Pneumomediastinum In Children Research Articles

Pneumothorax and pneumomediastinum in children.

Pneumothorax is a condition that describes the presence of air between the visceral and parietal pleura sheets and the consequent collapse of the lungs. The collapse of the lungs can be partial or total and can present in different clinical stages, such as a high-pressure pneumothorax that can cause a mediastinal shift. Pneumomediastinum is the presence of free air between the mediastinal tissues due to various causes. It can manifest spontaneously and be minimally symptomatic but can also develop due to severe complications. Its etiology includes numerous iatrogenic and traumatic factors. Although spontaneous pneumothorax and pneumomediastinum that develop in childhood are similar to adult patients, it is important to determine the appropriate treatment strategy in addition to the age group, the effectiveness of the treatment, the role of the applied treatment in reducing recurrence, and the etiologyoriented treatments if there is an underlying pathology.

The evaluation of secondary pneumomediastinum in children: the experience of a pediatric surgery clinic.

Pneumomediastinum, defined as mediastinal emphysema, is the term coined for the presence of air in the mediastinum. It is a rare condition that can occur in children due to various etiologies, especially trauma, and may appear without any underlying injury. We investigated the causes of secondary pneumomediastinum and the treatment approaches in children treated at our clinic. We retrospectively assessed 26 patients under the age of 18 diagnosed with pneumomediastinum at our clinic between 2011 and 2023. We reviewed patient files, evaluating clinical data including patient history, physical characteristics, symptoms, examination findings, imaging studies, hospital stay duration, treatment methods, and complications. The necessity for advanced imaging methods, bronchoscopy, and surgical interventions was determined. Causes of pneumomediastinum included multiple body trauma in three patients, blunt thoracic trauma in four patients, blunt trauma to the cervical region in two, crush syndrome in three, penetrating trauma to the thorax and cervical region in three, hanging from the neck in one, drowning in water in one, birth trauma in one, foreign body aspiration in six, a tracheal polyp in one, and iatrogenic causes in one. Excluding those with foreign body aspiration, computed tomography was performed on all patients. Bronchoscopy was performed in six patients, detecting tracheal lacerations in two. Of these, tracheal lacerations during bronchoscopy were identified in two patients with foreign body aspiration. Twenty-three patients received conservative management, and six patients died. Patients were categorized into two groups: complicated and uncomplicated. It was observed that stays in intensive care and wards were longer in complicated patients (p<0.05). However, no difference was detected in the resolution time of pneumomediastinum between complicated and uncomplicated patients (p>0.05). Although pneumomediastinum is a self-limiting pathology, ventilation difficulties alongside pneumomediastinum should raise suspicion of esophageal and tracheal injuries, necessitating further investigations. Since the etiologies are very different, each patient should be evaluated separately. In most patients, pneumomediastinum regresses on its own. However, patients with complications should be carefully evaluated for accompanying diseases and injuries.

Spontaneous Pneumomediastinum in Children: The Experience of a Pediatric Tertiary Center in Antalya

Objective: To evaluate the demographic data, clinical findings, complications and prognosis of children with spontaneous pneumomediasinum. Material and Methods: This was a retrospective chart review including demographic characteristics, trigger factors, underlying diseases, symptoms, signs, length of hospital stay, complications, treatments, and outcomes of 15 children aged <18 years with a discharge diagnosis of pneumomediastinum, between January 2009 and August 2019, at the University of Health Sciences Antalya Training and Research Hospital. Results: The mean age of the 12 boys (80%) and three girls (20%) with spontaneous pneumomediastinum was 11.33 ± 7 years, with a range of 4 months to 17 years. The most common trigger factor was severe cough and/or bronchospasm due to respiratory tract infection. In 8 patients with pneumomediastinum seen radiologically on the chest X-ray, thoracic computed tomography was also taken. Pneumorrhachis was determined on the thoracic computed tomography of 3 (20%) patients. Pneumomediastinum was accompanied by pneumothorax in 7 (46.6%) cases. The mean length of hospital stay was 8.4 ± 4.5 days (3-18 days). All patients except one recovered and were discharged and followed up for 1-72 months. Hospital records showed no recurrence during the follow-up period. Conclusions: Spontaneous pneumomediastinum is a rare, self-limiting condition in childhood and the prognosis depends on the underlying disease. The problem of whether or not routine chest computed tomography scanning should be performed in children with spontaneous pneumomediastinum has not yet been resolved, but if chest computed tomography scanning is performed in every patient with spontaneous pneumomediastinum, pneumorrachis might be detected more frequently. Key Words: Spontaneous pneumomediastinum, Pneumorrhachis, Pneumomediastinum, Pneumothorax

Spontaneous Pneumomediastinum in Children

Scarce studies about spontaneous pneumomediastinum (SPM) in pediatric patients are published because of lower incidence in a child than an adult. This article is a literature review of pediatric SPM, discussing about aspects of incidence rate, epidemiology, pathophysiology, diagnosis, management, and prognosis about pediatric SPM. In conclusion, SPM is usually a benign disease and treatable with only supportive care. However, poorer prognosis is noted; if it is complicated with other underlying diseases or complications, then aggressive treatment might be needed.

Management and Outcomes of Spontaneous Pneumomediastinum in Children.

Management of spontaneous pneumomediastinum in the pediatric population is highly variable. There are limited data on the use of diagnostic tests and the need for admission. Our objectives were to characterize the management of pediatric spontaneous pneumomediastinum, determine the diagnostic yield of advanced imaging, and describe the patients' outcomes. This is a retrospective cohort study of all patients presenting to a single tertiary pediatric emergency department between January 2008 and February 2015 diagnosed with pneumomediastinum. Patients were identified using 2 complementary strategies: International Classification of Diseases, Ninth Revision billing codes and a keyword search of the hospital radiology database. We identified 183 patients with spontaneous pneumomediastinum. The mean age was 12.8 ± 4.8 years. Diagnosis was established by chest radiograph (CXR) in 165 (90%) patients, chest computed tomography in 15 (8%), neck imaging in 2 (1%), and abdominal imaging in 1. After diagnosis, many patients underwent additional studies: repeat CXR (99, 54%), chest computed tomography (53, 29%), esophagram (45, 25%), and laryngoscopy (15, 8%). Seventy-eight percent of patients (n = 142) were admitted with a median length of stay of 27 hours (18.4-45.6 hours). Six patients returned to the emergency department within 96 hours for persistent chest pain; 2 were admitted, and 1 was found to have worsening pneumomediastinum on CXR. We performed a secondary analysis on 3 key subgroups: primary spontaneous pneumomediastinum (64, 35%), secondary gastrointestinal-associated pneumomediastinum (31, 17%), and secondary respiratory-associated pneumomediastinum (88, 48%). No patients in the study received an invasive intervention for pneumomediastinum. In all patients, further studies did not yield additional diagnostic information. Our data suggest that patients with spontaneous pneumomediastinum who are clinically well appearing can be managed conservatively with clinical observation, avoiding exposure to radiation and invasive procedures.

Etiologia şi managementul terapeutic al pneumotoraxului şi pneumomediastinului la copil

Etiologia şi managementul terapeutic al pneumotoraxului şi pneumomediastinului la copil

Subcutaneous emphysema and pneumomediastinum in child with asthma revealing occult foreign body aspiration: a case report

BackgroundExacerbations of asthma constitute the most common cause of pneumomediastinum and subcutaneous emphysema in children. Foreign body aspiration is a rare cause of pneumomediastinum and subcutaneous emphysema. Foreign body aspiration leading to the occurrence of pneumomediastinum in a child with asthma may go unnoticed and be wrongly attributed to asthma, which leads to delayed diagnosis as well as to life-threatening and long-term complications.Case presentationWe describe a case of a 6-year-old Moroccan boy with asthma who was admitted to our emergency department for acute dyspnea and persistent dry cough. The patient was initially treated as having acute asthma exacerbation. Owing to insufficient clinical and radiographic improvement with asthma treatment, a rigid bronchoscopy under general anesthesia was performed. A pumpkin seed was removed from the left main bronchus. Clinical and radiographic improvement was achieved after foreign body extraction.ConclusionsThis case emphasizes that the possibility of foreign body aspiration should always and carefully be considered by the emergency physician when faced with a child with asthma presenting with pneumomediastinum and subcutaneous emphysema as an important differential diagnosis even in the absence of a history of foreign body aspiration.

Spontaneous resolution of pneumomediastinum in children – clinical experience

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Korecka K, Hyla-Klekot L, Kęsek M, Kudela G, Bulandra A, Koszutski T. Spontaneous resolution of pneumomediastinum in children – clinical experience. Pediatria Polska - Polish Journal of Paediatrics. 2019;94(2):105-110. doi:10.5114/polp.2019.85039. APA Korecka, K., Hyla-Klekot, L., Kęsek, M., Kudela, G., Bulandra, A., & Koszutski, T. (2019). Spontaneous resolution of pneumomediastinum in children – clinical experience. Pediatria Polska - Polish Journal of Paediatrics, 94(2), 105-110. https://doi.org/10.5114/polp.2019.85039 Chicago Korecka, Klaudia, Lidia Hyla-Klekot, Mateusz Kęsek, Grzegorz Kudela, Andrzej Michał Bulandra, and Tomasz Koszutski. 2019. "Spontaneous resolution of pneumomediastinum in children – clinical experience". Pediatria Polska - Polish Journal of Paediatrics 94 (2): 105-110. doi:10.5114/polp.2019.85039. Harvard Korecka, K., Hyla-Klekot, L., Kęsek, M., Kudela, G., Bulandra, A., and Koszutski, T. (2019). Spontaneous resolution of pneumomediastinum in children – clinical experience. Pediatria Polska - Polish Journal of Paediatrics, 94(2), pp.105-110. https://doi.org/10.5114/polp.2019.85039 MLA Korecka, Klaudia et al. "Spontaneous resolution of pneumomediastinum in children – clinical experience." Pediatria Polska - Polish Journal of Paediatrics, vol. 94, no. 2, 2019, pp. 105-110. doi:10.5114/polp.2019.85039. Vancouver Korecka K, Hyla-Klekot L, Kęsek M, Kudela G, Bulandra A, Koszutski T. Spontaneous resolution of pneumomediastinum in children – clinical experience. Pediatria Polska - Polish Journal of Paediatrics. 2019;94(2):105-110. doi:10.5114/polp.2019.85039.

A Case of Spontaneous Pneumomediastinum in children during swimming

Spontaneous pneumomediastinum(SPM) is relatively rare in children without chest or neck trauma and it is a uncommondisease characterized by the presents of interstitial air in the mediastinum. This is an uncommon complication of exerciseactivity. Herein, we report a case of SPM presented in a 8-year-old male, who complained of chest discomfort and sorethroat after swimming in the ocean.

Management of spontaneous pneumomediastinum in children

PurposeWe characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest series to date and propose a management pathway. MethodsAll patients at our institution with ICD-9 code 518.1 confirmed to have isolated radiographic findings of spontaneous pneumomediastinum between January 2003 and February 2014 were retrospectively reviewed for admission, intensive care unit (ICU) stay, complications, and outcome. ResultsWe identified 96 children with 99 episodes, median age 14.1years (IQR: 8.7–16.4). Primary symptoms were chest pain, cough, and dyspnea. Most were hospitalized (n=91, 91.9%), with 20 (20.2%) admitted to ICU. Median lengths of stay (LOS) were 1day (IQR: 1–2) for non-ICU admissions and 3days (IQR: 2–3) for ICU admissions. The surgical service discharged non-ICU patients 0.94days earlier than medical services (95% CI 0.38–1.50, p=0.0014). Asthma affected neither LOS nor ICU admission rates. Follow-up imaging, when obtained (n=81, 81.8%), did not alter management. Recurrences occurred in three asthmatics, all after one year. Each was rehospitalized and discharged uneventfully. No patient developed pneumomediastinum-related complications (e.g., pneumothorax, pneumopericardium, or mediastinitis). ConclusionSpontaneous pneumomediastinum without associated comorbidities can be managed with expectant outpatient observation without further imaging. Children with asthma should be treated independent of spontaneous pneumomediastinum.

Characteristics of pediatric noniatrogenic pneumomediasinum

Purpose: Pneumomediastinum is rare in children and adolescents, and its causes have not yet been clearly determined. We aimed to identify the causes, clinical manifestations and prognosis of noniatrogenic pneumomediastinum in children. Methods: From February 2007 to June 2014, we retrospectively investigated 121 patients with pneumomediastinum under 18 years of age in 2 hospitals. Eighteen patients with pneumomediastinum after thoracotomy and 35 patients with iatrogenic pneumomediastinum were excluded. Results: Sixty-eight patients were divided into 4 age groups: those under 1 year of age (n= 9, 13.2%), those 1 to 5 years of age (n= 9, 13.2%), those 6 to 10 years of age (n= 17, 25.0%) and those over 11 years of age (n= 33, 48.5%). Chest pain (n= 43, 63.2%) was the most common initial complaint and subcutaneous emphysema was identified in 18 patients (26.5%). Chest x-ray was diagnostic in all except 9 patients (13.2%). Predisposing causes of pneumomediastinum were idiopathic (n= 26, 38.2%), respiratory tract infection (n= 23, 33.8%), asthma exacerbation (n= 4, 5.9%), trauma (n= 4, 5.9%), endobronchial foreign body (n= 2, 2.9%), interstitial lung disease (n= 5, 7.4%), and neonatal respiratory disease (n= 4, 5.9%). Chest pain (P< 0.001) and idiopathic cause (P= 0.001) were shown to linearly increase with age. On the contrary, tachypnea (P< 0.001), dyspnea (P= 0.016), and interstitial lung disease (P= 0.008) were shown to have a decreasing linear association with age. The length of hospital stay was significantly increased in patients with interstitial lung disease (P= 0.042), those with pneumothorax (P= 0.044), and those without chest pain (P= 0.013). Conclusion: According to age groups, there were significant differences in causes and clinical manifestations. In particular, pneumomediastinum that developed in younger patients with interstitial lung disease showed unfavorable outcomes, such as dyspnea, pneumothorax, and increased length of hospital stay. Therefore, precise evaluation of predisposing causes and careful management are needed for children with pneumomediastinum. (Allergy Asthma Respir Dis 2015;3:145-150)

Etiologies of spontaneous pneumomediastinum in children in middle Taiwan

Spontaneous pneumomediastinum (SPM), while rare, is probably underestimated in children. Treatment targets on the underlying disease and trigger factors. The study aimed in analysis different etiology in different age groups. Total 37 children with SPM were analyzed from two medical centers in middle Taiwan from 1994 to 2007. Incidence of SPM in children was 1:11,726 patients at Department of Pediatric Emergency in middle Taiwan. Bimodal peak in incidence occurred in those under 7 and in those aged 15-18 years old. The Characteristic symptoms were dyspnea (64.9%), followed by chest pain (62.2%) and neck pain (40.5%); common specific physical signs were subcutaneous emphysema (SCE) (67.6%) and Hammer's sign (13.5%). Trigger factors were infection (43.2%), asthma (21.0%), esophageal rupture (5.4%), foreign body aspiration (2.7%), and diabetic ketoacidosis (2.7%). Idiopathic SPM accounted for 35.1% of patients with mean age 14.1 years. In age distribution, preschoolers (<7 years old) got SPM mostly due to lower respiratory tract infection. In adolescents, the most common etiologies were asthma and upper respiratory tract infection. Mean hospitalization was 6.4 days. Although 17 (46.0%) patients needed intensive care, nearly all had complete resolution in chest radiography before discharge. Clinician should keep alert to incidence of SPM from these symptoms. Etiologies varied with age and treatment must target on factors and underlying disease.

Haemorrhagic disease of newborn presenting as subdural hematoma

Spontaneous pneumomediastinum (SPM) following pneumonia is an uncommon entity in paediatric practice. The prevalence of SPM is reported between 1 in 800 to 1 in 42000 by Chalumeau et al [1]. Damore et al [2] in a retrospective study reported a prevalence of 0.2% in children presenting in the emergency room with underlying asthma and acute exacerbation. 70% of cases of pneumomediastinum in children are due to bronchospasm or respiratory tract infection [3]. We describe two cases of spontaneous pneumomediastinum in children which developed during an episode of pneumonia without any history of bronchial asthma, trauma or foreign body aspiration. While the first case recovered spontaneously the second case had malignant pneumomediastinum requiring placement of a mediastinal drain and intercostal drainage tube. The cases highlight the varied clinical course of pneumomediastinum from spontaneous resolution to a fatal outcome.

Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication?

The purpose of the present study was to evaluate the incidence of epidural air associated with spontaneous pneumomediastinum in children. The subjects consisted of 25 boys and 17 girls with an age range of 3-14 years (mean age: 8.5 years) who underwent chest computed tomography (CT) for evaluation of spontaneous pneumomediastinum. The CT scans and medical records were reviewed retrospectively. Of the 42 patients, four (9.5%) had intraspinal air on CT. The air was interpreted as epidural in every patient. The small number of patients with epidural air meant that there was no significant difference in age, gender, or clinical manifestations between groups with and without epidural air. Subcutaneous emphysema was identified in all four patients with epidural air versus 18 out of 38 patients (47%) without epidural air. The patients with epidural air did not have any neurologic symptoms. Irrespective of the presence or absence of epidural air, every patient had a favorable outcome without any serious complications. In patients with spontaneous pneumomediastinum, epidural air may be more common than was previously realized. It is suggested that an air leak may spread from the mediastinum into the epidural space via the cervical fascial planes and neural foramina.

Pneumomediastinum in the neonatal and paediatric intensive care unit

The incidence, aetiology and pathophysiology of pneumomediastinum (PM), an uncommon and potentially serious disease in neonates and children, were evaluated. A retrospective chart review of all patients diagnosed with PM who were hospitalised in the intensive care unit of the University Children’s Hospital Zürich, Switzerland, from 2000 to 2006, was preformed. We analysed the incidence, severity and causes of PM and investigated the possible differences between neonatal and non-neonatal cases. Seven children and nine neonates were identified with PM. All patients had a good outcome. Six cases of PM in the group of children older than 4 weeks were deemed to be caused by trauma, infection and sports, whereas one case was idiopathic. All nine neonatal cases presented with symptoms of respiratory distress. We were able to attribute four cases of neonatal PM to pulmonary infection, immature lungs and ventilatory support. Five neonatal cases remained unexplained after careful review of the hospital records. In conclusion, PM in children and neonates has a good prognosis. Mostly, it is associated with extrapulmonary air at other sites. It is diagnosed by chest X-ray alone. We identified mechanical events leading to the airway rupture in most children >4 weeks of life, whereas we were unable to identify a cause in half of the neonates studied (idiopathic PM).

Medical causes of pneumomediastinum in children.

The purpose of this study was to determine the possible causes, clinical findings, and associated complications of pneumomediastinum in children. Medical records from January 1985 to December 1994 were retrospectively reviewed at Children's Hospital Medical Center of Akron using International Classification of Diseases, ninth revision, codes to identify cases of pneumomediastinum. The medical causes, nontraumatic and noniatrogenic, of pneumomediastinum were studied; intubated or trauma patients and patients having undergone procedures were excluded. Neonates were also excluded. Twenty-nine cases of pneumomediastinum were identified. Two patients (7%) had recurrent pneumomediastinum. Only the first episode of pneumomediastinum was included in the data analysis. Twenty males (69%) and nine females (31%) were affected. The most common medical causes of pneumomediastinum were asthma exacerbations (17/59%) and infections (8/28%). Over the 10-year period, the prevalence of pneumomediastinum in children with asthma exacerbations was 0.2% (21/10,472); 1% (1/126) in children with airway foreign bodies and 0.2% (1/351) in children with esophageal foreign bodies. The most common signs and symptoms were subcutaneous emphysema (22/76%), sore throat or neck pain (11/38%), and Hamman's crunch (3/10%). The most common complication was pneumothorax with small pneumothoraces in 2 patients (7%) and a tension pneumothorax in 1 asthmatic with recurrent pneumomediastinum. Patients without sore throat or neck pain and patients admitted to the intensive care unit had greater hospital lengths of stay. Pneumomediastinum appears to be uncommon in children. The most common medical causes were asthma and infections. The most common signs and symptoms were subcutaneous emphysema, sore throat or neck pain, and Hamman's crunch. The most common complication was pneumothorax. The clinical significance of pneumomediastinum is its cause and association with significant complications.

Spontaneous pneumomediastinum in children.

SUMMARY. Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema, and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma.

Spontaneous pneumomediastinum in children: clinical and natural history.

Investigation of the clinical characteristics and natural history of nine children with spontaneous pneumomediastinum (SPM) was conducted at the Tel Aviv University Sheba Medical Centre between 1984 and 1994. Most cases occurred in the setting of a valsalva-type manoeuvre, while symptoms and signs on admission were mainly chest pain, dyspnoea, neck pain, subcutaneous emphysema, and Hamman's sign. Three clinical patterns concerning longterm sequelae were identified: patients without any long-term sequelae, patients with a tendency to airway hyperreactivity and subclinical asthma, and patients in whom SPM was the presenting feature of their asthma. Close personal follow up, including pulmonary function tests, should be designed for all children with Spontaneous pneumomediastinum.

Spontaneous pneumomediastinum in children: clinical and natural history

Spontaneous pneumomediastinum in children: clinical and natural history

Mediastinal tube placement in children with pneumomediastinum

To describe the technique, hemodynamic response, and complication rate after the insertion of a percutaneous mediastinal tube for drainage of pneumomediastinum. A combined retrospective and prospective study in mechanically ventilated children with pneumomediastinum. Multidisciplinary pediatric intensive care unit at a children's hospital. The medical records and chest radiographs of 25 (15 retrospective and 10 prospective) patients who had placement of a mediastinal tube for drainage of pneumomediastinum from 1990 to 1995 were reviewed. Hemodynamic data were collected prospectively in the ten consecutive children from January 1994 to April 1995. Mediastinal tube placement: The subxyphoid area was cleansed with povidone-iodine and draped. An 18-gauge, thin-walled introducer needle was inserted 1 to 2 cm below the xyphoid process at an angle of 20 degrees from the anterior abdominal wall, directed at the substernal space. Either a 9-Fr or 11-Fr pericardiocentesis catheter was inserted over a wire and advanced to the third intercostal space. The catheter was secured and connected to 10 cm H2O suction, using a standard thoracostomy tube drainage device. The size of the mediastinal air column on a lateral chest radiograph was measured before and after placement of the mediastinal tube. The mean change in the size of the mediastinal air column was -1.6 cm (median -1.5, p < .001). In the ten prospective patients, hemodynamic data were recorded immediately before and after placement of a mediastinal tube from previously placed arterial and central venous pressure catheters. The mean hemodynamic changes after the mediastinal tube placement were: heart rate -4 beats/min (median = -1, p = .14); systolic blood pressure 16 mm Hg (median = 10, p = .007); diastolic blood pressure 11 mm Hg (median = 11, p = .005); mean arterial pressure 12 mm Hg (median = 8, p = .005); and central venous pressure -2 mm Hg (median = -1, p = .04). In four patients with pulmonary artery thermodilution catheters, the mean increase in cardiac index immediately following placement of the mediastinal tube was 34%. No complications, including bleeding, cardiac puncture, or infection occurred. These findings suggest that hemodynamic compromise commonly accompanies pneumomediastinum in children. Decompression of the mediastinal space and drainage of the pneumomediastinum, using this simple bedside technique for continuous drainage, can be performed rapidly and safely in children, resulting in immediate hemodynamic improvement, and allowing for continuous drainage.