Pneumomediastinum in a surf lifesaver

Pneumomediastinum from sports-related trauma: key findings and recommendations

Pneumomediastinum can result from blunt chest trauma in sports. Diagnosis is made using chest radiography. The natural history of isolated pneumomediastinum is benign; however, it can be associated with more serious injuries, such as disruption of the tracheobronchial tree or a perforated digestive viscus. Patients with isolated pneumomediastinum should be monitored with serial chest radiographs. Patients may return to full activity once their chest radiographs have returned to normal, they exhibit no symptoms, and they have regained their stamina.

Pneumomediastinum in a high school football player: a case report

OBJECTIVE

To provide athletic trainers with information about the mechanism, evaluation, and treatment of pneumomediastinum.

BACKGROUND

This is a case study of a high school football player who suffered pneumomediastinum as a result of a flat-handed thump to his sternal area during a blocking drill. Pneumomediastinum is a relatively rare occurrence in sports. Common mechanisms include direct blunt trauma, vomiting, sneezing, Valsalva maneuver, and forceful coughing. Typical signs and symptoms include chest pain, dyspnea, tenderness, crepitus in the neck that can be aggravated with swallowing, and a positive Hamman's sign with auscultations.

DIFFERENTIAL DIAGNOSIS

Pneumothorax, pneumopericardium, sternal contusion, rib fracture, upper respiratory infection, and myocardial infarction.

TREATMENT

Conservative management includes restriction from athletic activities, prophylactic antibiotics, and sleeping in a semireclined position. Surgical repair of the defect may be indicated if repeat radiographs fail to show improvement after 1 week.

UNIQUENESS

It is rare that a relatively light blow through shoulder pads would result in a pneumomediastinum. Review of the literature does not include this athlete's symptoms of congestion, nasal voice, or sore throat as typical signs of pneumomediastinum.

CONCLUSIONS

The literature indicates that an uncomplicated pneumomediastinum will typically resolve in 2 weeks' time. In this case, symptomatic evaluation warranted only 1 week of rest before the athlete was allowed to return to full activity.

Pneumomediastinum in a female track and field athlete: a case report

OBJECTIVE

To present the case of an elite female track and field athlete who suffered a pneumomediastinum resulting from a Valsalva maneuver performed while throwing the javelin.

BACKGROUND

Episodes of chest pain and labored breathing in athletes may be alarming. Accurate, early diagnosis is enhanced by an awareness of those relatively rare conditions that may cause these symptoms.

DIFFERENTIAL DIAGNOSIS

Bronchial injury/fracture, retropharyngeal abscess, acute pulmonary disease, pneumomediastinum, pneumothorax, cardiac disease, allergic reaction.

TREATMENT

The athlete was given intravenous morphine for pain, prescribed oral pain medication, and restricted from strenuous activity for 6 weeks. Aerobic exercise was allowed after pain and air in the neck subsided, which was estimated at 1 week postinjury.

UNIQUENESS

This is a rarely reported case of a pneumomediastinum in a female and a track and field athlete.

CONCLUSIONS

Medical personnel must be aware of the possibility of pneumomediastinum in track and field athletes and in female athletes and must be knowledgeable in the followup care and the safe return of the athlete to activity.