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Pediatric Emergency Care May 2017Described since 1939 in the adult population, spontaneous pneumomediastinum is less known in children. Because of its symptoms and a generally benign evolution, it is... (Review)
Review
INTRODUCTION
Described since 1939 in the adult population, spontaneous pneumomediastinum is less known in children. Because of its symptoms and a generally benign evolution, it is probably an underestimated diagnosis. However, it has to be considered in the differential diagnosis of acute thoracic pain.
METHODS
The incidence being low, we conducted a narrative literature review to identify the circumstances leading to a spontaneous pneumomediastinum, the most relevant signs and symptoms, investigations, as well as treatment recommendations.
RESULTS
Of 216 patients, 66.2% are boys, and mean ages range from 6.9 to 14 years. The most frequent comorbidity in children is asthma (22.2%), and the most common trigger factors are bronchospasm (49%), cough (45.6%), various respiratory tract infections, vomiting (10.3%), and foreign body aspiration (8.3%). It remains idiopathic in 33.3%. Relevant signs are chest pain (54.6%), neck pain and/or sore throat (53.3%), and dyspnea (41.2%). The most relevant sign is palpation of subcutaneous emphysema (66.4%). The classically described Hamman crunch is only present in 11.6%. Chest x-ray provides the right diagnosis in 99.5% of the patients. Pneumothorax is associated in 11.6%. Most patients are hospitalized (88.3%); treatment is based on oxygen therapy, painkillers, and rest. In some series, there can be up to 25.8% of patients requiring intensive care and 5.5% requiring drainage of associated pneumothorax. Survival rate is 92.5%, and long-term follow-up shows normal x-rays after 4 days and no recurrence.
CONCLUSIONS
Spontaneous pneumomediastinum is uncommon in children but must be considered in pediatric patients with acute chest and/or neck pain. History taking, physical examination, and standard chest x-ray are most often diagnostic, and there is rarely a need for other investigation.Hospitalization is not always indispensable; ambulatory management can be considered. Outcome is good, and follow-up can be clinical, therefore avoiding further x-rays.
Topics: Acute Disease; Adolescent; Chest Pain; Child; Diagnosis, Differential; Dyspnea; Female; Humans; Incidence; Male; Mediastinal Emphysema; Neck Pain; Oxygen Inhalation Therapy; Pharyngitis; Pneumothorax; Radiography, Thoracic; Subcutaneous Emphysema; Treatment Outcome
PubMed: 26855340
DOI: 10.1097/PEC.0000000000000625 -
The New England Journal of Medicine Apr 2019
Topics: Adolescent; Asthma; Humans; Lung; Male; Mediastinal Emphysema; Radiography, Thoracic; Subcutaneous Emphysema
PubMed: 30970192
DOI: 10.1056/NEJMicm1811009 -
Acta Medica Academica Aug 2023The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the...
OBJECTIVE
The aim of the present series was first to present our experience in the management of 37 patients with spontaneous pneumomediastinum (SPM), and further to indicate the necessity of identifying true SPM cases as they are currently inadequately defined.
METHODS
This is a single-center, retrospective study, conducted in a university hospital. Consecutive adult patients with pneumomediastinum (PM) between January 2009 and March 2020 were involved in the series. The data about age, gender, symptoms, signs, treatment, length of hospital stay (LOS), and in-hospital mortality were evaluated.
RESULTS
In total, 87 cases with pneumomediastinum (37 with spontaneous and 50 with secondary PM) were analyzed. Patients in both groups were of similar ages (P=0.4). Sufferers with secondary PM were more likely to have: an associated pneumothorax (19% vs 58%, P<0.05), a chest tube placed (18.9% vs 58%, P<0.05), an associated pleural effusion (0% vs 18%, P<0.05). They presented with a longer LOS (3.9 vs 5.3 days, P<0.05), and were more likely to die (0% vs 10%, P<0.05). Additionally they showed a higher prevalence of radiologic subcutaneous emphysema (49% vs 74%, P<0.05).
CONCLUSION
Spontaneous pneumomediastinum is an onset of clinical importance with a low mortality rate, short LOS and good longterm prognosis. It often presents with chest pain, dyspnea and/or subcutaneous emphysema. However, secondary causes of mediastinal air must be ruled out, due to their potential devastating outcome if not diagnosed promptly. A consensus aimed at an update of the classification guidelines is more than indispensable.
Topics: Adult; Humans; Mediastinal Emphysema; Retrospective Studies; Dyspnea; Length of Stay; Subcutaneous Emphysema
PubMed: 37933505
DOI: 10.5644/ama2006-124.408 -
Journal of Pediatric Surgery Mar 2023Pediatric spontaneous pneumomediastinum is known to have a benign course. Despite this, there is no consensus or standardization for the workup and management. There are...
BACKGROUND
Pediatric spontaneous pneumomediastinum is known to have a benign course. Despite this, there is no consensus or standardization for the workup and management. There are often a variety of imaging studies performed for patients with similar presentations.
METHODS
This is a retrospective chart review evaluating the presentation, workup, and management of all pediatric patients with a primary diagnosis of spontaneous pneumomediastinum over a 5-year period at a children's hospital.
RESULTS
Of the 62 patients, the initial workup consisted of either a chest x-ray (CXR) only (n = 31, 50%), a chest computed tomography scan only (n = 11, 18%) or both (n = 14, 23%); additionally, some patients came with 'other' imaging only (n = 3, 5%) or no imaging (n = 3, 5%). Twenty-seven patients (44%) underwent an additional CXR and 19 (31%) underwent an esophagram. All esophagrams were negative for an esophageal leak. A presenting symptom of pain was associated with a hospital stay of less than 24 h (p = 0.008) while shortness of breath (p = 0.0005) and emesis (p = 0.0006) were associated with a hospital stay of greater than 24 h. Associated diagnoses of respiratory infections (p = 0.02) and gastrointestinal issues (p = 0.006), such as hyperemesis, were associated with inpatient admission.
CONCLUSION
Pediatric patients with spontaneous pneumomediastinum benefit from evaluation, management, and treatment based on their presenting symptoms. There is an opportunity to decrease unnecessary radiation exposure in this patient population with fewer CXRs and avoidance of esophagrams, neither of which alter management.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Child; Mediastinal Emphysema; Retrospective Studies; Radiography; Tomography, X-Ray Computed; Dyspnea
PubMed: 36460493
DOI: 10.1016/j.jpedsurg.2022.10.016 -
Jornal Brasileiro de Pneumologia :... Jun 2020
Topics: Adult; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Mediastinal Emphysema; Pandemics; Pneumonia, Viral; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32556025
DOI: 10.36416/1806-3756/e20200190 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Jun 2023Subcutaneous emphysema is the local tissue swelling caused by the gas entering the subcutaneous tissue through the tissue gap. Although subcutaneous emphysema is usually... (Review)
Review
Subcutaneous emphysema is the local tissue swelling caused by the gas entering the subcutaneous tissue through the tissue gap. Although subcutaneous emphysema is usually a nonfatal and self-limited disease, in severe cases, the gas may spread to the neck, mediastinum and chest, resulting in mediastinal emphysema and other serious complications. This article reviews the etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis of subcutaneous emphysema related to dental therapy,and operations that may cause subcutaneous emphysema in stomatology department,as well as the treatment and prognosis of subcutaneous emphysema, with a view to providing some references for dentists.
Topics: Humans; Diagnosis, Differential; Mediastinal Emphysema; Subcutaneous Emphysema; Neck; Face
PubMed: 37272006
DOI: 10.3760/cma.j.cn112144-20221008-00520 -
Anales de Pediatria Apr 2019
Topics: Humans; Infant, Newborn; Mediastinal Emphysema; Subcutaneous Emphysema
PubMed: 29691133
DOI: 10.1016/j.anpedi.2018.03.011 -
Asian Cardiovascular & Thoracic Annals Feb 2022There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the...
INTRODUCTION
There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes.
METHODS
The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium).
RESULTS
A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006).
CONCLUSION
Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.
Topics: COVID-19; Female; Humans; Male; Mediastinal Emphysema; Middle Aged; Pneumothorax; SARS-CoV-2; Treatment Outcome
PubMed: 34247490
DOI: 10.1177/02184923211031134 -
Clinical Medicine (London, England) Jul 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; Pneumothorax; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 36220238
DOI: 10.7861/clinmed.22-4-s51 -
Asian Cardiovascular & Thoracic Annals Oct 2014To describe and clarify management protocols in relation to spontaneous pneumomediastinum, and try to integrate criteria on this subject. (Review)
Review
OBJECTIVE
To describe and clarify management protocols in relation to spontaneous pneumomediastinum, and try to integrate criteria on this subject.
BACKGROUND
Thoracic physicians are faced with patients who present with gas in the mediastinum, frequently without an obvious etiologic factor. Published material contains heterogeneous information from which different conclusions can be drawn.
METHODS
In a Medline search from 1990 to 2012, we collected data on mortality, morbidity, signs, symptoms, etiologic factors, and diagnostic methods. Standardized mean differences were calculated.
RESULTS
We identified 600 patients in 27 papers with series of >5 patients without precipitating or etiologic factors previous to the clinical presentation, but athletic activity, drug abuse, and history of asthma played an apparent role in the disease process. Most patients complained of thoracic pain and dyspnea, with subcutaneous emphysema and Hamman's sign. The most common complication was tension pneumothorax. Morbidity was seen in 2.8%; no mortality has been reported so far.
CONCLUSION
Spontaneous pneumomediastinum is a rare disease with a benign course, which should be treated conservatively unless a complication mandates an invasive procedure. An algorithm for diagnosis and treatment is offered, based on the available evidence.
Topics: Algorithms; Critical Pathways; Humans; Mediastinal Emphysema; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 24887879
DOI: 10.1177/0218492313504091