Central European Journal of Medicine

, Volume 9, Issue 5, pp 642–647 | Cite as

Spontaneous pneumomediastinum: ten years of our experience in diagnosis and outcome

  • Sanja Hromis
  • Biljana Zvezdin
  • Ivan Kopitovic
  • Senka Milutinov
  • Violeta Kolarov
  • Marija Vukoja
  • Bojan ZaricEmail author
Research Articlet


Spontaneous pneumomediastinum (SPM) is a rare clinical condition that may be mild but also dramatic with sudden onset of chest pain and dyspnea accompanied by swelling and subcutaneous crepitations. The objective of this study was to analyze the clinical presentation and outcome of SPM in a specialized pulmonary tertiary care centre over a 10 years year period. In subsequent followup, we received information related to recurrence episodes of SPM by patients or their GPs physicians. Eighteen patients, 15 (83%) men, mean age 24 years (SD ±7.86) were diagnosed with SPM. Predominant symptoms were chest pain and cough (n=11) then dyspnea (n=9). Asthma was the most common predisposing condition (n=12). Pneumomediastinum was present on chest radiograph in 17 cases (94%), and in one case it was detected only by computed tomography. The mean length of hospital stay was 7 days (SD ±4.4 days). All our patients recovered and there were no complications. Recurrent event occurred in one asthma patient, 2 years after the first episode. Although, SPM is usually a self-limiting and benign condition, close monitoring is necessary. Recurrence is rare, but possible, with no evidence that routine monitoring of those patients is needed.


Pneumomediastinum Subcutaneous emphysema Chest radiograph Asthma Hamman’s sign 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    Macia I., Moya J., Ramos R., Morera R., Escobar I., Saumench J., et al.. Spontaneous pneumomediastinum: 41 cases, Eur J Cardiothorac Surg. 2007; 31:1110–1114PubMedCrossRefGoogle Scholar
  2. [2]
    Rapose A., Naniwadekar A., Sarvat B., Sarria J.C., Esophageal Perforation and Pneumomediastinum: Rare Complications of Tuberculosis. Infect Dis Clin Pract. 2008; 16: 266–267CrossRefGoogle Scholar
  3. [3]
    Hamman L., Spontaneous mediastinal emphysema, Bull Johns Hopkins Hosp. 1939; 64: 1–21Google Scholar
  4. [4]
    Takada K., Matsumoto S., Hiramatsu T., Kojima E., Shizu M., Okachi S., et al., Spontaneous pneumomediastinum: an algorithm for diagnosis and management, Ther Adv Respir Dis. 2009; 3: 301–307PubMedCrossRefGoogle Scholar
  5. [5]
    Perna V., Vilà E., Guelbenzu J.J., Amat I., Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients, Eur J Cardiothorac Surg. 2010; 37(3): 573–575PubMedCrossRefGoogle Scholar
  6. [6]
    Jones G.M., Rae W., Lwin A.A., Kurukulaaratchy R. J., Pneumomediastinum Leading to Respiratory Compromise as a Complication of Acute Severe Asthma, Am. J. Respir. Crit. Care Med. 2013; 187: e5–e6PubMedCrossRefGoogle Scholar
  7. [7]
    Miura H, Taira O, Hiraguri S. Ohtani K., Kato H., Clinical Features of Medical Pneumomediastinum, Ann Thorac Cardiovasc Surg. 2003; 9(3): 188–191PubMedGoogle Scholar
  8. [8]
    Newcomb A.E., Clark C.P., Spontaneous pneumomediastinum: a benign curiosity or a significant problem?, Chest. 2005; 128; 3298–3302PubMedCrossRefGoogle Scholar
  9. [9]
    Abolnik I., Losses I.S., Breuer R., Spontaneous pneumomediastinum: a report of 25 cases, Chest. 1991; 100: 93–95PubMedCrossRefGoogle Scholar
  10. [10]
    Iyer V.N., Joshi A.Y., Ryu J.H., Spontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients, Mayo Clin Proc. 2009; 84(5): 417–421PubMedCentralPubMedCrossRefGoogle Scholar
  11. [11]
    Caceres M., Ali S.Z., Braud R., Weiman D, Garrett H.E. Jr., Spontaneous pneumomediastinum: a comparative study and review of the literature, Ann Thorac Surg. 2008; 86: 962–966PubMedCrossRefGoogle Scholar
  12. [12]
    Kwon S.J., Blum G.M., Kalhan R., A 23-Year-Old Woman With Sudden-Onset Dyspnea and Chest Pain Penetrating to the Back, Chest. 2008; 133: 574–578PubMedCrossRefGoogle Scholar
  13. [13]
    Ba-Ssalamah A., Schima W., Umek W., Herold C.J., Spontaneus pneumomediastinum, Eur Radiol. 1999; 9: 724–727PubMedCrossRefGoogle Scholar
  14. [14]
    Kaneki T., Kubo K., Kawashima A., Koizumi T., Sekiguchi M., Sone S., Spontaneous pneumomediastinum in 33 patients: yield of chest computed tomography for the diagnosis of the mild type, Respiration. 2000; 67(4): 408–411PubMedCrossRefGoogle Scholar
  15. [15]
    Delgado-Plasencia L, González-García I, Rodríguez-González D. Torres-Monzón A.E., Pneumomediastinum as a complication of emphysematous cholecystitis: Case report, BMC Gastroenterology. 2010; 10–99Google Scholar
  16. [16]
    Koullias G.J., Korkolis D.P., Wang X.J., Hammond G.L., Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients, Eur J Cardiothorac Surg. 2004; 25(5): 852–855PubMedCrossRefGoogle Scholar
  17. [17]
    Yellin A., Gapany-Gapanavicius M., Lieberman Y., Spontaneous pneumomediastinum: is it a rare cause of chest pain?, Thorax. 1983; 38: 383–385PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sanja Hromis
    • 1
  • Biljana Zvezdin
    • 1
  • Ivan Kopitovic
    • 1
  • Senka Milutinov
    • 1
  • Violeta Kolarov
    • 1
  • Marija Vukoja
    • 1
  • Bojan Zaric
    • 1
    Email author
  1. 1.Institute for Pulmonary Diseases of Vojvodina, Faculty of MedicineUniversity of Novi SadNovi SadSerbia

Personalised recommendations