Spontaneous Pneumomediastinum Research Articles

Bronchial foreign body presenting as pneumothorax and pneumomediastinum in a young child.

Pneumomediastinum (PM) and subcutaneous emphysema (SCE) following foreign body aspiration are very rare. Pneumomediastinum (PM) occurs due to alveolar rupture, whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature, but in some cases, it might be fatal. Therefore, proper assessment and management are required to limit the life-threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered. There is also a rare possibility of spontaneous expectoration of a foreign body dislodged in the trachea.

Spontaneous Pneumomediastinum and bilateral subcutaneous emphysema; a rare case presentation in Asthmatic patient

The presence of free air or gas in the mediastinal structures and the pericardial sac without a clear precipitating cause is known as spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium. Young, healthy persons without a major underlying lung condition are less likely to experience it. Here we presented a 15 years old female known asthmatic patient presented with sudden onset of shortness of breath, dry cough and swelling over the neck down to the abdomen. This patient was managed with asthmatic medication and oxygen conservatively and discharged from the hospital with significant improvement. Spontaneous pneumomediatinum should be taken into consideration after excluding out common illnesses when a youngster complains of chest pain or tightness. Clinical characteristics and a chest CT scan can be used to diagnose SPM. Most patients with spontaneous pneumomediastinum and subcutaneous emphysema had mild to moderate sequel and responded well to conservative therapy

Spontaneous Pneumomediastinum in a Patient with Marijuana Use.

Spontaneous pneumomediastinum is the presence of air in the mediastinum that occurs from an unclear aetiology.Marijuana use can trigger severe vomiting in patients, leading to spontaneous pneumomediastinum through the Macklin effect.

Neumomediastino como complicación de enfermedad pulmonar intersticial en dermatomiositis

Introduction: dermatomyositis is an idiopathic, heterogenous, inflammatory myopathy, which is difficult to diagnose. It is associated with cutaneous manifestations and is considered a variable disease in terms of clinical presentation, course, and prognosis. It may involve different organs and systems, in addition to the skin and muscles. Case report: 56-year-old patient with a history of dermatomyositis who was admitted to the emergency room with dysphagia to solids and liquids, asthenia and adynamia. A thoracic CT scan evidenced pneumomediastinum and multilobar consolidations. Symptoms improved after antibiotic management and methotrexate initiation. Discussion: not many cases of pneumomediastinum in the context of interstitial disease associated with dermatomyositis have been described, thus studying this condition is relevant. The patient did not refer respiratory symptoms. The endoscopy study and esophageal CT scan did not reveal esophageal perforation, thus pneumologists attributed this clinical presentation to the Macklin effect. Conclusion: spontaneous pneumomediastinum is a rare complication carrying a high mortality rate, however it can occur in patients with interstitial lung disease.

Spontaneous pneumomediastinum: A comprehensive review of diagnosis and management.

Pneumomediastinum is a rare condition defined by the presence of air in the mediastinum. In the absence of traumatic injury, iatrogenic injury, or clear etiology, it is called spontaneous pneumomediastinum (SPM). Spontaneous pneumomediastinum most commonly occurs in younger individuals and has a self-limiting course with a good outcome. The purpose of the present manuscript is to systematically review the existing literature on SPM evaluation and management for updated clinical understanding of this condition. A literature search was conducted of publications about SPM on MEDLINE/PubMed and Google Scholar by identifying all the articles with key search terms "pneumomediastinum" and "spontaneous pneumomediastinum". Inclusion criteria were case series published in English between 1980 and 2023. In total, 24 case series were selected and reviewed to determine presenting symptoms, clinical signs and predisposing factors associated with spontaneous pneumomediastinum. Most patients were male; the average age at diagnosis was 26.3 years. The most common presenting symptoms were chest pain and dyspnea. The most common exam finding was subcutaneous emphysema, in 35.4% of patients. Only 5.9% had the classic Hamman's sign. Risk factors include history of asthma, history of smoking, and recent physical activity. This manuscript presents an extensive review of relevant literature highlighting the diagnosis and essential management of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum and surgical emphysema presenting as rhinolalia following ecstasy ingestion: a case report

BackgroundWe present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use.Case presentationThis case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved.ConclusionsThis case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use.

Recurrent Spontaneous Pneumomediastinum Induced by Electronic Cigarettes

Vaping is the process of inhaling an aerosol produced by heating a liquid or wax containing substances such as nicotine, flavoring, and aditives with a device called electronic cigarette (EC). Consumers who use the EC tend to overinhale and then forcefully exhale to eliminate the vapor, performing an exaggerated Valsalva maneveur, usually produced in much greater quantity than generated by a regular cigarette. This can increase their risk for developing potential spontaneus pneumomediastinum. Pneumomediastinum is the presence of air or gas in the mediastinum, that can be classified as spontaneous or secondary. Here we present a case of recurrent spontaneous pneumomediastinum due to EC use.

Spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no clinical signs: 12 cases

Pneumomediastinum denotes the presence of gas within the mediastinum and generally occurs by leakage of air from an aerated viscus that traverses or abuts the mediastinal plane. The Macklin effect has been described in several veterinary studies and describes gas tracking along the perivascular interstitium following alveolar rupture causing interstitial emphysema, pneumomediastinum and subsequently cervical subcutaneous emphysema. This retrospective case series describes incidental spontaneous pulmonary interstitial emphysema, pneumomediastinum and cervical subcutaneous emphysema secondary to the Macklin effect in dogs with no related clinical signs. Twelve dogs were identified from the author’s institution, of which 75 % were Sighthounds (Greyhounds, Whippets or Lurchers). Pulmonary interstitial emphysema had a predominantly paravascular distribution, although in some cases a parabronchial distribution was also identified. We conclude that incidental pulmonary interstitial emphysema, pneumomediastinum and secondary cervical subcutaneous emphysema can be incidental, presumed secondary to the Macklin effect and that Sighthound breeds may be overrepresented.

Primary Spontaneous Pneumomediastinum and Extensive Cervical Emphysema in COVID-19 Infection: a Case Report

Primary Spontaneous Pneumomediastinum and Extensive Cervical Emphysema in COVID-19 Infection: a Case Report

Spontaneous Subcutaneous Emphysema and Pneumomediastinum in a Child with No Risk Factors: A Case Report

Spontaneous Subcutaneous Emphysema and Pneumomediastinum in a Child with No Risk Factors: A Case Report

Spontaneous Pneumomediastinum as the Result of Marijuana Use

Spontaneous Pneumomediastinum as the Result of Marijuana Use

Extracorporeal membrane oxygenation versus invasive ventilation in patients with COVID-19 acute respiratory distress syndrome and pneumomediastinum: A cohort trial.

Patients with severe respiratory failure due to COVID-19 who are not under mechanical ventilation may develop severe hypoxemia when complicated with spontaneous pneumomediastinum (PM). These patients may be harmed by invasive ventilation. Alternatively, veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) may be applied. We report on the efficacy of V-V ECMO and invasive ventilation as initial advanced respiratory support in patients with COVID-19 and acute respiratory failure due to spontaneous PM. This was a retrospective cohort study performed between March 2020 and January 2022. Enrolled patients had COVID-19 and acute respiratory failure due to spontaneous PM and were not invasively ventilated. Patients were treated in the intensive care unit (ICU) with invasive ventilation (invasive ventilation group) or V-V ECMO support (V-V ECMO group) as the main therapeutic option. The primary outcomes were mortality and ICU discharge at 90 days after ICU admission. Twenty-two patients were included in this study (invasive ventilation group: 13 [59%]; V-V ECMO group: 9 [41%]). The V-V ECMO strategy was significantly associated with lower mortality (hazard ratio [HR] 0.33 [95% CI 0.12-0.97], p = 0.04). Five (38%) patients in the V-V ECMO group were intubated and eight (89%) patients in the invasive ventilation group required V-V ECMO support within 30 days from ICU admission. Three (33%) patients in the V-V ECMO group were discharged from ICU within 90 days compared to one (8%) patient in the invasive ventilation group (HR 4.71 [95% CI 0.48-45.3], p = 0.18). Preliminary data suggest that V-V ECMO without invasive ventilation may improve survival in COVID-19-related acute respiratory failure due to spontaneous PM. The study's retrospective design and limited sample size underscore the necessity for additional investigation and warrant caution.

Pulmonary interstitial emphysema and spontaneous pneumomediastinum are more prevalent in sighthounds than other dog breeds undergoing thoracic CT.

Spontaneous pneumomediastinum is an uncommon condition described in veterinary medicine with concurrent respiratory disease. It can be caused by the Macklin effect, which is when gas leaks from the alveoli into the surrounding interstitial lung tissue. Pulmonary interstitial emphysema (PIE) is the presence of gas within the pulmonary vascular sheaths and indicates the presence of the Macklin effect. In the authors' experience, spontaneous pneumomediastinum and PIE are more prevalent in sighthound dogs than in other breeds and are often considered incidental findings. This retrospective, observational, cross-sectional study compared the prevalence of PIE and subsequent pneumomediastinum in sighthound with other purebred dogs. It characterized the appearance of PIE in CT and analyzed a possible association with concomitant pulmonary pathologies or with the use of general anesthesia. Medical records and thoracic CTs of sighthounds and nonsighthound dogs from two institutions were reviewed. A total of 256 dogs, comprising 127 sighthounds and 129 other purebred dogs, were included. The prevalence of PIE and pneumomediastinum was statistically higher in sighthound (14.2%) compared with other nonsighthound dogs (2.2%). There was no statistical association between the presence of PIE and pneumomediastinum with different age and weight groups or with sex. There was no statistical difference in the prevalence of PIE and pneumomediastinum between dogs with and without pulmonary pathology or in dogs undergoing CT with sedation or general anesthesia. Spontaneous pneumomediastinum in sighthounds is more prevalent than in other breeds, and its prevalence is not associated with the presence of pulmonary pathology or the use of general anesthesia.

Fatal Triad: Spontaneous Pneumothorax, Pneumomediastinum, and Pneumorrhachis in a Case of Paraquat Ingestion

Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis. Aim is to reinforce the importance of a high index of suspicion in early diagnosis when the above findings are present with ARDS in absence of trauma and a history of alleged substance ingestion. Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oral ulcers, yellow discoloration of eyes with fever, and decreased urine output for three days after consuming some substance with his seafood. On examination, he had yellow discoloration of eyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsum of the tongue and lateral margins with generalized subcutaneous emphysema. In addition, decreased air entry in the bilateral lung field and muffled heart sounds were present. He had an acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine tested positive for myoglobin and muscle enzymes (creatinine kinase and lactate dehydrogenase (LDH)) were raised. He was intubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liver failure was started with empirical antibiotics and intravenous fluids. We supplemented thiamine and vitamin K, and hemodialysis was done in view of progressive renal failure. Radiological evaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachis which were managed conservatively. His respiratory parameters worsened despite maximal ventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. He succumbed to his illness on day five of admission and seven days after toxin ingestion. Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid its use for suicidal and homicidal purposes. More research is required to find measures to intervene early and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in a patient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS).

Early Diagnosis Aids in Successful Management of Rare Complications of COVID-19: Spontaneous Pneumothorax and Pneumomediastinum with Cytokine Release Syndrome

Abstract Coronavirus disease-2019 (COVID-19) has become a global pandemic and a health problem of epic proportions. The disease is mild in the majority of cases. Respiratory symptoms predominate and acute respiratory distress syndrome (ARDS) is the commonest complication associated with the disease. Chest X-ray plays an important role in the initial evaluation and follow-up of COVID-19 disease at different stages, more so, in resource-limited settings. It is useful to monitor disease progression and possibly to exclude other unusual causes of dyspnea. In this case series, we present a rare manifestation in COVID-19-positive patients: spontaneous pneumothorax and pneumomediastinum associated with the cytokine release syndrome (CRS) which was successfully managed at COVID care intensive care unit.

A case of skin rash associated with spontaneous pneumomediastinum

A case of skin rash associated with spontaneous pneumomediastinum

Spontaneous Pneumomediastinum in Children: Underdiagnosis and Overtreatment

Background: Spontaneous pneumomediastinum (SPM) is a rare and benign self-limiting condition characterized by the presence of air in the mediastinum without an apparent cause. Boerhaave syndrome, on the other hand, is a rare condition caused by spontaneous esophageal perforation due to severe vomiting. The mediastinum is a complex anatomical region housing vital organs, making clinical comprehension challenging. Objectives: There is no established approach to diagnosing and treating children with SPM. Despite similarities in the presence of air in the mediastinum, SPM and Boerhaave syndrome are distinct entities. However, the primary challenge for patients is ruling out esophageal perforation. We aimed to highlight this rare issue by presenting the results of our patient series to guide further examination in pediatric patients with mediastinal air. Methods: We included twenty-four pediatric patients diagnosed with SPM between 2014 and 2022. Demographic and clinical characteristics, diagnostic procedures, treatments, and follow-up details were retrospectively recorded. Results: The mean age of the twenty male and four female patients was 14 years. Common triggers included coughing (45%), increased physical exertion (33%), and retching/vomiting (8%). All patients experienced chest pain, with additional symptoms such as dyspnea (50%), neck pain (30%), and dysphagia (12%). Symptoms resolved within two days of hospitalization. Patients were often misdiagnosed and received inappropriate treatment at other centers before being transferred to our hospital. A fluoroscopic esophagogram conducted within an average of 22 hours from admission revealed no abnormalities. Oral feeding was withheld for an average of 28 hours. The mean duration of symptom-free hospitalization without treatment was 32 hours. Conclusions: It appears that emergency department physicians may lack familiarity with pneumomediastinum. Surgeons' concerns about missing Boerhaave's syndrome may lead to unnecessary tests, prolonged fasting, and hospital stays for patients with SPM.

Spontaneous pneumomediastinum: case series and literature review

Spontaneous pneumomediastinum (SPM) is a condition characterised by presence of air in the mediastinum that is not iatrogenic or secondary to trauma. We conducted a retrospective review of 4 cases, treated at our hospital for SPM in 2023. The mean age of the patients was 35 years (range, 28-58 years), with 3 male (75%). Only one of the patients (25%) had precipitating projectile vomiting followed by hematemesis. Chest pain was by far the most common symptom (75%). One patient presented with haematemesis, raised inflammatory markers and fever. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In all cases a computed tomography (CT) scan of the chest with on table contrast was performed with half of the patients needing fluoroscopy swallow later in the admission. Half of the patients were treated for suspected oesophageal perforation and received antibiotics and kept nil by mouth, the other two patients only required supportive care. The mean length of hospital stay was 3.4 days (range, 1.2-4.7 days). SPM is a benign process primarily affecting young otherwise healthy males. There is a growing body of evidence to suggest that CT of the chest with on table contrast should be reserved for patients presenting with red flags such as abdominal pain, hematemesis, fever and raised inflammatory markers.

A clinical review of spontaneous pneumomediastinum.

Primary spontaneous pneumomediastinum is a rare, often benign and self-limited condition defined by air within the mediastinum. However, correctly distinguishing primary spontaneous pneumomediastinum from secondary causes, especially esophageal perforation, remains a diagnostic challenge. There is significant debate regarding the balance of completing a thorough but not overly invasive and costly diagnostic workup. This clinical review aims to gather the limited data regarding spontaneous pneumomediastinum management from case series and retrospective cohort studies, and presents an evaluation algorithm and treatment plan stratified by clinical history. Understanding specifically if the patient presents with coughing versus forceful vomiting is critical to help elucidate the etiology and guide management of pneumomediastinum. Patients who present with forceful vomiting or retching should be considered with higher degree of suspicion for secondary causes of pneumomediastinum, specifically esophageal perforation. However, especially in children, aggressive diagnostic workup is not warranted in every case. After ruling out other etiologies of pneumomediastinum, spontaneous pneumomediastinum can be commonly treated with symptomatic management without the aggressive use of antibiotics or diet restriction. Hospital length of stay may also be minimized on a case-by-case basis. Overall, recurrence of spontaneous pneumomediastinum is rare and outpatient follow up may be safely limited to those at highest risk of recurrence.

Management of Pediatric Patients With Spontaneous Pneumomediastinum: A Retrospective Chart Review

PurposeGiven the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm. MethodsRetrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data. ResultsWe identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission. DiscussionThere is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted. Type of StudyRetrospective Cohort Study. Level of EvidenceIII.