European Journal of Trauma and Emergency Surgery

, Volume 45, Issue 5, pp 927–931 | Cite as

Pneumomediastinum and pneumopericardium following blunt thoracic trauma: much ado about nothing?

  • David James Jackson Muckart
  • Timothy Craig HardcastleEmail author
  • David Lee Skinner
Original Article



Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. Aim: review of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning.


Admissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed.


Three hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury.


The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.


Pneumomediastinum Pneumopericardium Chest trauma Blunt Severe Outcome 


Compliance with ethical standards

Conflict of interest

No conflict of interest reported for any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery, Nelson R Mandela School of Clinical MedicineUniversity of KwaZulu-NatalCongellaSouth Africa
  2. 2.Trauma ServiceInkosi Albert Luthuli Central HospitalMayvilleSouth Africa
  3. 3.Adult Intensive Care Service, Division of Anaesthesiology and Critical CareKing Edward VIII HospitalKwaZulu-NatalSouth Africa

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