Pneumomediastinum causes: Difference between revisions

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{{Pneumomediastinum}}
{{Pneumomediastinum}}
{{CMG}} {{AE}} Jacquelyne DiTroia


==Causes==
{{CMG}} {{AE}} {{Trusha}}, Jacquelyne DiTroia
It is most commonly caused by:


* Oesophageal rupture, for example in [[Boerhaave syndrome]]
==Overview==
Spontaneous pneumomediastinum may be caused without any underlying [[pathology]]. Secondary pneumomediastinum may be caused by blunt or penetrating trauma to the neck, chest or abdomen. [[Iatrogenesis|Iatrogenic]] causes include disruption of the [[Airway|airways]] or [[Gastrointestinal tract|GI tract]] during [[Endoscopy|endoscopic procedures]], [[Intubation|intubation/extubation]], [[central vascular access procedure]], [[pleural cavity]] instrumentation, chest or abdominal surgery. Pneumomediastinum has also been associated with: [[Mycoplasma pneumonia|''Mycoplasma pneumonia'']], [[anorexia]], obesity and [[Barotrauma|pulmonary barotrauma]] in scuba diver or an airplane passenger during rapid ascends or descends.


* [[Asthma]] or other conditions leading to alveolar rupture
==Causes==
* [[Esophageal perforation]]
Spontaneous pneumomediastinum may be caused without any underlying pathology in an apparently healthy individual.
* Esophageal or bowel rupture
* Use of Breathing Machines
* Excess coughing, sneezing, vomiting
 
It has also been associated with:
* [[Mycoplasma pneumoniae]] [[pneumonia]]<ref name="pmid17899058">{{cite journal |author=Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A |title=Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia |journal= |volume= |issue= |pages= |year=2007 |pmid=17899058 |doi=10.1007/s00247-007-0611-1}}</ref>
 
* [[Anorexia]]<ref name="pmid17909893">{{cite journal |author=Hatzitolios A, Ntaios G |title=Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity |journal= |volume= |issue= |pages= |year=2007 |pmid=17909893 |doi=10.1007/s00408-007-9037-7}}</ref>
 
* [[Obesity]]<ref name="pmid17909893">{{cite journal |author=Hatzitolios A, Ntaios G |title=Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity |journal= |volume= |issue= |pages= |year=2007 |pmid=17909893 |doi=10.1007/s00408-007-9037-7}}</ref>
 
It can be induced to assist thoracoscopic surgery.<ref name="pmid17669882">{{cite journal |author=Utsumi T, Shiono H, Fukai I, Akashi A |title=Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum |journal=Interactive cardiovascular and thoracic surgery |volume=6 |issue=3 |pages=411–2 |year=2007 |pmid=17669882 |doi=10.1510/icvts.2006.147355}}
</ref>
 
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<ref>{{cite journal |author=Tetzlaff K, Reuter M |title=Recurrent pulmonary barotrauma (PBT) in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives |journal=Undersea Hyperb Med |volume=25 |issue=2 |pages=127–8 |year=1998 |pmid=9670439 |doi= |url=http://archive.rubicon-foundation.org/2412 |accessdate=2008-06-05}}</ref><ref>Dr. Richard Moon, Diver's Alert Network Vice President and Medical Director, http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=40 </ref>, a free-diver<ref>{{cite journal |author=Jacobson FL, Loring SH, Ferrigno M |title=Pneumomediastinum after lung packing |journal=Undersea Hyperb Med |volume=33 |issue=5 |pages=313–6 |year=2006 |pmid=17091828 |doi= |url=http://archive.rubicon-foundation.org/5045 |accessdate=2008-06-05}}</ref> or an airplane passenger<ref>{{cite journal |author=Nicol E, Davies G, Jayakumar P, Green ND |title=Pneumopericardium and pneumomediastinum in a passenger on a commercial flight |journal=Aviat Space Environ Med |volume=78 |issue=4 |pages=435–9 |year=2007 |month=April |pmid=17484349 |doi= |url=http://www.ingentaconnect.com/content/asma/asem/2007/00000078/00000004/art00014 |accessdate=2008-06-05 }}</ref> ascends or descends.


=== Common Causes ===
Common causes of pneumomediastinum are [[Iatrogenesis|Iatrogenic]] and include:<ref name="pmid17669882">{{cite journal |author=Utsumi T, Shiono H, Fukai I, Akashi A |title=Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum |journal=Interactive cardiovascular and thoracic surgery |volume=6 |issue=3 |pages=411–2 |year=2007 |pmid=17669882 |doi=10.1510/icvts.2006.147355}}</ref>
* [[Endoscopy|Endoscopic procedures]]
* [[Intubation|Intubation/extubation]]
* Central vascular access procedure
* [[Pleural cavity]] instrumentation
* Chest or abdominal surgery
* [[Tracheostomy]]


=== Less Common Causes ===
Less common cause of pneumomediastinum is pulmonary [[barotrauma]] resulting when a person moves to or from a higher pressure environment, including:
* Scuba diver<ref name="pmid9670439">{{cite journal |vauthors=Tetzlaff K, Reuter M |title=Recurrent pulmonary barotrauma (PBT) in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives |journal=Undersea Hyperb Med |volume=25 |issue=2 |pages=127–8 |date=1998 |pmid=9670439 |doi= |url=}}</ref>
* Free diver<ref>{{cite journal |author=Jacobson FL, Loring SH, Ferrigno M |title=Pneumomediastinum after lung packing |journal=Undersea Hyperb Med |volume=33 |issue=5 |pages=313–6 |year=2006 |pmid=17091828 |doi= |url=http://archive.rubicon-foundation.org/5045 |accessdate=2008-06-05}}</ref>
* Airplane passenger<ref>{{cite journal |author=Nicol E, Davies G, Jayakumar P, Green ND |title=Pneumopericardium and pneumomediastinum in a passenger on a commercial flight |journal=Aviat Space Environ Med |volume=78 |issue=4 |pages=435–9 |year=2007 |month=April |pmid=17484349 |doi= |url=http://www.ingentaconnect.com/content/asma/asem/2007/00000078/00000004/art00014 |accessdate=2008-06-05 }}</ref>
*Amiodarone-induced pulmonary toxicity<ref name="LeonardCorris1997">{{cite journal|last1=Leonard|first1=A.|last2=Corris|first2=P.|last3=Parums|first3=D.|last4=Donaldson|first4=L|last5=Grant|first5=I S|last6=Naysmith|first6=M R|last7=Thomas|first7=J S. J|last8=Jessurun|first8=G. A J|title=Amiodarone pulmonary toxicity|journal=BMJ|volume=314|issue=7097|year=1997|pages=1831–1831|issn=0959-8138|doi=10.1136/bmj.314.7097.1831b}}</ref>


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Inhalation of varnish fumes.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Amiodarone-induced pulmonary toxicity
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Esophageal perforation]], Oesophageal rupture, [[Boerhaave syndrome]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Interventions in the tracheobronchial tree or GI tract, endoscopies, intubation/extubation, thyroidectomy, tracheostomy.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Dermatomyoscitis.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Blunt or penetrating truma to the chest or abdomen.
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Tooth extraction
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Anorexia]], [[obesity]] breathing machines, ascend/descend injury during deep sea diving
|-
|-
|}
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
 
*Airplane passenger
{{col-begin|width=80%}}
*[[Amiodarone]]-induced pulmonary toxicity
{{col-break|width=33%}}
*Central vascular access procedure
 
*Chest or abdominal surgery
{{col-end}}
*Endoscopic procedures
*Free diver
*Intubation/extubation
*Pleural cavity instrumentation
*Scuba diver
*Tooth extraction
*Tracheostomy


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 19:00, 17 December 2018

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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], Jacquelyne DiTroia

Overview

Spontaneous pneumomediastinum may be caused without any underlying pathology. Secondary pneumomediastinum may be caused by blunt or penetrating trauma to the neck, chest or abdomen. Iatrogenic causes include disruption of the airways or GI tract during endoscopic procedures, intubation/extubation, central vascular access procedure, pleural cavity instrumentation, chest or abdominal surgery. Pneumomediastinum has also been associated with: Mycoplasma pneumonia, anorexia, obesity and pulmonary barotrauma in scuba diver or an airplane passenger during rapid ascends or descends.

Causes

Spontaneous pneumomediastinum may be caused without any underlying pathology in an apparently healthy individual.

Common Causes

Common causes of pneumomediastinum are Iatrogenic and include:[1]

Less Common Causes

Less common cause of pneumomediastinum is pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, including:

  • Scuba diver[2]
  • Free diver[3]
  • Airplane passenger[4]
  • Amiodarone-induced pulmonary toxicity[5]

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning Inhalation of varnish fumes.
Dermatologic No underlying causes
Drug Side Effect Amiodarone-induced pulmonary toxicity
Ear Nose Throat Esophageal perforation, Oesophageal rupture, Boerhaave syndrome
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Interventions in the tracheobronchial tree or GI tract, endoscopies, intubation/extubation, thyroidectomy, tracheostomy.
Infectious Disease No underlying causes
Musculoskeletal / Ortho Dermatomyoscitis.
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Blunt or penetrating truma to the chest or abdomen.
Urologic No underlying causes
Dental Tooth extraction
Miscellaneous Anorexia, obesity breathing machines, ascend/descend injury during deep sea diving

Causes in Alphabetical Order

  • Airplane passenger
  • Amiodarone-induced pulmonary toxicity
  • Central vascular access procedure
  • Chest or abdominal surgery
  • Endoscopic procedures
  • Free diver
  • Intubation/extubation
  • Pleural cavity instrumentation
  • Scuba diver
  • Tooth extraction
  • Tracheostomy

References

  1. ↑ 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. doi:10.1510/icvts.2006.147355. PMID 17669882.
  2. ↑ 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.
  3. ↑ Jacobson FL, Loring SH, Ferrigno M (2006). "Pneumomediastinum after lung packing". Undersea Hyperb Med. 33 (5): 313–6. PMID 17091828. Retrieved 2008-06-05.
  4. ↑ Nicol E, Davies G, Jayakumar P, Green ND (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. Unknown parameter |month= ignored (help)
  5. ↑ Leonard, A.; Corris, P.; Parums, D.; Donaldson, L; Grant, I S; Naysmith, M R; Thomas, J S. J; Jessurun, G. A J (1997). "Amiodarone pulmonary toxicity". BMJ. 314 (7097): 1831–1831. doi:10.1136/bmj.314.7097.1831b. ISSN 0959-8138.


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