Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication?

BACKGROUND: The purpose of the present study was to evaluate the incidence of epidural air associated with spontaneous pneumomediastinum in children. METHODS: The subjects consisted of 25 boys and 17 girls with an age range of 3-14 years (mean age: 8.5 years) who underwent chest computed tomography (CT) for evaluation of spontaneous pneumomediastinum. The CT scans and medical records were reviewed retrospectively. RESULTS: Of the 42 patients, four (9.5%) had intraspinal air on CT. The air was interpreted as epidural in every patient. The small number of patients with epidural air meant that there was no significant difference in age, gender, or clinical manifestations between groups with and without epidural air. Subcutaneous emphysema was identified in all four patients with epidural air versus 18 out of 38 patients (47%) without epidural air. The patients with epidural air did not have any neurologic symptoms. Irrespective of the presence or absence of epidural air, every patient had a favorable outcome without any serious complications. CONCLUSION: In patients with spontaneous pneumomediastinum, epidural air may be more common than was previously realized. It is suggested that an air leak may spread from the mediastinum into the epidural space via the cervical fascial planes and neural foramina.