Pneumomediastinum and subcutaneous emphysema after pulmonary function tests in a young healthy woman

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.

Air Quality and Respiratory Health among Adolescents from the United Arab Emirates

PURPOSE

To examine the role of air quality in relation to chronic bronchitis, emphysema, asthma, wheeze, and dry cough among adolescents from the United Arab Emirates (UAE).

METHODS

A survey was administered on 6,363 adolescents from 9 UAE regions. Data consists of demographic, socioeconomic, residential, and behavioural variables, such as location of residence, residing near industry/gas stations/dumpsites/construction sites, residing near overhead power line/plants, exposure to tobacco, residential exposure, ethnicity, concern over air pollution, smoking, and purposely smelling gasoline fumes/glue/correctors/car exhaust/burning black ants. Logistic regression modeling was used to determine significant predictors of respiratory health.

RESULTS

Asthma prevalence was 12.3%, followed by chronic bronchitis (1.8%) and emphysema (0.5%). Overall 12.2% reported wheeze and 34.8% reported a dry nocturnal cough in the past year. Multivariate analyses suggest that sex is a significant predictor of asthma and dry cough. Exposure to tobacco and arts/crafts/ceramics/stain is significant predictor of respiratory health. Tobacco smoking and purposely smelling gasoline fumes/glue/correctors/car exhaust/burning black ants are significant predictors of wheeze and dry cough.

CONCLUSIONS

This study suggests that exposure to air quality and behavioral factors such as smoking and purposely smelling gasoline fumes, glue, correctors, car exhaust, or burning black ants are significant predictors of respiratory health among UAE adolescents.

Spontaneous pneumomediastinum, pneumopericardium and epidural pneumatosis: insights on clinical management

Spontaneous pneumomediastinum is a benign condition that has been reported, however the association with epidural pneumatosis is much less common. A 27-year-old male presented with concomitant air in the epidural space, mediastinum and pericardium after illicit drug use and engagement in sexual activity. The patient was hemodynamically stable. Non-invasive tests ruled out aerodigestive injury. The patient was discharged after a short observation without intervention. Invasive and potentially risky diagnostic tests may be safely avoided in patients who remain asymptomatic with this unique presentation.

A case of spontaneous pneumomediastinum and epidural pneumatosis in a young woman in the Emergency Department

BACKGROUND

Pneumomediastinum is a relatively rare, yet typically benign, clinical condition that usually presents in young men.

OBJECTIVE

This report will describe a relatively rare event of pneumomediastinum with epidural extension in a young woman and will discuss the etiology, clinical manifestations, and treatment options for this condition.

CASE REPORT

The patient presented to the Emergency Department (ED) with typical symptoms of shortness of breath and chest pain, but was found on computed tomography to have epidural pneumatosis. No precipitating event was found.

CONCLUSION

This case of spontaneous pneumomediastinum with associated epidural pneumatosis in a young woman presenting to the ED is a relatively benign condition that typically does not require any significant work-up or treatment.

Spontaneous pneumomediastinum: a report of 2 cases

We report 2 cases of spontaneous pneumomediastinum (SPM) with clinical presentations similar to pericarditis, including positional chest pain, tachycardia, a precordial rub, and electrocardiographic changes. Chest radiography is the most commonly used imaging modality for diagnosis, but the findings may be subtle. In select patients, a more extensive diagnostic approach is warranted. Spontaneous pneumomediastinum is self-limiting, and the risk of recurrence is negligible. These cases serve to illustrate the need to include spontaneous pneumomediastinum in the differential diagnosis of pericarditis.

Spontaneous pneumomediastinum: a comparative study and review of the literature

BACKGROUND

Spontaneous pneumomediastinum (SPM) is an unusual occurrence with few cases reported. It is seen after intrathoracic pressure changes leading to alveolar rupture and dissection of air along the tracheobronchial tree. This study was undertaken to provide a thorough clinical and radiologic analysis of this patient population.

METHODS

A retrospective comparative analysis was performed on patients with SPM over 12 years. Patient demographics, clinical presentation, and radiographic and diagnostic studies were recorded. A clinical and radiologic comparison was performed with secondary pneumomediastinum.

RESULTS

Seventy-four patients were identified with a diagnosis of pneumomediastinum. A total of 28 patients with SPM were identified. The major initial complaints were chest pain (54%), shortness of breath (39%), and subcutaneous emphysema (32%). The main triggering events were emesis (36%) and asthma flare-ups (21%). No apparent triggering event was noted in 21% of patients. Chest radiograph was diagnostic in 69%; computed tomography was required in 31%. Esophagram, esophagoscopy, and bronchoscopy were performed on an individual basis and were invariably negative. When compared with secondary pneumomediastinum, SPM is more likely to be discovered by chest radiography, has a lower incidence of pneumothorax and pleural effusion, requires a shorter hospital stay, and has no associated mortality.

CONCLUSIONS

Spontaneous pneumomediastinum is a benign condition that often presents with chest pain or dyspnea. It can develop without a triggering event and with no findings on chest radiography. Treatment is expectant and recurrence is low. Secondary causes must be ruled out to avoid an unfavorable outcome.

Spontaneous pneumomediastinum: a benign curiosity or a significant problem?

OBJECTIVE

To identify the significance of spontaneous pneumomediastinum (SPM) and to optimize its management.

METHODS

A retrospective analysis was undertaken of all patients presenting with SPM over a 5-year period. Eighteen patients were identified, and information on their presentations, initial diagnoses, comorbidities, investigations, clinical courses, length of hospital stays, and outcomes were collated.

SETTING

The emergency department referrals of two major Melbourne teaching hospitals.

RESULTS

SPM is an uncommon condition presenting in approximately 1 in 30,000 emergency department referrals. The typical patient identified from this study is a young man who is likely to have a history of asthma, and who is also likely to smoke or to use illicit drugs. The most common presentation is nonspecific pleuritic chest pain with dyspnea. Complications are rare, and the clinical course benign, but the possibility of a ruptured viscus or an initial misdiagnosis often leads to a great number of investigations. A proposed algorithm of management is given. Other serious and potentially life-threatening conditions, such as Boerhaave syndrome need to be excluded.