Spontaneous pneumomediastinum: Clinical and natural history

Edward A Panacek, Andrew J. Singer, Bruce W. Sherman, Amanda Prescott, William F. Rutherford

Research output: Contribution to journalArticlepeer-review

160 Scopus citations


Study objective: To evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum. Design: A retrospective case series was conducted to identify patients diagnosed with spontaneous pneumomediastinum. ICD-9 discharge codes were used for 1984 to 1990 at two institutions, and emergency department records of a third hospital were reviewed for 1981 to 1986. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. Setting: Three university tertiary care hospitals. Participants: All ED patients more than 12 years old with a diagnosis of spontaneous pneumomediastinum. Interventions: None. Results: Seventeen cases were identified. Age range was 15 to 41 years (mean, 25 years). Presenting symptoms were chest pain in eight (47%), dyspnea in three (18%), both symptoms in three (18%), and neither in three (18%). Three patients complained only of throat discomfort. Nine (52%) had a Hamman's crunch, 11 (65%) had subcutaneous emphysema, and two (11%) had a small pneumothorax. Five (29%) were smokers, and five (29%) had normal esophograms. Thirteen of 17 (76%) cases were associated with illicit inhalational drug use. Twelve cases (70%) had history of a "Valsalva-type" maneuver. All but three were admitted to a hospital, with a mean stay of 2.5 days (range, one to six). No patient suffered complications or required interventions for spontaneous pneumomediastinum. Specifically, no patient developed a subsequent pneumothorax or airway compromise. The three patients not admitted were followed up by telephone contact. All did well with rapid resolution of their symptoms. Conclusion: Most spontaneous pneumomediastinum cases occur in the setting of inhalational drug use. One hundred percent of patients will have a symptom directly related to the spontaneous pneumomediastinum, with 82% presenting with either dyspnea or chest pain. Most (88%) will present with either subcutaneous emphysema or a Hamman's crunch on examination. Simple spontaneous pneumomediastinum has a very benign course and does not require hospitalization. Serial radiographs, likewise, did not change the medical management of spontaneous pneumomediastinum.

Original languageEnglish (US)
Pages (from-to)1222-1227
Number of pages6
JournalAnnals of Emergency Medicine
Issue number10
StatePublished - 1992
Externally publishedYes


  • pneumomediastinum

ASJC Scopus subject areas

  • Emergency Medicine


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