an uncommon, self-limiting, typically benign disorder, affecting mostly young males with or without an apparent precipitating factor.…”