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Spontaneous Pneumomediastinum: Experience in 18 Adult Patients

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Abstract

Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum, developing in the absence of traumatic, iatrogenic, or preceding pulmonary pathologies (emphysema, chronic bronchitis, and lung cancer). The aim of this study was to review our experiences with SPM, underlining its symptomatology, diagnosis, treatment, and followup, and defining a reasonable course of assessment and management. A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in our institution between 1998 and 2005. Eighteen patients (10 males) were identified (average age = 25 ± 4.8 years). Acute onset of chest pain was the predominant symptom at presentation. All patients developed clinically evident subcutaneous emphysema and underwent chest computerized tomography. Fiber bronchoscopy and echocardiogram were used selectively (8 patients). The average hospital stay was 6 (±1.4) days. Sixteen patients were conservatively treated, and only two patients were treated with thoracic drainage due to a related pneumothorax. The disease followed a benign evolution in all patients and, as of today, no relapse has been reported. SPM is an uncommon pathology with a usually benign course. The authors discuss SPM. A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment.

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References

  1. Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF (1992) Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med 21:1222–1227

    Article  PubMed  CAS  Google Scholar 

  2. Jougon JB, Ballester M, Delcambre F, et al. (2003) Assessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg 75:1711–1714

    Article  PubMed  Google Scholar 

  3. Ralph-Edwards AC, Pearson FG (1994) Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 58:1758–1760

    Article  PubMed  CAS  Google Scholar 

  4. Macklin MT, Macklin CC (1944) Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine 23:281–358

    Article  Google Scholar 

  5. Raley JC, Andrews JI (2001) Spontaneous pneumomediastinum presenting as jaw pain during labor. Obstet Gynecol 98:904–906

    Article  PubMed  CAS  Google Scholar 

  6. Gerazounis M, Athanassiadi K, Kalantzi N, Moustardas M (2003) Spontaneous pneumomediastinum: a rare benign entity. J Thorac Cardiovasc Surg 126(3):774–776

    Article  PubMed  Google Scholar 

  7. Bodart E, de Bilderling G, Nisolle JF, Trigaux JP, Tuerlinckx D (1999) Spontaneous pneumomediastinum in an adolescent: an underestimated cause of chest pain. Arch Pediatr 6(12):1293–1296

    Article  PubMed  CAS  Google Scholar 

  8. Koelliker PD, Brannam LA (1999) Epidural pneumatosis associated with spontaneous pneumomediastinum: case report and review of the literature. J Emerg Med 17:247–250

    Article  PubMed  CAS  Google Scholar 

  9. Gorbach JS, Counselman FL, Mendelson MH (1997) Spontaneous pneumomediastinum secondary to hyperemesis gravidarum. J Emerg Med 15:639–643

    Article  PubMed  CAS  Google Scholar 

  10. Hoover LR, Febinger DL, Tripp HF (2000) Rhinolalia: an underappreciated sign of pneumomediastinum. Ann Thorac Surg 69:615–616

    Article  PubMed  CAS  Google Scholar 

  11. Dechambre S, d’Odemont JP, Cornelis JP, Fastrez J (1995) Spontaneous pneumomediastinum after sneezing. Ann Thorac Surg 60(5):1457

    Article  PubMed  CAS  Google Scholar 

  12. Abolink I, Lossos IS, Brewer R (1991) Spontaneous pneumomediastinum. Chest 100:93–95

    Google Scholar 

  13. Birrer RB, Calderon J (1984) Pneumothorax, pneumomediastinum, and pneumopericardium following Valsalva’s maneuver during marijuana smoking. N Y State J Med 12:619–620

    Google Scholar 

  14. Hamman L (1939) Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 64:1–21

    Google Scholar 

  15. Aribas OK, Gormus N, Aydogdu Kiresi D (2001) Epidural emphysema associated with primary spontaneous pneumothorax. Eur J Cardiothorac Surg 20(3):645–646

    Article  PubMed  CAS  Google Scholar 

  16. Sutherland FW, Ho SY, Campanella C (2002) Pneumomediastinum during spontaneous vaginal delivery. Ann Thorac Surg 73(1):314–315

    Article  PubMed  Google Scholar 

  17. O’Sullivan AJ, Casey JH (1997) Spontaneous pneumomediastinum and diabetic ketoacidosis. Med J Aust 166:245–246

    PubMed  CAS  Google Scholar 

  18. Weathers LS, Brooks WG, DeClue TJ (1995) Spontaneous pneumomediastinum in a patient with diabetic ketoacidosis: a potentially hidden complication. South Med J 88(4):483–484

    PubMed  CAS  Google Scholar 

  19. Rey C, Alvin P, Pariente D, Courtecuisse V (1994) Pneumomediastinum in a young girl with anorexia nervosa. Arch Pediatr 1(7):652–654

    PubMed  CAS  Google Scholar 

  20. Le Floch AS, Lapostolle F, Danhiez F, Adnet F (2002) Pneumomediastinum as a complication of recreational ecstasy use. Ann Fr Anesth Reanim 21(1):35–37

    Article  PubMed  CAS  Google Scholar 

  21. Morgan EJ, Henderson DA (1981) Pneumomediastinum as a complication of athletic competition. Thorax 36:155–156

    PubMed  CAS  Google Scholar 

  22. Maravelli AJ, Skiendzielewski JJ, Snover W (2000) Pneumomediastinum acquired by glass blowing. J Emerg Med 19(2):145–147

    Article  PubMed  CAS  Google Scholar 

  23. Gray JM, Hanson GC (1966) Mediastinal emphysema: aetiology, diagnosis and treatment. Thorax 21:325–332

    Article  PubMed  CAS  Google Scholar 

  24. Bauman MH, Sahn SA (1992) Hamman’sign revisited. Chest 102:1281–1282

    Google Scholar 

  25. Bejvan SM, Godwin JD (1996) Pneumomediastinum. Old signs and new signs. AJR Am J Roentgenol 166:1041–1048

    PubMed  CAS  Google Scholar 

  26. Levin B (1973) The continuous diaphragm sign: a newly recognized sign of pneumomediastinum. Clin Radiol 24:337–338

    Article  PubMed  CAS  Google Scholar 

  27. Lillard RL, Allen RP (1965) The extrapleural air sign in pneumomediastinum. Radiology 85: 1093–1097

    PubMed  CAS  Google Scholar 

  28. Schwartz M, Rossoff L (1994) Pneumomediastinum and bilateral pneumothoraces in a patient with hyperemesis gravidarum. Chest 106:1094–1096

    Google Scholar 

  29. Zylak CM, Standen JR, Barnes GR, Zylak CJ (2000) Pneumomediastinum revisited. RadioGraphics 20:1043–1057

    PubMed  CAS  Google Scholar 

  30. Koullias GJ, Korkolis DP, Wang XJ, Hammond GL (2004) Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg 25(5):852–855

    Article  PubMed  Google Scholar 

  31. Freixinet J, Garcia F, Rodriguez PM, et al. (2005) Spontaneous pneumomediastinum long-term follow-up. Respir Med 99(9):1160–1163

    Article  PubMed  Google Scholar 

  32. Dayen C, Mishellany H, Hellmuth D, et al. (2001) Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature. Rev Mal Respir 18(5):537–540

    PubMed  CAS  Google Scholar 

  33. Triaridis S, Konstantinidis I, Noussios G, Karagiannidis K, Permekerlis A (2002) A diagnostic challenge: investigating suspected tracheobronchial and pharyngoesophageal tears. Are there gold standards? Acta Otorhinolaryngol Belg 56(3):331–334

    PubMed  CAS  Google Scholar 

  34. Newcomb AE, Clarke CP (2005) Spontaneous pneumomediastinum: a benign curiosity or a significant problem? Chest 128(5):3298–3302

    Article  PubMed  Google Scholar 

  35. Koscielny S, Gottschall R (2005) Diagnostic and therapeutic procedure for spontaneous emphysema of the neck and mediastinum. HNO 53(7):645–650

    Article  PubMed  CAS  Google Scholar 

  36. Miura H, Taira O, Hiraguri S, Ohtani K, Kato H (2003) Clinical features of medical pneumomediastinum. Ann Thorac Cardiovasc Surg 9(3):188–191

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Unit of Thoracic Surgery, Department of Cardiovascular and Thoracic Sciences, Azienda Ospedaliera Universitaria “G. Martino”, Messina, Italy

    Baldassare Mondello, Rosaria Pavia, Mario Barone, Pietro Barresi & Maurizio Monaco

  2. Unit of Respiratory Diseases, Department of Cardiovascular and Thoracic Sciences, Azienda Ospedaliera Universitaria “G. Martino”, Messina, Italy

    Paolo Ruggeri

  3. Unit of Respiratory Diseases, Department of Cardiovascular and Thoracic Sciences, Azienda Ospedaliera Universitaria “G. Martino”, Via Consolare Valeria, 98125, Messina, Italy

    Paolo Ruggeri

Authors
  1. Baldassare Mondello
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  2. Rosaria Pavia
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  3. Paolo Ruggeri
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  4. Mario Barone
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  5. Pietro Barresi
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  6. Maurizio Monaco
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Correspondence to Paolo Ruggeri.

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Mondello, B., Pavia, R., Ruggeri, P. et al. Spontaneous Pneumomediastinum: Experience in 18 Adult Patients. Lung 185, 9–14 (2007). https://doi.org/10.1007/s00408-006-0002-7

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  • DOI: https://doi.org/10.1007/s00408-006-0002-7

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