Fact-sheet: Pneumomediastinum
Updated on 10/06/2017 at 4:37 PM
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Definition
Pneumomediastinum = air within the mediastinum, secondary to tracheobronchial or esophageal rupture, post-traumatic, post-radiation, or postoperative.
Spontaneous pneumomediastinum of the young adult: Rare but benign cause of pneumomediastinum in young adults, possibly asthmatic.
Pathophysiological mechanism of spontaneous pneumomediastinum of the young adult:
- Endobronchial hyperpressure (Valsalva-like effort against a closed glottis)
- Alveolar rupture
- Gas dissemination within the peribronchovascular space up to the pulmonary hilum
- Pneumomediastinum, possibly quite extensive
Clinical features
- Lateralized chest pain
- Sub cutaneous emphysema
- Neck discomfort
- Hamman's sign: crepitant auscultatory sound synchronous with heartbeats (pathognomonic)
Radiography
- Air lucency along the left border of the cardiac silhouette
- Sub cutaneous hyperlucencies of the cervical region
CT
- Pneumomediastinum without pneumothorax or pneumopericardium
- Sub cutaneous emphysema
- No abnormality of the tracheobronchial tree or digestive structures
Management
- The natural course of spontaneous pneumomediastinum in the young adult is toward resolution within 48 to 96 hours, with complete disappearance of clinical and radiological signs. No specific therapy, including antibiotic therapy and oxygen therapy, has demonstrated proven efficacy. Recurrences appear rare. Complications are exceptional; however, cases of compressive pneumomediastinum with tamponade requiring surgical drainage have been reported