Pneumomediastinum natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
Pneumomediastinum is considered a benign entity with good prognosis. The main symptom of pneumomediastinum is chest pain. The onset of the pain is sudden and acute or follows exacerbation of underlying pathology such as asthma. Spontaneous pneumomediastinum usually resolves by itself, but prolonged cases have also been reported (>2 months). There also have been incidences of recurrence.
Natural History
- Patient with pneumomediastinum presents with sudden onset of acute chest pain, usually retrosternal, radiating to the neck or the back.[1]
- Uncomplicated spontaneous pneumomediastinum usually resolves by itself.[2]
- Few incidents of recurrences have been reported.[3]
- In rare cases, significant amount of air is accumulated in the mediastinum, causing vessel or tracheal obstruction and inducing symptoms and signs of tamponade and decreased venous return.
- If left untreated, patients with pneumomediastinum may progress to develop death.
Complications
Complication of pneumomediastinum include:
- Subcutaneous emphysema
- Pneumothorax
- Pneumorrhachis
- Malignant pneumomediastinum: Rarely, pneumomediastinum may progress to malignant one in case of missed trauma to esophagus or airways. Accumulation of a large amount of air in the mediastinum causing pneumopericardium or compression of airways.
- Death
Prognosis
- The prognosis depends on the associated and precipitating conditions of pneumomediastinum.[4]
- Spontaneous pneumomediastinum has the most favorable prognosis. Spontaneous pneumomediastinum usually resolves by itself, but chronic cases have been reported (>2 months).
References
- ↑ Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, Perna V, Rivas F (June 2007). "Spontaneous pneumomediastinum: 41 cases". Eur J Cardiothorac Surg. 31 (6): 1110–4. doi:10.1016/j.ejcts.2007.03.008. PMID 17420139.
- ↑ Mihos P, Potaris K, Gakidis I, Mazaris E, Sarras E, Kontos Z (September 2004). "Sports-related spontaneous pneumomediastinum". Ann. Thorac. Surg. 78 (3): 983–6. doi:10.1016/j.athoracsur.2004.03.017. PMID 15337032.
- ↑ Yellin A, Gapany-Gapanavicius M, Lieberman Y (May 1983). "Spontaneous pneumomediastinum: is it a rare cause of chest pain?". Thorax. 38 (5): 383–5. PMC 459563. PMID 6879488.
- ↑ Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE (September 2008). "Spontaneous pneumomediastinum: a comparative study and review of the literature". Ann. Thorac. Surg. 86 (3): 962–6. doi:10.1016/j.athoracsur.2008.04.067. PMID 18721592.