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Classification scheme of pneumomediastinum. Pneumomediastinum can be broken down into two main categories, secondary and idiopathic. Both categories have multiple causes
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Pneumomediastinum (PM) is defined as the presence of free air in the mediastinal cavity. It is often regarded as a revealing sign of a more serious medical condition. PM is broken down into two categories, one, with an instigating event, referred to as secondary PM. The other is when free air is discovered in the mediastinal cavity without a clear...
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The spontaneous pneumomediastinum is characterized by the air presence in the mediastinum. It is a generally benign disease which evolves in a satisfactory way between 2 and 15 days, that is not associated to any directly known cause. It is infrequent in the old age. It mainly presents with chest pain, dyspnea and subcutaneous emphysema. Diagnosis...
Tracheobronchial injury is a rare but potentially fatal occurrence, with most cases resulting from penetrating trauma or blunt and iatrogenic injury during medical procedures such as endotracheal intubation, bronchoscopy, or surgery. Early recognition of clinical symptoms can help stratify patient risk and guide management, though these symptoms ar...
Spontaneous pneumomediastinum (SPM) is a rare self-limiting benign condition that manifests as free air in the mediastinum without any underlying etiology. This under-reported diagnosis occurs usually in young males, with few reports in females. Here, we present a case of a 17-year-old healthy female who presented to the emergency department (ER) w...
Spontaneous pneumomediastinum (SPM) refers to the presence of air in the mediastinum without any obvious cause. It is an uncommon condition occurring due to alveolar rupture as a result of increased intrathoracic pressure. It is commonly seen in young males, patients with known asthmatic disorders and pulmonary diseases. We report a rare case of SP...
Combination of postpartum spontaneous pneumomediastinum and subcutaneous emphysema is a very rare event that mainly occurs during the second stage of labor. Symptoms usually appear during the immediate postpartum period and include acute chest pain, shortness of breath, neck swelling and subcutaneous emphysema. These symptoms may mimic fatal condit...
Citations
... 1 Both interstitial lung diseases (ILD) and bronchoscopic procedures are well described as possible secondary causes of pneumomediastinum with reported incidence rates of up to 4% on transbronchial biopsy and 2% on endobronchoscopic ultrasound (EBUS) guided biopsy. [2][3][4] Bronchoscopy is frequently performed in the investigation of immunotherapy associated pneumonitis to exclude other aetiologies including infection. However the risk of pneumomediastinum from bronchoscopic evaluation of active pneumonitis has not been well elucidated in the literature. ...
... Pneumomediastinum has been well described as a complication of active pneumonitis in the setting of ILD and additionally as a rare complication of bronchoscopy, although primarily related to interventions such as transbronchial or EBUS biopsy. 3 In the setting of ILD it is well understood that active inflammation in combination with architectural F I G U R E 1 CT pulmonary angiogram demonstrating pneumomediastinum. ...
... 1 A similar pathophysiological process occurs in transbronchial and EBUS biopsy which can create an iatrogenic air-leak into the mediastinal space. 3 This case describes a common clinical conundrum of differentiating IRAE associated pneumonitis from an infectious process in the setting of recent prednisolone. The authors postulate that primarily active IRAE pneumonitis was the most likely source of the development of pneumomediastinum. ...
We describe the case of an 87‐year‐old gentleman referred to a metropolitan hospital in Sydney with pneumomediastinum complicating immunotherapy associated pneumonitis and recent bronchoscopic intervention. The contribution of pneumonitis in the setting of interstitial lung disease has been well described to developing pneumomediastinum however this is less clear in the setting of immunotherapy associated pneumonitis and to what extent bronchoscopic intervention compounds this risk. image
... Pneumomediastinum also described as mediastinal emphysema is defined as the presence of air in the mediastinum [4][5][6]. Interestingly, when this is associated with subcutaneous emphysema it is known as Hamman's Syndrome and was first described in 1939 by Hamman in a post-partum patient [7], although the phenomenon has been reported to have been first described by Laenek in 1827 [4][5][6]. ...
... Pneumomediastinum also described as mediastinal emphysema is defined as the presence of air in the mediastinum [4][5][6]. Interestingly, when this is associated with subcutaneous emphysema it is known as Hamman's Syndrome and was first described in 1939 by Hamman in a post-partum patient [7], although the phenomenon has been reported to have been first described by Laenek in 1827 [4][5][6]. ...
... (13) Relevant signs include subcutaneous emphysema in 70% of patients, and in approximately a quarter of cases, a positive Hamman's sign, defined as a crunching sound synchronous with the heartbeat, heard loudest over the precordium and in the left lateral decubitus position, which increases in intensity during inspiration. (11,14) This sign is thought to be due to the heart beating against air-filled tissues, and can also sometimes be heard in pneumothorax without pneumomediastinum. (15) In pneumomediastinum, radiological findings on plain x-ray typically reveal radiolucency between the heart borders and inner surface of the mediastinal pleura including the main pulmonary artery and aortic arch. ...
... (10) Predisposing factors include being of young age, male sex, underlying pulmonary conditions, recreational drug use and smoking. Precipitating factors include emesis, cough, retching, Valsalva manoeuvre and strenuous physical activity.(11) ...
Introduction: Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity. Case Study: Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck. Results: The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home. Conclusion: This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium.
... In 1618, the first case of spontaneous pneumomediastinum was reported by Gordon, when Louise Bourgeois observed subcutaneous emphysema in a parturient [1]. It was subsequently described by Hamman in 1939 [2]. Spontaneous pneumomediastinum, which usually appears abruptly, is most commonly seen in young, male adults with a slender build [3][4][5]. ...
Spontaneous pneumomediastinum is a rare pathology. It occurs mainly in young adults. Its abrupt onset is characteristic, with chest pain, subcutaneous emphysema and dyspnoea. We report a case of pneumomediastinum in a 25-year-old patient with asthma triggered by coughing. The patient presented with acute respiratory failure and retrosternal chest pain. The chest X-ray showed a pneumo-mediastinum with emphysema of the cervical and thoracic soft tissues. A CT scan confirmed the diagnosis of medium-intensity pneumomediastinum with minimal pneumothorax. The outcome was favourable in 4 days after exsufflation, oxygen therapy and conventional medical treatment.
... Secondary pneumomediastinum is a result of traumatic or iatrogenic etiologies, such as endoscopic, post-operative, and airway-related procedures and may represent injury to the esophagus, tracheobronchial tree, or lungs. On the other hand, spontaneous pneumomediastinum (SPM) occurs with no clear inciting event despite some predispositions such as preexisting respiratory disease, excessive emesis, or lean body habitus 2,3 . In children, a severe asthma exacerbation is the major cause of SPM, and pediatric SPM has a bimodal incidence with those less than 7 (typically related to asthma) and then 13-to 17-year-old cases that are not due to asthma 4,5 . ...
Spontaneous pneumomediastinum (SPM) is a rare condition in children and young adults that raises concern for esophageal perforation or extension of an air leak, resulting in admissions with multiple interventions performed. To assess our outcomes, and to evaluate our resource utilization, we reviewed our experience with SPM. We conducted a retrospective review of SPM cases in patients aged 5–25 years old occurring between 2011 and 2021 at a single academic tertiary care center. Clinical, demographic, and outcome variables were collected and analyzed, and cohorts were compared using Fischer’s Exact Test and Welch’s T Test. 166 SPM cases were identified—all of which were Emergency Department (ED) presentations. 84% of the cases were admitted. 70% had Computerized Tomography (CT) scans, with no defined criteria for imaging. Comparison of floor admissions with discharges from the ED showed no significant difference in presenting symptoms, demographics, or outcomes between the two groups. Recurrence was noted in 4 patients with a range of 5.9 months–4.9 years from the initial episode. In the largest SPM study in the pediatric and young adult population, we noted no significant difference in management or outcomes in admitted or ED discharge patients nor those with CT imaging. Our results suggest that a large number of SPM can be managed safely with discharge from the ED.
... Typically, trauma and other serious chronic lung disorders are the most prevalent causes of PM. However, a spontaneous Pneumomediastinum (SPM) associated with subcutaneous emphysema, Hamman's syndrome, can arise as a Pneumomediastinum (PM) without a de ned etiology and can typically occur in response to physiologic or pathologic events (2). For example, labor is a physiological process that can lead to excessive straining and eventually to SPM, which is sometimes mistaken as other clinical emergencies (3). ...
Background: In medicine, Pneumomediastinum (PM) refers to the presence of free air in the mediastinal cavity. Typically, trauma and other serious chronic lung disorders are the most prevalent causes of PM. It is estimated that Hamman’s syndrome, spontaneous pneumomediastinum and subcutaneous emphysema, occurs in approximately 1 in 100,000 live births and is highly associated with prolonged labor time. Amniotic fluid embolism (AFE) is a rare obstetric emergency characterized by severe hypotension, hypoxia, and coagulopathy and it is one of the leading causes of maternal mortality during labor or shortly after delivery. There are several case reports which described Hamman’s syndrome during or after delivery and AFE during and after labor separately, but we did not find any case in the literature which AFE and Hamman’s syndrome simultaneously occur in the same patient.
Case report: In the presenting case report, we described a 26-year-old female patient who suddenly developed shortness of breath, chest pain, and cough after normal vaginal delivery. She was diagnosed with AFE with Hamman’s syndrome and was treated with conservative management. After one week of hospitalization, the patient was discharged in good health.
Conclusion: AFE is a potentially high mortality condition, but with early diagnosis and management the outcome of the mother can be improved.
... Another word for the presence of air in the mediastinum is pneumomediastinum. 1,2 Pneumomediastinum is a rare disorder that occurs in 1/100,000 spontaneous births or 1/44,500 emergency department visits, with a higher incidence in children ( This patient was subjected to a radiological examination, which pointed out pneumomediastinum and subcutaneous emphysema (Figures 2a and b (Figure 3). ...
Background: The term pneumomediastinum (PNM) refers to the presence of air within the mediastinal cavity. This illness is uncommon but can arise in adolescents with severe asthma attacks. In children aged 5 to 34, the incidence of pneumomediastinum after an acute asthma attack is 1 in 25,000. Men made up the majority of patients (76 percent of all cases). Pneumomediastinum can be diagnosed with the assistance of a chest CT scan. Case: A young man was diagnosed with pneumomediastinum due to an acute asthma attack in this case report. Symptoms of uncontrolled asthma include shortness of breath that worsens with wheezing, chest tightness, and a nonproductive cough. Since the age of 12, the patient in this instance has been receiving salbutamol inhalers. The physical examination revealed polyphonic lung respiration and subcutaneous crepitus in the neck, shoulders, and anterior chest. With adequate management of an asthma episode, pneumomediastinum recovers spontaneously, followed by recurrent symptomatic status, physical examination, and radiography examination. Discussion: Acute asthma exacerbations are one of the factors that can lead to spontaneous pneumomediastinum, in which mediastinal air can permeate the tissue and generate a pneumothorax, and if there is air in the subcutaneous area, it can lead to subcutaneous emphysema. Conclusion: Pneumomediastinum was a rare incidence, pulmonologists examining young adults with acute asthma exacerbations should evaluate for pneumomediastinum. In usual asthma therapy, a chest CT-scan is essential to screen for pneumomediastinum.
... Secondary pneumomediastinum, on the other hand, is generally described in the literature as trauma-induced, including iatrogenic pneumomediastinum, and is referred to as traumatic pneumomediastinum. [2] The entry of air into the mediastinum occurs as a result of damage to mediastinal-associated structures (such as alveolar rupture) or traumas that disrupt the integrity of the wall. The mechanism most commonly implicated in spontaneous occurrences is the Macklin phenomenon. ...
... The mechanism most commonly implicated in spontaneous occurrences is the Macklin phenomenon. [2] Patients may present with symptoms such as shortness of breath, chest pain, difficulty swallowing, neck pain, odynophagia, etc. [1] As part of the initial diagnostic approach, obtaining a chest X-ray is generally recommended. [3] Chest X-rays yield accurate results in up to 90% of cases; however, a lung computed tomography (CT) scan is the most accurate test for definitive exclusion and diagnosis. ...
... [4] The reported prevalence of pneumomediastinum is approximately around 0.002%. [2] The most common presenting symptoms are chest pain and shortness of breath. This renders pneumomediastinum a small component within a broad differential diagnosis spectrum. ...
Background:
Pneumomediastinum signifies the accumulation of air within the mediastinum. This condition can develop sponta-neously or as a secondary condition due to trauma or iatrogenic causes. Although rare, it is part of a wide differential diagnosis scale due to its most common presenting symptoms: chest pain and shortness of breath.
Methods:
Our study is a retrospective, observational, and cohort investigation. It included patients who presented to the emer-gency department and were diagnosed with pneumomediastinum through computed tomography. The study evaluated patients' so-ciodemographic features, methods of presentation, chest tube insertion, other surgical procedures, outcomes, and patient dispositions. The primary outcome of the study focused on the results of traumatic and spontaneous pneumomediastinum: hospital admission, the necessity for thoracostomy tube insertion, requirement for surgical procedures, and mortality. The secondary aim was to determine the relationship between other clinical features and laboratory parameters and their impact on the outcomes.
Results:
The study comprised 67 cases. The average age of the cases was 44.89±2.41 years. Of the cases, 67.2% (n=45) were male. In terms of development, 40.3% (n=27) of cases were classified as spontaneous, and 59.7% (n=40) were post-trauma pneumomediasti-num diagnoses. Among symptoms, 50.7% (n=34) of patients experienced dyspnea, and 49.3% (n=33) presented with chest pain, while symptoms like cough, fever, nausea, vomiting, and swallowing difficulty were reported in varying proportions. Among the patients, 9.0% (n=6) had lung disease, 29.9% (n=20) had comorbidities, 3.0% (n=2) had a history of substance use, 14.9% (n=10) underwent thoracostomy tube insertion, and 20.9% (n=14) required surgical procedures. While 35.8% (n=24) of the patients were admitted to the intensive care unit, 13.4% (n=9) died. The mean total hospital stay was calculated as 8.68±1.12 days. No statistically significant relationship was found between the development of pneumomediastinum and hospital admission (p=0.507).
Conclusion:
Upon examining the causes of pneumomediastinum cases, it was observed that patients with a history of trauma required thoracostomy tube insertion and surgical intervention more frequently. However, when classified as spontaneous or trau-matic, both groups exhibited similar clinical courses and outcomes. Both groups demonstrated favorable clinical outcomes.
... Spontaneous pneumomediastinum (SPM) is characterized by free air or gas located within the mediastinum that is not associated with any noticeable cause, such as chest trauma, intrathoracic infections, surgery, other organ rupture or mechanical ventilation. [1] Subcutaneous emphysema (SE) is a related phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which may then extend to other regions of the body. ...
... The mediastinum, a central intrathoracic extrapleural compartment situated between the lungs; bounded by the sternum, costochondral junctions, vertebral bodies, and ribs [1] , serves as a pivotal anatomical region. Pneumomediastinum, characterized by the presence of air within this space, was initially delineated by Laënnec in 1819 [2] . This condition may arise secondarily to physical trauma or other circumstances prompting air leakage from the lungs, airways, or gastrointestinal tract into the thoracic cavity [3] . ...
... Among patients with spontaneous pneumomediastinum, chest pain emerges as the most reported symptom, evident in 75% of cases [2,3] . Furthermore, dyspnea (49%), posterior neck pain (36%), cough (36%), dysphagia (18%) [2] , as well as sore throat and abdominal pain (10%), may manifest concurrently. ...
... Among patients with spontaneous pneumomediastinum, chest pain emerges as the most reported symptom, evident in 75% of cases [2,3] . Furthermore, dyspnea (49%), posterior neck pain (36%), cough (36%), dysphagia (18%) [2] , as well as sore throat and abdominal pain (10%), may manifest concurrently. Notably, subcutaneous emphysema represents the prevailing clinical sign during physical examination, observed in approximately 58% of patients [2] . ...
