International Journal of Gerontology
Volume 2, Issue 4 , Pages 222-228, December 2008

Spontaneous Pneumomediastinum: A Clinical Radiologic Analysis

  • Shih-Yi Lee

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Chin-Yin Sheu

      Affiliations

    • Department of Diagnostic Radiology, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chien-Liang Wu

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Chung-Lieh Hung

      Affiliations

    • Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Yu-Ling Weng

      Affiliations

    • Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Ching-Chi Lin

      Affiliations

    • Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Wen-Han Chang

      Affiliations

    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Wen-Han Chang, Department of Emergency Medicine, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan

Accepted 26 October 2008.

Article Outline

SUMMARY 

Background

Spontaneous pneumomediastinum is clinically distinct from pneumomediastinum occurring secondary to thoracic hollow organ perforation. The latter may be a catastrophic event requiring invasive intervention, but it is questionable whether such interventions are necessary in spontaneous pneumomediastinum. Limited data are available regarding the characteristics of history and radiologic manifestations in spontaneous pneumomediastinum. The present study aimed to systematically evaluate the initial and subsequent clinical and radiologic manifestations of spontaneous pneumomediastinum as well as the need for additional diagnostic procedures and therapy.

Methods

A retrospective study of patients with a diagnosis of spontaneous pneumomediastinum in a tertiary medical center from January 1990 to November 2006 was performed. The patients' clinical information and results of radiologic interventions were analyzed.

Results

A total of 42 patients were included. Spontaneous pneumomediastinum was diagnosed in all cases by chest films. A left pericardial airstrip was the most common initial manifestation. In this series, there was only one patient with a pneumothorax, and none of the patients developed pleural effusion or mediastinal fluid as shown by chest X-rays after the disease onset.

Conclusion

Spontaneous pneumomediastinum occurs mostly in non-elderly patients. Evaluation of typical clinical information and uncomplicated serial chest X-ray findings of spontaneous pneumomediastinum could avoid unnecessary invasive procedures and intensive care unit stays, which could put pressure on medical resources. A plain film X-ray is adequate for diagnosing spontaneous pneumomediastinum as long as the appropriate findings are sought and there is adequate application of lateral radiography.

Key Words:  mediastinal emphysema , pericardial , pneumomediastinum , spontaneous

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PII: S1873-9598(09)70011-0

doi:10.1016/S1873-9598(09)70011-0

International Journal of Gerontology
Volume 2, Issue 4 , Pages 222-228, December 2008

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