Pneumomediastinum

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Pneumomediastinum
Other namesMediastinal emphysema
A CT scan showing air in the mediastinum
SpecialtyRadiology Edit this on Wikidata

Pneumomediastinum (from

pulmonary barotrauma.[1]

Signs and symptoms

The main symptom is usually severe central chest pain. Other symptoms include laboured breathing, voice distortion (as with helium) and

Hamman's crunch
). Pneumomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart.[5]

Cause

It is most commonly caused by:[citation needed]

  • Boerhaave syndrome
  • crack cocaine
    use or other conditions leading to alveolar rupture
  • Bowel rupture
    , where air in the abdominal cavity tracts up into the chest.

It has also been associated with:

It can be induced to assist thoracoscopic surgery.[8]

It can be caused by a pulmonary

arterial gas embolism, pneumothorax and subcutaneous or pulmonary interstitial emphysema. Factors which may prevent free escape of the compressed breathing gas include holding the breath or respiratory obstructions such as cysts, mucus plugs, or scar tissue.[10]

In rare cases, pneumomediastinum may also arise as a result of blunt chest trauma (e.g. car accidents, fights, over pressure of breathing apparatus), while still evolving in the same fashion as the spontaneous form.[13]

Pneumomediastinum is most commonly seen in otherwise healthy young male patients and may not be prefaced by a relevant medical history of similar ailments.[14]

Diagnosis

Pneumomediastinum is uncommon and occurs when air leaks into the

CT scanning of the thorax.[citation needed
]

  • Pneumomediastinum and right sided pneumothorax post first rib fracture in a mountain biking accident.
    Pneumomediastinum and right sided pneumothorax post first rib fracture in a mountain biking accident.
  • Pneumomediastinum with angel wing sign[15]
    Pneumomediastinum with angel wing sign[15]
  • Pneumomediastinum as seen on ultrasound[16]

Treatment

The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively. Breathing high flow oxygen will increase the absorption of the air. If the air is under pressure and compressing the heart, a needle may be inserted into the cavity, releasing the air. Surgery may be needed to repair the hole in the trachea, esophagus or bowel.[citation needed]

If there is lung collapse, it is imperative the affected individual lies on the side of the collapse. Although painful, this allows full inflation of the unaffected lung.

References

  1. ^ a b "Travelers Medical Guide: Glossary". dan.org. Retrieved 28 September 2022.
  2. ^ Laënnec RTH. De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur. 1st ed. Paris: Brosson & Chaudé; 1819.
  3. PMID 17048358
    .
  4. ^ Quresi SA, Tilyard A (2008). "Unusual Presentation of Spontaneous Mediastinum: A Case Report". Cases Journal 1:349. doi:10.1186/1757-1626-1-349.
  5. ^ Beg MH, Reyazuddin, Ansari MM (1988). "Traumatic tension Pneumomediastinum Mimicking Cardiac Tamponade". Thorax 43:576-677. doi: 10.1136/thx.43.7.576.
  6. S2CID 26500618
    .
  7. S2CID 6771220
    .
  8. PMID 17669882
    .
  9. PMID 9670439. Archived from the original on 2012-05-03. Retrieved 2008-06-05.{{cite journal}}: CS1 maint: unfit URL (link
    )
  10. ^ a b "Mmediastinal emphysema". Encyclopedia Britannica. Retrieved 28 September 2022.
  11. PMID 17091828. Archived from the original on 2012-05-03. Retrieved 2008-06-05.{{cite journal}}: CS1 maint: unfit URL (link
    )
  12. PMID 17484349
    .
  13. ^ Yellin A, Gapany-Gapanavicius M, Lieberman Y (1983). "Spontaneous Pneumomedistinum: Is It a Rare Cause of Chest Pain?". Thorax 38:383-385.
  14. ^ Cicak B, Verona E, Mihatov-Stefanovic I, Vrsalovic R (2009). "Spontaneous Pneumomediastinum in a Healthy Adolescent". Acta Clinica Croatica 48(4):461-7.
  15. ^ Zahed, Asef. "Angel wing sign | Radiology Case | Radiopaedia.org". Radiopaedia.
  16. ^ "UOTW #67 - Ultrasound of the Week". Ultrasound of the Week. 29 January 2016. Retrieved 27 May 2017.

External links

Look up pneumomediastinum in Wiktionary, the free dictionary.


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