Pneumomediastinum


Pneumomediastinum from Greek pneuma – "air", also known as mediastinal emphysema is pneumatosis abnormal presence of air or other gas in the mediastinum First described in 1819 by René Laennec,12 the condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways, or bowel into the chest cavity

Contents

  • 1 Signs and symptoms
  • 2 Cause
  • 3 Diagnosis
  • 4 Treatment
  • 5 References
  • 6 External links

Signs and symptomsedit

The main symptom is usually severe central chest pain Other symptoms include laboured breathing, voice distortion as with helium and subcutaneous emphysema, specifically affecting the face, neck, and chest3 Pneumomediastinum can also be characterized by the shortness of breath that is typical of a respiratory system problem It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle Hamman's crunch Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart4

Causeedit

It is most commonly caused by:

  • Oesophageal rupture, for example in Boerhaave syndrome
  • Asthma or other conditions leading to alveolar rupture
  • Bowel rupture, where air in the abdominal cavity tracts up into the chest

It has also been associated with:

  • Mycoplasma pneumoniae pneumonia5
  • obesity6

It can be induced to assist thoracoscopic surgery7 It can be caused by a pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, such as when a SCUBA diver,89 a free-diver10 or an airplane passenger11 ascends or descends

In rare cases, pneumomediastinum may also arise as a result of blunt chest trauma eg car accidents, fights, over pressure of breathing apparatus, while still evolving in the same fashion as the spontaneous form12

Pneumomediastinum is most commonly seen in otherwise healthy young male patients and may not be prefaced by a relevant medical history of similar ailments13

Diagnosisedit

Pneumomediastinum is uncommon and occurs when air leaks into the mediastinum The diagnosis can be confirmed via chest X-ray showing a radiolucent outline around the heart and mediastinum or via CT scanning of the thorax

Treatmentedit

The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively Breathing high flow oxygen will increase the absorption of the air If the air is under pressure and compressing the heart, a needle may be inserted into the cavity, releasing the air Surgery may be needed to repair the hole in the trachea, esophagus or bowel

If there is lung collapse, it is imperative the affected individual lies on the side of the collapse, although painful, this allows full inflation of the unaffected lung

Referencesedit

  1. ^ Laënnec RTH De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur 1st ed Paris: Brosson & Chaudé; 1819
  2. ^ Roguin A 2006 "Rene Theophile Hyacinthe Laënnec 1781-1826: the man behind the stethoscope" Clinical medicine & research 4 3: 230–5 PMC 1570491  PMID 17048358 doi:103121/cmr43230 
  3. ^ Quresi SA, Tilyard A 2008 "Unusual Presentation of Spontaneous Mediastinum: A Case Report" Cases Journal 1:349 doi:101186/1757-1626-1-349
  4. ^ Beg MH, Reyazuddin, Ansari MM 1988 "Traumatic tension Pneumomediastinum Mimicking Cardiac Tamponade" Thorax 43:576-677 doi: 101136/thx437576
  5. ^ Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A 2007 "Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia" Pediatric Radiology 37 12: 1286–8 PMID 17899058 doi:101007/s00247-007-0611-1 
  6. ^ Hatzitolios A, Ntaios G 2007 "Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity" Lung 185 6: 373 PMID 17909893 doi:101007/s00408-007-9037-7 
  7. ^ Utsumi T, Shiono H, Fukai I, Akashi A 2007 "Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum" Interactive cardiovascular and thoracic surgery 6 3: 411–2 PMID 17669882 doi:101510/icvts2006147355 
  8. ^ Tetzlaff K, Reuter M 1998 "Recurrent pulmonary barotrauma PBT in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives" Undersea Hyperb Med 25 2: 127–8 PMID 9670439 Retrieved 2008-06-05 
  9. ^ Dr Richard Moon, Diver's Alert Network Vice President and Medical Director, http://wwwdiversalertnetworkorg/medical/articles/articleasparticleid=40
  10. ^ Jacobson FL, Loring SH, Ferrigno M 2006 "Pneumomediastinum after lung packing" Undersea Hyperb Med 33 5: 313–6 PMID 17091828 Retrieved 2008-06-05 
  11. ^ Nicol E, Davies G, Jayakumar P, Green ND April 2007 "Pneumopericardium and pneumomediastinum in a passenger on a commercial flight" Aviat Space Environ Med 78 4: 435–9 PMID 17484349 Retrieved 2008-06-05 
  12. ^ Yellin A, Gapany-Gapanavicius M, Lieberman Y 1983 "Spontaneous Pneumomedistinum: Is It a Rare Cause of Chest Pain" Thorax 38:383-385
  13. ^ Cicak B, Verona E, Mihatov-Stefanovic I, Vrsalovic R 2009 "Spontaneous Pneumomediastinum in a Healthy Adolescent" Acta Clinica Croatica 484:461-7
  14. ^ "UOTW #67 - Ultrasound of the Week" Ultrasound of the Week 29 January 2016 Retrieved 27 May 2017 

External linksedit

  • 00964 at CHORUS
  • Pneumomediastinum Radiology from MedPix


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