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

1. inhaling cocaine
2. smoking cocaine
3. smoking marijuana

• vomiting
• retching
• asthma
• coughing
• esophageal rupture
• recent endoscopy
• trauma
  • Search for other more serious injuries (larynx, bronchus, esophagus)

Clinical Features

• chest pain
  • voice change, cough, stridor
• 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

See Also

• Thoracic Trauma

Sources

Harwood-Nuss, Rosens