Clinical analysis of 71 spontaneous pneumomediastinum cases: an observational study from a tertiary care hospital in Japan

BackgroundSpontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any underlying disease. Some cases of spontaneous pneumomediastinum have been reported in the past, although only few reports are available, and its management remains uncertain. This study reviewed our experience in the diagnosis and treatment of spontaneous pneumomediastinum.MethodsA retrospective study of 71 cases treated for spontaneous pneumomediastinum at the Yodogawa Christian Hospital between April 2005 and March 2020 was conducted.ResultsThe patients’ mean age was 19.3 years (range, 7–48 years). A triggering event was noted in 69% of the cases. Seventy-six percent of the patients were admitted to the hospital, and 24% were outpatients. Treatment included analgesia, rest, antibiotics, and/or oxygen therapy. Thirty-six patients (51%) were treated with antibiotics. None of the cases presented any complications, including mediastinitis or worsening respiratory condition. Two patients (3%) had a recurrence of spontaneous pneumomediastinum.ConclusionsAll the patients, with or without antimicrobial treatment and hospitalization, had favorable outcomes. We should therefore reconsider the need for hospitalization and antimicrobial therapy for patients with mediastinitis prophylaxis.     

Spontaneous Pneumomediastinum: A Rare Complication of Bronchial Asthma

Pneumomediastinum is a rare complication of an acute exacerbation of asthma. We describe a 28-year-old female who was admitted to hospital with acute severe exacerbation of asthma and developed a spontaneous pneumomediastinum (SPM) with associated subcutaneous emphysema. She was successfully managed conservatively. On follow up there was resolution of the subcutaneous emphysema and the pneumomediastinum, clinically and radiologically. SPM although usually a self-limiting condition, can occasionally be life threatening. Therefore, it is important to raise the awareness of this potential complication of asthma.     

Spontaneous pneumomediastinum and subcutaneous emphysema in systemic sclerosis

A 40-year-old woman with known systemic sclerosis presented with dyspnea. She had been treated for pneumonia, 2 months prior to the present admission and at this time presented with sudden dyspnea and was found to have a spontaneous pneumomediastinum and subcutaneous emphysema. Pneumomediastinum is an extremely rare complication in patients with systemic sclerosis.     

Spontaneous cervicothoracolumbar pneumorrhachis,pneumomediastinum and pneumoperitoneum

Introduction: Pneumorrhachis, or epidural pneumatosis, is a rare entity that is usually traumatic or iatrogenic. Usually, the epidural emphysema is limited to a few vertebral spaces. Less commonly, it is secondary to mediastinal air that tracks into the epidural space. Mediastinal air is usually associated with subcutaneous emphysema, but rarely is it associated with pneumopericardium or pneumoperitoneum. The cause of pneumomediastinum is usually identifiable on history or radiology. Methods: Report of a case. Results: We report the extremely rare simultaneous occurrence of self‐limiting cervicothoracolumbar pneumorrhachis, pneumomediastinum, cervical subcutaneous emphysema and pneumoperitoneum in a healthy 20‐year‐old gentleman in the absence of an identifiable cause. Conclusion: Extensive pneumorrhachis and pneumoperitoneum may simultaneously accompany pneumomediastinum and subcutaneous emphysema in the absence of an identifiable cause and still follow a benign clinical course. Please cite this paper as: Al‐Mufarrej F, Gharagozloo F, Tempesta B and Margolis M. Spontaneous cervicothoracolumbar pneumorrhachis, pneumomediastinum and pneumoperitoneum. The Clinical Respiratory Journal 2009; 3: 239–243.     

Pneumomediastinum,subcutaneous emphysema,and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis

Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.     

Spontaneous resolution of diffuse persistent pulmonary interstitial emphysema

Persistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly. Although conservative management is accepted as the initial form of management in most cases, a review of the published literature found that a significant proportion of localized PPIE cases eventually require surgical resection. This case illustrates that extensive bilateral PPIE associated with a persistent pneumomediastinum can resolve spontaneously thus demonstrating that conservative management without surgical intervention may be appropriate for some children.     

Pneumomediastinum in Diabetic Ketoacidosis

A 13-year-old girl was admitted with diabetic ketoacidosis. She was found to have a pneumomediastinum. This resolved spontaneously on correction of the metabolic disturbance. The condition is generally benign.     

Spontaneous pneumomediastinum in anorexia nervosa: A case report and review of the literature on pneumomediastinum and pneumothorax

We report a case of a 20‐year‐old white woman with the history of anorexia nervosa presenting with spontaneous pneumomediastinum (SPM). On admission, her body mass index (BMI) was 9.9 kg/m². Physical examination revealed subcutaneous crepitation especially in the axillae, the intercostal spaces, between the scapulae and along the spine. A chest X‐ray showed extensive tissue emphysema, especially in the upper mediastinum. In a computed tomography (CT) scan, additional air was found in the upper retroperitoneal space adjacent to the stomach and to the left of the aorta. The patient recovered clinically within three weeks, and a CT scan showed a complete remission of the pneumomediastinum and subcutaneous emphysema. Based on this, case review of the literature about the frequency of pneumomediastinum in young patients with low weight is presented concerning epidemiology, etiology, symptoms, diagnosis, treatment, time to recovery and prognosis. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Pneumomediastinum and subcutaneous emphysema secondary to amyopathic dermatomyositis with cryptogenic organizing pneumonia in invasive breast cancer: a case report and review of literature

Amyopathic dermatomyositis (ADM) is recognized as a variant phenotype of dermatomyositis and characterized by typical skin manifestations without evidence of muscular inflammation. While interstitial lung disease (ILD) is occasionally found as one of the lung manifestations in ADM patients, the development of a pneumomediastinum and/or subcutaneous emphysema in this disease entity is one of the extremely rare pulmonary complications. These latter complicated pulmonary manifestations have been usually reported in idiopathic ADM with ILD without any other associated medical conditions. We report a case presented with the spontaneous pneumomediastinum and subcutaneous emphysema in both ADM and cryptogenic organizing pneumonia during adjuvant chemotherapy based on cyclophosphamide for breast cancer.     

Case Report: Pneumomediastinum and pneumothorax complicating colonoscopy

Colonic perforation is potentially the most serious complication of colonoscopy. Both the clinical manifestation and rapidity of onset of symptoms can vary depending on whether the perforation occurs directly into the peritoneal cavity or into the retroperitoneal space. Colonic perforation is often associated with abdominal pain, although more uncommon presentations have been documented. A case report of a unilateral pneumothorax and pneumomediastinum complicating colonoscopy is described, which responded well to conservative measures without recourse to surgical intervention, antibiotic therapy or parenteral alimentation.     

Clinical experience of spontaneous pneumomediastinum: diagnosis and treatment

Background

Spontaneous pneumomediastinum (SPM) is a benign disease with a variety degree of severity but definite treatment modality is not clearly identified with its rarity. The purpose of this study was to review our experience and discuss the management of SPM according to the severity of disease.

Methods

From March 1996 to December 2012, total 64 patients were enrolled and classified as mild, moderate and severe groups and subsequent clinical courses were analyzed retrospectively.

Results

Fifty-one were males and 13 were females (M:F =3.9:1) with a mean age of 18 years old (range: 10-30 years old). Thirty-six patients were in mild, 22 in moderate and 6 in severe group. Chief complaints were chest pain (50 cases; 78.1%), neck pain (35 cases; 54.7%), dyspnea (18 cases; 28.1%), odynophagia (9 cases; 14.1%) and precipitating factors were coughing in 12 cases, feeding problems in 9 cases, and vomiting in 7 cases; however, 34 patients (53.1%) had no precipitating signs. All patients received oxygen therapy (100%), prophylactic antibiotics in 57 patients (89.1%), and pain medications in 47 patients (73.4%). The mean hospital stay was 4.6 days (range: 1-10 days). There was an increased linear trend according to time to visit (P=0.023) but clinical course demonstrated no significant trend between groups.

Conclusions

These data demonstrated that there was no difference in symptom, clinical course and SPM was adequately treated with conservative management regardless of the degree of severity of SPM.     

Spontaneous pneumomediastinum and dermatomyositis may be a not so rare association: report of a case and review of the literature

One patient with dermatomyositis (DM) who developed spontaneous pneumomediastinum (SPnM) is described. A review of 15 previously reported cases shows that this is a complication of DM but not of polymyositis. It occurs in young patients with recent onset of disease characterized by cutaneous vasculopathy, and patients treated with immunosuppressive drugs have, in general, better outcomes. We suggest that the onset of SPnM in DM patients must alert to possible vasculitic activity and that immunosuppressive agents with progressive tapering of corticosteroids are part of the most reasonable approach in these cases. An erratum to this article can be found at     

纵隔气肿诊断为心血管神经症一例报告

【】本文报告一例纵隔气肿诊断为心血管神经症,患者,女,39岁,主因“间断心悸、气短1天”入院。患者于1天前情绪激动大笑后出现心悸、气短,心率偏快,无明显阳性体征,心血管方面的观察及医疗器械检查均未发现器质性心脏病的表现,予吸氧、控制心室率、扩冠、改善循环等治疗未见明显好转,入院诊断为“心血管神经症”,未能在第一时间明确诊断,直到入院后行胸部CT诊断为纵隔气肿。提示在诊断纵膈气肿时,应结合病史,避免误诊。     

Pneumomediastinum Following Anastomotic Leakage in Colon Surgery: A Case Report and Literature Review

We are presenting the case of a 62-year-old woman who developed a pneumomediastinum as a complication of anastomotic leakage (AL) following laparoscopic sigmoid resection due to diverticulitis. The patient presented with retroperitoneal air, pneumomediastinum, emphysematous gall bladder, air in the wall of stomach, and proximal small bowel. There were a few tiny air bubbles around the anastomosis. We discuss this unusual clinical presentation of intraperitoneal and extraperitoneal air as a presenting sign of AL.     

An unexpected complication of robotic cardiac surgery: Pneumomediastinum

Pneumomediastinum is a rare entity that is defined as free air in the mediastinal space. A 26-year-old male patient was admitted with pneumomediastinum as an unexpected complication of robotic surgery. Diffuse subcutanous emphysema was observed suddenly on Postoperative Day 3 without respiratory distress. Air trapping into the mediastinum was seen on chest X-ray and computed tomography. The patient was followed in the intensive care unit for 7?days and managed conservatively. Subcutaneous emphysema reduced gradually. In conclusion, although it is a rare condition, pneumomediastinum should be kept in mind as a complication of robotic cardiac surgery.     

Spontaneous Remission of Adult Acute Lymphoblastic Leukemia: A Very Rare Event

A middle aged male presented to us with an unusual problem when his acute lymphoblastic leukemia (ALL) disappeared without any chemotherapy. We faced a dilemma whether to go ahead and treat his initial diagnosis or wait. Eventually he did relapse and was treated, albeit with a fatal outcome. Such spontaneous remission in acute leukemia are a very rare event, more common in acute myeloid leukemia and in children. Spontaneous remission in adult ALL is rarely described in literature.     

Pneumomediastinum,Pneumopericardium, and Pneumoperitoneum Caused by Peridiverticulitis of the Colon: Report of a Case

A 50-year-old woman with breast carcinoma metastases in the left supraclavicular region was treated because of free air in the mediastinum, around the heart and vascular pedicle, below the diaphragmatic dome, and subcutaneous neck and supraclavicular emphysema, without radiologic signs of pneumothorax. Diverticulosis of the colon and an occult perforation of the diverticulum in the retroperitoneal region of the colon were diagnosed. The patient was treated by segmental resection of the colon with anastomosis, drainage of the abdominal cavity, and antibiotics. To our knowledge, this is the only report in the literature about pneumopericardium caused by peridiverticulitis of the colon.Supported by research grant No. J3-3460-0302-01 by the Ministry of Education, Science and Sport of Slovenia.