Spontaneous pneumomediastinum: a benign pathology?
analysis of 25 cases and review of the literature
DOI:
https://doi.org/10.31837/cir.urug/5.2.6Keywords:
pneumomediastinum, ectopic air, subcutaneous emphysema, mediastinal emphysemaAbstract
Introduction and objectives: Spontaneous pneumomediastinum is defined as interstitial air in the mediastinum with no established primary cause that predominates in young adult males. The objective of this study is to inform about the usual management in our hospital and to propose a diagnostic-therapeutic algorithm.
Materials and methods: Descriptive and retrospective study of 25 cases of spontaneous pneumomediastinum diagnosed at our hospital, in a period of 25 years. Demographic data, predisposing and triggering factors, symptoms, diagnosis, treatment, and recurrences were analyzed.
Results: The mean age was 22 years, with asthma, drug inhalation, tooth extractions, or smoking as predisposing factors. The most frequent symptoms were chest pain, dyspnea, dysphonia, and dysphagia / odynophagia. The initial diagnosis was obtained by chest x-ray, sometimes being completed with computerized tomography, esophagogram, or laryngoscopy. All patients were admitted conservatively. During follow-up, 12 % presented recurrence of the pneumomediastinum, which resolved without complications.
Discussion: The presence of free mediastinal air can be perceived as a finding of poor prognosis, but previous studies conclude that spontaneous pneumomediastinum has a benign course, although the diagnosis must be made by exclusion, since the bulk of the evidence is secondary pneumomediastinum.
Conclusions: Spontaneous pneumomediastinum is a benign and infrequent entity that may have predisposing and triggering factors, although there is no apparent primary cause. It usually resolves conservatively in a few days, although there may be recurrences.
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Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE Jr. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008; 86:962.doi: 10.1016/j.athoracsur.2008.04.067
Vanzo V, Bugin S, Snijders D, Bottecchia L, Storer L, Barbato A. Pneumomediastinum and pneumopericardium in an 11-year-old rugby player: a case report. J Athl Train 2013; 48:277.doi: 10.4085/1062-6050-48.1.11
Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013; 5:460.doi: 10.4103/1947-2714.117296
Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F et al. Spontaneouspneumomediastinum: experience in 18 patients during the last 12 years.J Bras Pneumol. 2017 Mar-Apr; 43(2):101-105. doi: 10.1590/S1806-37562016000000052
Campillo-Soto A, Coll-Salinas A, Soria-Aledo V, Blanco-Barrio A, Flores-Pastor B, Candel-Arenas M, et al. [Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases.] Arch Bronconeumol 2005; 41:528 –31.
doi: 10.1157/13078656
Zachariah S, Gharahbaghian L, Perera P, Joshi N. Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. West J Emerg Med 2015; 16:321.
doi: 10.5811/westjem.2015.1.24514
Fitzwater JW, Silva NN, Knight CG, Malllvvvezzi L, Ramos-Irizarry C, Brunweit C.. Management of spontaneous pneumomediastinum in children. J Pediatr Surg 2015; 50:983. doi:10.1016/j.jpedsurg.2015.03.024
Potz BA, Chao LH, Ng TT, Okereke IC. Clinical Significance of SpontaneousPneumomediastinum. Ann Thorac Surg. 2017 Aug; 104(2):431-435. Doi: 10.1016/j.athoracsur.2017.02.051
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. Doi: 10.1016/j.ejcts.2007.03.008
Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr 2008; 167:415-8. Doi: 10.1007/s00431-007-0517-9
Lee CY, Wu CC, Lin CY. Etiologies of spontaneous pneumomediastinum in children in middle Taiwan. Pediatr Pulmonol 2010; 45:869.Doi: 10.1002/ppul.21124
Cáceres M, Z. Ali S, Braud R, Weiman D, Garret Jr HE. Spontaneous Pneumomediastinum: A Comparative Study and Review of the Literature. Ann Thorac Surg 2008;86(3):962-6. Doi: 10.1016/j.athoracsur.2008.04.067.
Grossman A, Romem A, Azaria B, Goldstein L, Barenboim E. Pneumomediastinum in student aviators: 10 cases with return to flying duty. Aviat Space Environ Med 2005; 76:63-5.
Marasco SF, Lim HK. Ecstasy-associated pneumomediastinum. Ann R Coll Surg Engl 2007; 89:389-93. Doi 10.1308/003588407X183373
Zaia BE, Wheeler S. Pneumomediastinum after inhalation of helium gas from party balloons. J Emerg Med 2010; 38:155-8. Doi: 10.1016/j.jemermed.2007.02.066
Pourmotabed S, Jalili M. Pneumomediastinum following Crystal Use: A Report of Two Cases. Case Rep Emerg Med 2016; 2016:9730484. Doi: 10.1155/2016/9730484
Albanese J, Gross C, Azab M, Mahalean S, Makar R. Spontaneous pneumomediastinum: A rare complication of methamphetamine use. Respir Med Case Rep. 2017 Mar 10; 21:25-6. Doi: 10.1016/j.rmcr.2017.03.007
Clemente Lorenzo MM, López López MÁ, Barquilla Cordero PM. Spontaneouspneumomediastinum. Med Clin (Barc). 2017;149(8):e43.
Lorraine Ng, Saul T, Lewiss RE. Sonographic evidence of spontaneous pneumomediastinum. Am J Emerg Med 2013; 31:2;462.e3. Doi: 10.1016/j.ajem.2012.08.019
Swords C, Tan NC, Jonas N. The implications of pneumomediastinum and subcutaneous emphysema for the paediatric otolaryngologist. Int J Pediatr Otorhinolaryngol. 2017;101:241-5. Doi: 10.1016/j.ijporl.2017.07.041
Ebina M, Inoue A, Takaba A, Ariyoshi K. Management of spontaneouspneumomediastinum: Are hospitalization and prophylactic antibiotics needed? Am J Emerg Med. 2017;35(8):1150-3. Doi: 10.1016/j.ajem.2017.03.017
Newcomb AE, Clarke CP. Spontaneous pneumomediastinum: a benign curiosity or a significant problem? Chest 2005; 128:3298-302. Doi: 10.1378/chest.128.5.3298
Takada K, Matsumoto S, Hiramatsu T, Sizu M, Okachi S, Ninomiya K. Management of spontaneous pneumomediastinum based on clinical experience of 25 cases. Respir Med 2008; 102:1329-34. Doi: 10.1016/j.rmed.2008.03.023
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