Spontaneous pneumomediastinum

Clinical and natural history

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

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

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
Volume21
Issue number10
DOIs
StatePublished - 1992
Externally publishedYes

Fingerprint

Mediastinal Emphysema
Natural History
Subcutaneous Emphysema
Pneumothorax
Chest Pain
Dyspnea
Length of Stay
Valsalva Maneuver
Street Drugs
International Classification of Diseases
Tertiary Healthcare
Pharynx
Telephone
Tertiary Care Centers
Hospital Emergency Service
Hospitalization

Keywords

  • pneumomediastinum

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Panacek, E. A., Singer, A. J., Sherman, B. W., Prescott, A., & Rutherford, W. F. (1992). Spontaneous pneumomediastinum: Clinical and natural history. Annals of Emergency Medicine, 21(10), 1222-1227. https://doi.org/10.1016/S0196-0644(05)81750-0

Spontaneous pneumomediastinum : Clinical and natural history. / Panacek, Edward A; Singer, Andrew J.; Sherman, Bruce W.; Prescott, Amanda; Rutherford, William F.

In: Annals of Emergency Medicine, Vol. 21, No. 10, 1992, p. 1222-1227.

Research output: Contribution to journalArticle

Panacek, EA, Singer, AJ, Sherman, BW, Prescott, A & Rutherford, WF 1992, 'Spontaneous pneumomediastinum: Clinical and natural history', Annals of Emergency Medicine, vol. 21, no. 10, pp. 1222-1227. https://doi.org/10.1016/S0196-0644(05)81750-0
Panacek, Edward A ; Singer, Andrew J. ; Sherman, Bruce W. ; Prescott, Amanda ; Rutherford, William F. / Spontaneous pneumomediastinum : Clinical and natural history. In: Annals of Emergency Medicine. 1992 ; Vol. 21, No. 10. pp. 1222-1227.
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abstract = "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.",
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