Spontaneous Pneumomediastinum Research Articles

Non-Ventilated Patients with Spontaneous Pneumothorax or Pneumomediastinum Associated with COVID-19: Three-Year Debriefing across Five Pandemic Waves.

Spontaneous pneumothorax and pneumomediastinum (SP-SPM) are relatively rare medical conditions that can occur with or independently of COVID-19. We conducted a retrospective analysis of SP-SPM cases presented to the emergency departments (EDs) of two University-affiliated tertiary hospitals from 1 March 2020 to 31 October 2022. A total of 190 patients were identified: 52 were COVID-19 cases, and 138 were non-COVID-19 cases. The primary outcome we were looking for was in-hospital mortality. The secondary outcomes concerned the disease severity assessed by (a) days of hospitalization; (b) required mechanical ventilation (MV); and (c) required intensive care (IC). All were investigated in the context of the five pandemic waves and the patients' age and comorbidities. The pandemic waves had no significant effect on the outcomes of these patients. Logistic regression found age (OR = 1.043; 95%CI 1.002-1.085), COVID-19 (OR = 6.032; 95%CI 1.757-20.712), number of comorbidities (OR = 1.772; 95%CI 1.046-3.001), and ground-glass opacities over 50% (OR = 5.694; 95%CI 1.169-27.746) as significant risk predictors of in-hospital death while controlling for gender, smoking, the pandemic wave, and the extension of SP-SPM. The model proved good prediction performance (Nagelkerke R-square = 0.524) and would hold the same significant predictors for MV and IC.

Refiding syndrome and spontaneous pneumomediastinum in a teenage girl with anorexia nervosa

Anorexia nervosa is a syndrome associated with a deliberate decrease in body weight caused and / or maintained by the patient himself through a sharp restriction of the amount of food taken up to complete rejection of it, an obsessive fear of weight gain. The article describes a clinical case of a 15-year-old girl with anorexia nervosa and the development of severe protein-calorie deficiency, refiding syndrome and spontaneous pneumomediastinum, which required intensive therapy. The clinical features of the course of the disease and observation of the patient in dynamics are presented. Following modern clinical guidelines helped to identify complications in a timely manner, streamline diagnostic tactics, establish a diagnosis and determine the necessary therapy. The alertness of specialists regarding the appearance of complications, against the background of this eating disorder, will allow timely establishing the correct diagnosis, determining approaches to choosing a method of nutrition, tactics for expanding the diet, as well as drug correction of existing conditions.

Seasonal impact and Risk factors of Concurrent Spontaneous Pneumomediastinum and Pneumorrhachis in Adolescents

Seasonal impact and Risk factors of Concurrent Spontaneous Pneumomediastinum and Pneumorrhachis in Adolescents

Protracted Labor Complicated by Pneumomediastinum and Subcutaneous Emphysema: A Rare Case Report and Management Considerations.

BACKGROUND Spontaneous pneumomediastinum and subcutaneous emphysema (Hamman's syndrome) presents with sudden and life-threatening symptoms. Clinical signs include crackles that synchronize with the heartbeat on chest auscultation (Hamman's sign). This report describes the case of a 29-year-old woman with a protracted second stage of labor at 40 weeks of pregnancy with postpartum dyspnea, acute chest pain, and surgical emphysema due to pneumomediastinum (Hamman's syndrome). CASE REPORT This case report describes the case of a 29-year-old primigravida admitted to the hospital ward for spontaneous labor at 40 weeks of pregnancy. Due to a protracted second stage of labor, the delivery was assisted by Thierry's spatulas. Shortly after delivery, the patient developed dyspnea associated with subcutaneous emphysema in the inferior part of the face, neck, and anterior chest wall. As the clinical evaluation showed no signs of severity, we performed a chest X-ray, which confirmed the diagnosis of pneumomediastinum (Hamman's syndrome), excluded any other life-threatening condition, and led to a conservative treatment approach. CONCLUSIONS This report presents a rare association between protracted labor and Hamman's syndrome and highlights the importance of rapid diagnosis and management. In this case, the postpartum presentation was distinguished from pulmonary embolism, and emergency life-saving management was initiated.

Spontaneous pneumomediastinum and pneumopericardium in a young woman: a case report

Spontaneous pneumomediastinum and pneumopericardium in a young woman: a case report

A case of spontaneous pneumomediastinum, pneumothorax with subcutaneous emphysema in a preschool child

Spontaneous subcutaneous emphysema is the presence of gas or air beneath the skin and soft tissues. Pneumothorax and pneumomediastinum are identified by the existence of free gas or air in the associated spaces. 4-year-old with progressive body swelling of 12-hour duration, started just after nebulisation with bronchodilators prescribed for his cough and cold. Examination revealed conscious, anxious, irritable child and obvious superficial swelling of face, scalp, neck, chest and both upper limbs. tachycardia, tachypnoea and his oxygen saturation were 82% at the time of admission. There was crepitus on palpation. Investigations were done; A diagnosis of spontaneous pneumomediastinum, left pneumothorax with spontaneous subcutaneous emphysema was made. Managed with emergency implantable cardioverter-defibrillator (ICD) insertion, oxygen, intravenous antibiotics, intravenous fluids, analgesics, and nebulisation.

Mycobacterium abscessus pulmonary disease presenting with spontaneous pneumomediastinum and subcutaneous emphysema in childhood acute lymphoblastic leukemia: a case report and literature review

IntroductionMycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better understanding of this pathogen in children is essential.Case presentationWe report the case of a 49-month-old female child without previous underlying pulmonary diseases but with acute lymphoblastic leukemia (ALL). The patient was complicated with pneumonia during chemotherapy, which was primarily characterized by spontaneous pneumomediastinum and subcutaneous emphysema on chest computed tomography (CT). M. abscessus sequences were detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. With mechanical ventilation, closed thoracic drainage, and anti-infective therapy for 6 months, the patient’s infection was controlled. The patient completed 2.5 years of treatment for ALL, and the drugs were discontinued. The patient currently remains in complete hematologic remission.DiscussionWe reviewed the literature on 33 children with M. abscessus pulmonary disease. These children mostly had underlying immunodeficiency. Chest CT most often showed nodular shadows, consolidation, and bronchiectasis. Spontaneous pneumomediastinum and subcutaneous emphysema were not reported as major manifestations.ConclusionSpontaneous pneumomediastinum and subcutaneous emphysema were our patient's main characteristics on chest CT, and this study enriches the knowledge regarding possible imaging changes in M. abscessus pulmonary disease in children. This case report reflects good clinical experience in maintaining the balance between chemotherapy and anti-infective therapy in childhood ALL.

Recurrent thoracic air leak syndrome in patients affected by pulmonary graft-versus-host disease: Surgical strategies and outcome.

Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome. We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome. In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak. Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.

Persistent spontaneous pneumomediastinum in a dog with pulmonary fibrosis

AbstractA 5‐year‐old, 5.8‐kg, neutered, male, mix‐breed dog was presented to the emergency service of a university hospital for assessment of respiratory distress. Thoracic radiographs identified a moderate pneumomediastinum, mild cervical subcutaneous emphysema and moderate bilateral diffuse bronchial and unstructured interstitial pulmonary patterns. The dog had a 6‐week long history of progressive respiratory signs before presentation, culminating in acute respiratory embarrassment in the absence of a precipitating event. Three sets of radiographs were performed before presentation, which demonstrated a persistent pneumomediastinum and progressively severe pulmonary infiltrates. The dog was humanely euthanased after 24 hours of hospitalised care, with a diagnosis of interstitial pulmonary fibrosis made at postmortem examination. Spontaneous pneumomediastinum is usually an acute condition, which resolves within a few weeks of diagnosis and does not recur. Persistent spontaneous pneumomediastinum has been described in people previously, and is a rare potential sequela to severe chronic pulmonary disease in dogs.

Spontaneous Pneumomediastinum-Hamman Syndrome.

Spontaneous Pneumomediastinum-Hamman Syndrome.

Primary spontaneous pneumomediastinum: 237 cases in a single-center experience over a 10-year period and assessment of factors related with recurrence.

To evaluate the precipitating factors and symptoms of primary spontaneous pneumomediastinum (PSPM) and to assess the factors related with recurrent spontaneous pneumomediastinum (RSPM). From 2010 to 2021, 237 PSPM patients were included in this retrospective study. Clinical information including in-hospital periods, morbidity, mortality, presenting symptoms, precipitating events, smoking, and asthma history was obtained. The patients with smoking history were subdivided into "ex-smoker" or "current smoker". The severity of asthma was categorized into "mild intermittent", "mild persistent", "moderate persistent", or "severe persistent". During follow-up, patients with RSPM were classified into "recurrence" group and the others were into "no recurrence" group. Multivariate regression analysis was used to elucidate the associated factors with RSPM. The mean age of study patients (men: women = 222: 15) was 23.4 years and mean period of hospital stay was 7.5 days. There was no mortality and morbidity. Most frequent symptom and precipitating factor were acute chest pain (n = 211, 89.0%) and cough (n = 72, 30.4%), respectively. RSPM occurred in 11 patients (4.6%). The proportion of patients with smoking (72.8% vs. 37.1%, p = 0.010) or asthma (81.8% vs. 39.8%, p<0.001) was significantly higher in "recurrence" group than "no recurrence" group. On multivariate analysis, asthma was the only factor associated with RSPM (mild intermittent/persistent, OR = 7.092, p = 0.047; moderate persistent, OR = 8.000, p = 0.011). PSPM is a benign disease with no morbidity and mortality. Asthma may be the associated factor with RSPM; thus, despite the low rate of recurrence, patients with asthma should be informed about the chance of RSPM.

Spontaneous Pneumomediastinum Secondary to Undiagnosed Asthma inMilitary Adult.

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence.

An unusual case of abdominal pain: psychogenic vomiting complicated by spontaneous pneumomediastinum

BackgroundSpontaneous pneumomediastinum (SPM) was defined by the appearance of free air in the mediastinum that was not preceded by trauma, surgery, or other medical procedures. Among the numerous manifestations of SPM, abdominal pain had seldom been described.Case presentationA 25-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain for 7 days. The presenting clinical features and the radiological results were suggestive of psychogenic vomiting with spontaneous pneumomediastinum in a patient who suffered from abdominal pain.ConclusionsThe special feature of this case was the elucidation of a rare cause of abdominal pain, which should be differentiated in patients with vomiting combined with abdominal pain. The importance of this case was that its recognition may prevent unnecessary procedures to rule out or treat other causes of abdominal pain.

Successful treatment of rapidly progressive interstitial lung disease complicated by a refractory pneumomediastinum in a patient with anti‐MDA5 antibody‐positive dermatomyositis

AbstractIntroductionAnti‐melanoma differentiation‐associated gene 5‐positive dermatomyositis (anti‐MDA5+ DM) is a distinct subtype of DM, which is characterized by typical cutaneous features, minimal or no muscle involvement and notable interstitial lung disease, which typically progresses rapidly and has a high mortality. Spontaneous pneumomediastinum (PNM), a relatively unusual but serious complication of anti‐MDA5+ DM, further increases mortality. Currently, there is no generally accepted treatment regimen for anti‐MDA5+ DM‐associated PNM.Case DescriptionA 53‐year‐old man with anti‐MDA5+ DM presented with rapidly progressive interstitial lung disease that progressed to diffuse subcutaneous emphysema and PNM despite aggressive immunosuppressive therapies. He responded well to combined anti‐infection treatments, moderate immunotherapy, and continuous oxygen therapy.ConclusionComprehensive screening for potential infections, as well as close monitoring of the patient's immune status is essential for individualizing treatment and maximizing prognosis.

Pneumorrhachis with spontaneous pneumomediastinum in pediatric patients: An 11-year retrospective study in Southern Taiwan

Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM. Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed. In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n=24) and SPM plus PR (n=6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p=0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5mg/L), identified predisposing factors, and those with more severe grade of SPM (p=0.005, 0.001 and<0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p<0.001). All patients were successfully treated without morbidity and mortality. Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.

A Rare Case of Mild Spontaneous Pneumomediastinum Associated with Asthma Exacerbation.

Introduction: The presence of free air within the mediastinum, that is not associated with trauma, is known as spontaneous pneumomediastinum [1]. The disease was originally described by Rene Laennec in 1819. The word spontaneous was introduced by Hamman later in 1939.The condition can result from an injury that leads to air leakage into the mediastinum from the lung . Spontaneous indicates that it is encountered in patients with underlying lung diseases or without any medically relevant conditions as compared to that secondary pneumothorax that results from trauma [2]. The pathophysiological mechanisms underlying pneumomediastinum are six: 1) Direct mechanism 2) Hamman-Macklin mechanism 3) Subfascial route (secondary to pneumothorax or chest wall injury) 4) Subserosal route:

Pneumomediastinum in association with Covid-19: A less commonly considered differential diagnosis for worsening respiratory failure.

We have reported here two cases of coronavirus disease-2019 (COVID-19) patients aged 29 and 68 years who were diagnosed with pneumomediastinum (PM). PM is a rare complication that is being reported in association with COVID-19. Patients with COVID-19 can present with a variety of etiologies that make them vulnerable to PM. Respiratory complications due to COVID-19 are widely known, and it presents as mild to severe and critical illness. Spontaneous PM is a known complication of COVID-19. Despite seeming to be a lesser-known condition, PM can have a significant impact on disease progression and prognosis. We have presented here two contrasting cases of PM. The first patient was young and with moderate COVID-19 pneumonia and PM, while the second one was an old man with severe COVID-19 pneumonia manifestations. Both patients were diagnosed with PM, but their outcomes were completely different.

Pneumomediastinum as a predictor of negative prognosis in patients with coronavirus pneumonia

Aim of the study was to analyze the course of coronavirus pneumonia in patients with pneumomediastinum. Material and methods. The study included 139 patients, 71 of whom developed spontaneous pneumomediastinum against the background of coronavirus pneumonia. Laboratory, clinical and radiological data were analyzed and compared. Results. The relationship between the severity of viral pneumonia (3rd–4th degree of severity according to MSCT) and pneumomediastinum was revealed. It was found that spontaneous mediastinal emphysema in patients with COVID-19 signifcantly more often leads to the development of acute respiratory distress syndrome, multiple organ failure and can be a predictor of negative prognosis of the disease outcome. Conclusions. Pneumomediastinum in patients with viral pneumonia caused by a new coronavirus infection is a predictor of severe disease and poor prognosis. With an increase in spontaneous mediastinal emphysema without pneumothorax, it is recommended to perform mediastinotomy according to Razumovsky’s indications, and in case of clinically signifcant concomitant pneumothorax – drainage and revision of the mediastinum.

Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population.

What is the optimal management of spontaneous pneumomediastinum (SPM) and is there a risk of esophageal perforation in patients with SPM? We performed a retrospective case-control study of children through age 21, diagnosed with SPM in one hospital system over 10 years with the primary aim of describing the diagnostic workup, treatment patterns, and clinical outcomes. We hypothesized that SPM is a self-limited disease and is not associated with esophageal injury. Cases were identified using International Classification of Disease codes and excluded for trauma or severe infections. Median age was 16 years, 66% were male (n = 179). Chest radiography was performed in 97%, chest computed tomography (CT) in 33%, and esophagrams in 26%. Follow-up imaging showed resolution in 83% (mean = 17.2 days). SPM was not associated with esophageal perforation. We recommend avoiding CT scans and esophagrams unless there is discrete esophageal concern. Management of SPM should be guided by symptomatology.

Spontaneous pneumomediastinum and pneumopericardium in a young female: a case report

Spontaneous pneumomediastinum and pneumopericardium in a young female: a case report