Tungs’ Medical Journal (Jan 2022)
Clinical feature and outcome of spontaneous pneumomediastinum
Abstract
Background: Spontaneous pneumomediastinum is an uncommon disorder. Spontaneous pneumomediastinum was first described by Laennec in the early 19th century, and the first case was reported by Hamman in 1939. Spontaneous pneumomediastinum is the presence of free air in the mediastinum that is not preceded by infection, trauma, hollow-organ perforation, surgery, or other iatrogenic injuries.Objectives: This study aimed to present our experience with spontaneous pneumomediastinum, clarify its clinical presentation and course, and determine effective diagnostic tests and what constitutes unnecessary medical intervention. Methods: All patients presenting with spontaneous pneumomediastinum between October 2000 and October 2012 were retrospectively analyzed. Data, including clinical findings, precipitating factors, diagnostic investigations, and treatment outcomes, were collected. Results: A total of 15 patients with spontaneous pneumomediastinum were identified (14 males and 1 female with a mean age of 24.1 years). Chest pain, dyspnea, and cough were the most common clinical presentations. Of the 15 patients, 6 had a previous history of pulmonary disease: four had a history of asthma and two had a history of bronchiectasis. Precipitating factors, including, in order, upper respiratory tract infection, asthma exacerbation, and violent cough, were identified in 14 patients. Subcutaneous emphysema was observed in 12 patients. Of the 15 patients, 10 were diagnosed by plain chest radiology and 5 by chest computed tomography. Conservative treatment was performed on 14 patients. Mediastinal exploration was performed in one patient, and the operation findings revealed minimal air surrounded by soft tissue in the right paratracheal area. All patients were discharged in excellent condition. Conclusion: Spontaneous pneumomediastinum is an uncommon disorder that primarily affects young adult males. Chest pain and dyspnea are the most common clinical presentations. The clinical course of spontaneous pneumomediastinum is very benign, and the disease is self-limiting. Unnecessary aggressive therapy and invasive diagnostic procedures should be limited.
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