ORIGINAL ARTICLESpontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients
Section snippets
PATIENTS AND METHODS
The study was conducted at Mayo Clinic's site in Rochester, MN. A computer-assisted search was performed to identify all adult cases of SP diagnosed during an 11-year period from July 1, 1997, to June 30, 2008. Medical records were reviewed to exclude cases of traumatic and iatrogenic pneumomediastinum, including those associated with chest trauma, cardiopulmonary resuscitation, mechanical ventilation, or any surgical/interventional procedures. Neonatal and pediatric patients (<18 years) were
RESULTS
Demographic data for the 62 patients, including 41 men and 21 women, are outlined in Table 1. The median age at diagnosis of SP was 30 years (interquartile range [IQR], 20-69 years). Of the 62 study patients, 21 (34%) were active or past smokers at the time of diagnosis. Pneumomediastinum was diagnosed in these patients most often in the emergency department (49 patients [79%]) but also in the ICU (7 patients [11%]), outpatient clinic (5 patients [8%]), and hospital ward (1 patient [2%]).
DISCUSSION
Spontaneous pneumomediastinum is an uncommon disorder that can be encountered in a variety of clinical settings. The pathophysiology of SP was delineated by Macklin8 in his experimental animal model. His work showed how alveolar hyperinflation causes alveolar damage with subsequent leakage of air from alveolar spaces into the interstitium followed by proximal migration of air toward the hilum and the mediastinum alongside the pulmonary vasculature. Once the air reaches the mediastinum, it
CONCLUSION
Spontaneous pneumomediastinum is associated with a relatively benign clinical course but may be complicated by the occurrence of pneumothorax in 32% of patients, a frequency higher than has been previously reported. In the absence of a concomitant pneumothorax or severe illness requiring inpatient care, patients with SP could probably be treated on an outpatient basis. The clinical course of patients with SP is influenced more by the severity of the underlying disorder (eg, advanced
REFERENCES (27)
- et al.
Spontaneous pneumomediastinum: a benign curiosity or a significant problem?
Chest
(2005) - et al.
Management of spontaneous pneumomediastinum based on clinical experience of 25 cases
Respir Med
(2008 Sep) - et al.
Spontaneous pneumomediastinum: a report of 25 cases
Chest
(1991) - et al.
Persistent pneumomediastinum in interstitial fibrosis associated with rheumatoid arthritis: treatment with high-concentration oxygen
Chest
(2000) - et al.
A 34-year-old man with amyopathic dermatomyositis and rapidly progressive dyspnea with facial swelling
Chest
(2007) - et al.
Pneumomediastinum as a complication of “crack” smoking
Am J Emerg Med
(1988) - et al.
Pneumomediastinum resulting from performing Valsalva maneuvers during marihuana smoking
Chest
(1972) Pneumomediastinum in heroin and marijuana users
JACEP
(1976)- et al.
Spontaneous pneumomediastinum: clinical and natural history
Ann Emerg Med
(1992) - et al.
Spontaneous pneumomediastinum long-term follow-up
Respir Med
(2005 Sep)
Spontaneous pneumomediastinum: a comparative study and review of the literature
Ann Thorac Surg
Spontaneous pneumomediastinum: 41 cases
Eur J Cardiothorac Surg
Spontaneous pneumomediastinum in 33 patients: yield of chest computed tomography for the diagnosis of the mild type
Respiration
Cited by (120)
Utility of fluoroscopic oesophagography in the setting of spontaneous and blunt traumatic pneumomediastinum
2023, Clinical RadiologyCitation Excerpt :All positive fluoroscopic studies occurred in patients presenting with spontaneous pneumomediastinum resulting in a positivity rate of 4.7% (8/170) for that patient cohort. The positivity rate of nearly 5% in the spontaneous pneumomediastinum cohort, while still low, is higher than previous smaller studies, which had no positive cases in the setting of spontaneous pneumomediastinum.7,15–17 The higher positivity rate in the present larger patient population suggests that oesophagography of spontaneous pneumomediastinum may still be warranted given the high morbidity of underlying oesophageal injury and importance of early identification,1–3 especially in the setting of cough, vomiting/retching, and odynophagia.
Spontaneous pneumomediastinum
2022, Revue des Maladies RespiratoiresIdiopathic Spontaneous Pneumomediastinum
2021, American Journal of MedicineSpontaneous Pneumomediastinum: Unusual Cause of Sore Throat
2020, Journal of PediatricsMore Than a Frog: Sore Throat After Inhaling Methamphetamine
2020, Journal of Emergency Medicine