Case Report Spontaneous pneumomediastinum revisited (original) (raw)

Spontaneous pneumomediastinum revisited

Respiratory Medicine CME, 2011

Spontaneous pneumomediastinum is defined as free air within the mediastinum, not associated with trauma. Causes include exercise, drugs, asthma, vomiting, difficult labour and Valsalva maneuvers. It's a rare, usually benign and self-limited condition, more prevalent in young males. The triad of thoracic pain, dyspnoea and subcutaneous emphysema is typical. We report a case of a 23 year old man presenting to the emergency room complaining of odynophagia, thoracic pain and neck swelling. He had fever and productive purulent cough in the previous week. He had no abnormal findings but subcutaneous emphysema. We found a pneumomediastinum without pneumothorax, treated conservatively with complete resolution. Although frightening, this condition usually has good prognosis without specific treatment, other than avoidance of the cause.

Spontaneous Pneumomediastinum and Subcutaneous Emphysema: A Two Cases Reports

Scholars Journal of Medical Case Reports

Spontaneous pneumomediastinum (SPM) is an uncommon, mostly benign disorder that usually occurs in young adult males without any apparent pre-existing factor or disease. SPM responds extremely well to conservative treatment, without recurrence in the great majority of cases. We report two cases of SPM and pneumothorax in two young males following a forceful vomiting and a bout of sudden coughing with no underlying lung lesion.

Spontaneous pneumomediastinum. Case report

Case reports, 2017

Introduction: Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum. It is a rare entity considered benign and self-limiting, which mostly affects young adults. Its diagnosis is confirmed through clinical and radiological studies. Case description: 21-year-old male patient with cough and greenish expectoration for four days, associated with dyspnea, chest pain, fever and bilateral supraclavicular subcutaneous emphysema. Chest X-ray suggested pneumomediastinum, which was confirmed by tomography. The patient was hospitalized for observation and treatment. After a positive evolution, he was discharged on the sixth day. Discussion: SPM is a differential diagnosis in patients with chest pain and dyspnea. Its prevalence is lower than 0.01% and its mortality rate is low. It should be suspected in patients with chest pain and subcutaneous emphysema on physical examination. Between 70 and 90% of the cases can be identified by chest X-ray, while confirmation can be obtained through chest tomography. In most cases it does not require additional studies. Conclusion: SPM is a little known cause of acute chest pain, and rarely considered as a differential diagnosis; it is self-limited and has a good prognosis.

Spontaneous Pneumomediastinum with a Rare Presentation

Case Reports in Emergency Medicine, 2014

Spontaneous pneumomediastinum is an unusual and benign condition in which air is present in mediastinum. A 20-year-old male patient presented to ED with complaint of hoarseness and odynophagia from the day before, after weightlifting. The patient was nonsmoker and denied history of other diseases. On physical examination he had no dyspnea with normal vital signs. Throat examination and pulmonary auscultation were normal and no crepitation was palpable. We could not find subcutaneous emphysema in neck and chest examination. In neck and chest X-ray we found that air is present around the trachea. There was no apparent pneumothorax in CXR. In cervical and chest CT free air was present around trachea and in mediastinum. Subcutaneous emphysema was also evident. But there was no pneumothorax. The patient was admitted and went under close observation, oxygen therapy, and analgesic. The pneumomediastinum and subcutaneous emphysema gradually resolved within a week by conservative therapy and he was discharged without any complication. Many different conditions could be trigged because of pneumomediastinum but it is rarely seen in intense physical exertion such as weightlifting and bodybuilding. Two most common symptoms are retrosternal chest pain and dyspnea. But the patient here complained of hoarseness and odynophagia.

Silent Breathlessness: A Case and Brief Review of Spontaneous Pneumomediastinum

Cureus

Spontaneous pneumomediastinum is an uncommon diagnosis defined as the presence of free air in the mediastinum without an apparent cause. It is a self-limiting disorder that most often occurs in young males without any apparent precipitating factor or underlying disease process. Its pathophysiology involves the rupture of alveoli with resultant air penetration into the mediastinum. Underlying disease processes, such as asthma, physical trauma, including yelling, contact sports, and Valsalva during labor, have also been reported to cause spontaneous pneumomediastinum. Here, we present the case of an 18-year-old male who presented to us with the chief complaint of cough and the subsequent diagnosis of spontaneous pneumomediastinum.

Systematic review of spontaneous pneumomediastinum: a survey of 22 years' data

Asian Cardiovascular and Thoracic Annals, 2013

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...

Spontaneous Pneumomediastinum: A Comparative Study and Review of the Literature

The Annals of Thoracic Surgery, 2008

Literature Spontaneous Pneumomediastinum: A Comparative Study and Review of the http://ats.ctsnetjournals.org/cgi/content/full/86/3/962 located on the World Wide Web at: The online version of this article, along with updated information and services, is Print ISSN: 0003-4975; eISSN: 1552-6259.

A case of spontaneous pneumomediastinum presented with subcutaneous emphysema only

International Journal of Medical Science and Public Health, 2016

Subcutaneous emphysema with spontaneous pneumomediastinum is a rare benign condition, which, if diagnosed early, can be managed conservatively. We present a case of young woman who showed subcutaneous emphysema without any precipitating factors was found to reveal spontaneous pneumomediastinum and treated conservatively with rest, analgesics, and oxygen therapy.

Young man with Spontaneous Pneumomediastinum with Atypical Presentation

Razavi International Journal of Medicine, 2019

Introduction: Spontaneous pneumomediastinum (SPM) is a rare condition that is defined as the presence of free air in the mediastinal structures without underlying cause. It commonly happens after coughing, vomiting or intensive physical exercise. Most patients present to emergency department (ED) with dyspnea and chest pain. Young healthy adults are the most population that involve with this problem. Chest X-ray and Chest CT are modalities that can be used for approving the diagnosis. Although SPM seldom accompany with life threatening complications, it is usually a benign and self-limiting disorder. Here we introduce a patient with spontaneous pneumomediastinum with atypical presentation. Case Presentation: A 19-year-old man presented to ED with chief complaint of dyspnea without chest trauma. He denied any drugs consumption and his past medical history did not have noticeable problems. Patient's vital signs were normal and in physical examination, except mild emphysema of neck, other system inspection did not have any pathologic findings correspond with his complication. Chest X-ray and chest CT scan exhibited air in mediastinum without any other pathology like rib fracture. After three days his symptoms was resolved with no requiring to specific treatment. Conclusion: It is a rare condition and if it present with rare symptoms the diagnosis would be very difficult. More, physical examination and chest x-ray as the first diagnostic imaging in respiratory complaints may detect no obvious findings. SPM should be considered as differential diagnosis in young adults, with any respiratory complaint.

Spontaneous pneumomediastinum: a rare benign entity

The Journal of Thoracic and Cardiovascular Surgery, 2003

Spontaneous pneumomediastinum usually occurs in young people without an apparent precipitating factor or disease. Thoracic surgeons are involved in the diagnosis and management of this entity because of the potentially life-threatening conditions that either must be treated as an emergency or excluded, such as esophageal perforation or necrotizing mediastinitis. We present our modest experience in treating spontaneous pneumomediastinum. Materials: Between 1988 and 1998 we treated 22 cases of spontaneous pneumomediastinum in 18 male patients and 4 female patients, ranging in age between 12 and 32 years. All traumatic cases were excluded. Retrosternal chest pain was the main symptom the patients presented. In only 11 cases was subcutaneous emphysema present. Chest radiography was diagnostic in all our cases. Computed tomographic scan, when performed, confirmed the diagnosis. An esophagogram was essential to exclude an esophageal rupture. Last, a cardiologic examination especially focusing on pericarditis excluded cardiac disease. Results: Conservative treatment consisted of bed rest, oxygen therapy, and analgesics, which led to rapid resolution of the spontaneous pneumomediastinum. The mean hospital stay ranged between 3 and 10 days. In a follow-up of 3 to 12 years only 1 recurrence was observed. Conclusion: Spontaneous pneumomediastinum is usually an undiagnosed benign entity that responds very well to conservative treatment. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults.