Pneumomediastinum
Background
- usually occurs with sudden increase in intra-alveolar pressure causing alveolar rupture, air dissects into pulmonary interstitium and then into mediastinum, neck, or pericardium
- life threatening cause is esophageal rupture
- if no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition
Causes
- illegal drug use
- inhaling cocaine
- smoking cocaine
- smoking marijuana
- vomiting
- retching
- asthma
- coughing
- esophageal rupture
- recent endoscopy
- trauma
Clinical Features
- chest pain
- subQ emphysema in chest wall, neck, face, abdomen, scrotum
- "Hamman's Crunch" - crunching sound of heart during systole
Workup
- ABCs
- CXR
- Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated
Management
- supportive
- no specific therapy for spontaneous pneumomediastinum
- treat underlying cause
Disposition
- depends on underlying cause and severity of condition
- most pt's with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged
Sources
Harwood-Nuss, Rosens