Spontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients

Abstract

OBJECTIVE:To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. PATIENTS AND METHODS:We conducted a retrospective review of 62 consecutive adult patients (age ≥18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years).RESULTS: Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients [63%]), cough (28 [45%]), and dyspnea (27 [44%]). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). CONCLUSION:Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients.

Pneumomediastinum, subcutaneous emphysema, and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis

“…In addition, it can result in the feared air-block syndrome (a condition in which the presence of air in the interstitium and mediastinum does not find a way out, culminating in the generation of large pressures on the mediastinum, which affects circulation by compressing the vessels and the heart and prevents lung inflation and deflation). (2) In the present case, it is possible that the pneumomediastinum acted as a contributing factor to the fatal outcome because it facilitated the spread of infection and the perpetuation of inflammation, but without acting as a determinant of death, which was related to the interstitial lung disease and the severe, superimposed infectious process. In addition, it is of note that, in the present case, there was no indication for specific treatment for pneumomediastinum, such as mediastinotomy.…”

“…When mediastinal pressure rises abruptly and decompression by alternative pathways is insufficient to relieve pressure, there can be rupture of the mediastinal pleura and the development of pneumothorax ( Figure 3D). (2) The Brazilian Journal of Pulmonology has recently published a letter to the editor (7) describing a case of spontaneous pneumomediastinum and reporting, among other findings, pneumorrhachis, which is extremely rare. However, in that case, no imaging findings of dissection of air along the bronchovascular bundle were found.…”

“…Its clinical picture includes retrosternal chest pain (most common symptom), subcutaneous emphysema, dyspnea, dysphagia, dysphonia, asthenia, and the classical sign of Hamman's crunch (a crepitant sound that varies with the heartbeat on auscultation of the precordium). (1,2) In most cases, it is possible to identify a triggering event, such as acute exacerbations of asthma. Other known triggers include those related to the Valsalva maneuver, such as strenuous exercise, weight lifting, inhalation of illicit drugs, cough, forced evacuation, and labor, as well as vomiting, respiratory infections, foreign body aspiration, and barotrauma.…”

“…Other known triggers include those related to the Valsalva maneuver, such as strenuous exercise, weight lifting, inhalation of illicit drugs, cough, forced evacuation, and labor, as well as vomiting, respiratory infections, foreign body aspiration, and barotrauma. (1)(2)(3)(4)(5) The disease usually follows a benign, selflimiting course. (1,2) Treatment is supportive, consisting of using painkillers, resting, and avoiding maneuvers that generate an increase in transpulmonary pressure, such as the Valsalva maneuver and spirometry.…”

“…(1)(2)(3)(4)(5) The disease usually follows a benign, selflimiting course. (1,2) Treatment is supportive, consisting of using painkillers, resting, and avoiding maneuvers that generate an increase in transpulmonary pressure, such as the Valsalva maneuver and spirometry. (6) …”