Spontaneous pneumomediastinum: A 10 years' experience of a pulmonology ward

Abstract

Background: Spontaneous pneumomediastinum (SP) is a rare condition, frequently occurring without a known precipitating factor or underlying disease, so it requires a high level of suspicion to reach diagnosis. Objectives: We aim to describe the clinical and radiological features of all admitted SP cases in an adult Pulmonology service, during the last 10 years. Methods: A retrospective descriptive study was conducted to identify all patients (aged ≥18 years) diagnosed with SP, between January 2004-October 2014. Results: Of the identified 15 cases of SP, 73,3% were male patients. Mean age was 34,5±26,28 years. A precipitating factor was found in 86,7% of cases, including coughing bouts (53,3%), excessive tobacco use, inhalation of other drugs and varnishes, strenuous physical activity and emesis. Most patients had at least one predisposing factor, such as active cigarette smoking, recent respiratory infection, asthma or interstitial lung disease. Major complaints were dyspnea (80,0%); chest pain (73,3%); cough (53,3%); neck pain (46,7); dysphagia (33,3%); odynophagia (20,0%). Subcutaneous emphysema was found in 78,6% of patients. Chest radiograph was diagnostic in 73,3% of cases. There were 3 cases of simultaneous pneumothorax and 1 of pneumorachis. All patients were managed conservatively and there were no recurrences. Conclusions: The clinical presentation features found in our population are consistent with the rest of the literature but we report a significantly higher percentage of cases associated with a possible precipitating factor. We conclude that SP should be included in thoracic pain and dyspnea differential diagnosis and it diagnosis can be made with careful observation of the chest radiograph.