Pneumomediastinum physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
In spontaneous pneumomediastinum, the patient appears normal. Patient with pneumomediastinum secondary to an exacerbation of asthma may appear distressed. On physical examination, the most pathognomic sign of pneumomediastinum is Hamman's sign, which is mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heartbeat. Subcutaneous emphysema can also be detected in a patient with pneumomediastinum. | In spontaneous pneumomediastinum, the patient appears normal. Patient with pneumomediastinum secondary to an [[Asthma exacerbation resident survival guide|exacerbation of asthma]] may appear distressed. On physical examination, the most pathognomic sign of pneumomediastinum is [[Hamman's sign]], which is mediastinal crunch or click present on [[auscultation]] over the [[Apex of the heart|cardiac apex]] and the [[left sternal border]] synchronous with the heartbeat. [[Subcutaneous emphysema]] can also be detected in a patient with pneumomediastinum. | ||
==Physical Examination== | ==Physical Examination== | ||
The patient may present with the physical finding of the primary condition causing pneumomediastinum or precipitating factors including, asthma, | The patient may present with the physical finding of the primary condition causing pneumomediastinum or precipitating factors including, [[Asthma physical examination|asthma]], [[Chronic obstructive pulmonary disease physical examination|COPD]], [[Pneumonia/Physical examination|pneumonia]], [[Pneumothorax physical examination|pneumothorax]], [[Boerhaave syndrome physical examination|Boerhaave syndrome]], [[Cystic fibrosis physical examination|cystic fibrosis]], [[Mediastinitis physical examination|mediastinitis]], [[interstitial lung disease]], or [[Acute respiratory distress syndrome physical examination|ARDS]].<ref name="pmid11993787">{{cite journal |vauthors=Kobashi Y, Okimoto N, Matsushima T, Soejima R |title=Comparative study of mediastinal emphysema as determined by etiology |journal=Intern. Med. |volume=41 |issue=4 |pages=277–82 |date=April 2002 |pmid=11993787 |doi= |url=}}</ref><ref>{{cite journal|doi=10.3978/j.issn.2072-1439.2015.01.11}}</ref><ref name="pmid15997870">{{cite journal |vauthors=Chiu CY, Wong KS, Yao TC, Huang JL |title=Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children |journal=Asian Pac. J. Allergy Immunol. |volume=23 |issue=1 |pages=19–22 |date=March 2005 |pmid=15997870 |doi= |url=}}</ref><ref name="pmid19411438">{{cite journal |vauthors=Iyer VN, Joshi AY, Ryu JH |title=Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients |journal=Mayo Clin. Proc. |volume=84 |issue=5 |pages=417–21 |date=May 2009 |pmid=19411438 |pmc=2676124 |doi=10.1016/S0025-6196(11)60560-0 |url=}}</ref><ref name="DionísioMartins2017">{{cite journal|last1=Dionísio|first1=Patrícia|last2=Martins|first2=Luís|last3=Moreira|first3=Susana|last4=Manique|first4=Alda|last5=Macedo|first5=Rita|last6=Caeiro|first6=Fátima|last7=Boal|first7=Luísa|last8=Bárbara|first8=Cristina|title=Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years|journal=Jornal Brasileiro de Pneumologia|volume=43|issue=2|year=2017|pages=101–105|issn=1806-3756|doi=10.1590/s1806-37562016000000052}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Tachypnea | *[[Tachypnea]] | ||
*[[Tachycardia]] with regular pulse | *[[Tachycardia]] with regular pulse | ||
*Low [[Oxygen saturation|SpO2]] | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with spontaneous pneumomediastinum usually appear normal. | *Patients with spontaneous pneumomediastinum usually appear normal. | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with primary spontaneous pneumomediastinum is usually normal. | * [[Skin]] examination of patients with primary spontaneous pneumomediastinum is usually normal. | ||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with primary spontaneous pneumomediastinum is usually normal. | * HEENT examination of patients with primary spontaneous pneumomediastinum is usually normal. | ||
*[[Subcutaneous emphysema physical examination|Subcutaneous crepitation]] may be present on the [[face]]. | |||
===Neck=== | ===Neck=== | ||
*Subcutaneous crepitation may be present. | *[[Subcutaneous emphysema physical examination|Subcutaneous crepitation]] may be present. | ||
===Lungs=== | ===Lungs=== | ||
*Bronchial breathing sound | *[[Bronchial breathing]] sound may be heard on [[auscultation]]. | ||
*Mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heart sound(Hamman's sign). | *[[Mediastinum|Mediastinal]] crunch or click present on [[auscultation]] over the [[Apex of the heart|cardiac apex]] and the [[left sternal border]] synchronous with the [[Heart sounds|heart sound]] ([[Hamman's sign]]). | ||
*Subcutaneous crepitation. | *[[Subcutaneous emphysema physical examination|Subcutaneous crepitation]] may be present. | ||
===Heart=== | ===Heart=== | ||
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===Abdomen=== | ===Abdomen=== | ||
* [[Abdomen|Abdominal]] examination of patients with pneumomediastinum is usually normal. | * [[Abdomen|Abdominal]] examination of patients with pneumomediastinum is usually normal. | ||
*Subcutaneous crepitation may be present. | *[[Subcutaneous emphysema physical examination|Subcutaneous crepitation]] may be present. | ||
===Back=== | ===Back=== | ||
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===Neuromuscular=== | ===Neuromuscular=== | ||
* | * [[Neuromuscular]] examination of patients with pneumomediastinum is usually normal. | ||
===Extremities=== | ===Extremities=== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Medicine]] | |||
[[Category:Surgery]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 15:16, 11 February 2019
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Pneumomediastinum physical examination On the Web |
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Risk calculators and risk factors for Pneumomediastinum physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
In spontaneous pneumomediastinum, the patient appears normal. Patient with pneumomediastinum secondary to an exacerbation of asthma may appear distressed. On physical examination, the most pathognomic sign of pneumomediastinum is Hamman's sign, which is mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heartbeat. Subcutaneous emphysema can also be detected in a patient with pneumomediastinum.
Physical Examination
The patient may present with the physical finding of the primary condition causing pneumomediastinum or precipitating factors including, asthma, COPD, pneumonia, pneumothorax, Boerhaave syndrome, cystic fibrosis, mediastinitis, interstitial lung disease, or ARDS.[1][2][3][4][5]
Vital Signs
- Tachypnea
- Tachycardia with regular pulse
- Low SpO2
Appearance of the Patient
- Patients with spontaneous pneumomediastinum usually appear normal.
Skin
- Skin examination of patients with primary spontaneous pneumomediastinum is usually normal.
HEENT
- HEENT examination of patients with primary spontaneous pneumomediastinum is usually normal.
- Subcutaneous crepitation may be present on the face.
Neck
- Subcutaneous crepitation may be present.
Lungs
- Bronchial breathing sound may be heard on auscultation.
- Mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heart sound (Hamman's sign).
- Subcutaneous crepitation may be present.
Heart
- Cardiovascular examination of patients with pneumomediastinum is usually normal.
Abdomen
- Abdominal examination of patients with pneumomediastinum is usually normal.
- Subcutaneous crepitation may be present.
Back
- Back examination of patients with pneumomediastinum is usually normal.
Genitourinary
- Genitourinary examination of patients with pneumomediastinum is usually normal.
Neuromuscular
- Neuromuscular examination of patients with pneumomediastinum is usually normal.
Extremities
- Extremities examination of patients with pneumomediastinum is usually normal
References
- ↑ Kobashi Y, Okimoto N, Matsushima T, Soejima R (April 2002). "Comparative study of mediastinal emphysema as determined by etiology". Intern. Med. 41 (4): 277–82. PMID 11993787.
- ↑ . doi:10.3978/j.issn.2072-1439.2015.01.11. Missing or empty
|title=(help) - ↑ Chiu CY, Wong KS, Yao TC, Huang JL (March 2005). "Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children". Asian Pac. J. Allergy Immunol. 23 (1): 19–22. PMID 15997870.
- ↑ Iyer VN, Joshi AY, Ryu JH (May 2009). "Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients". Mayo Clin. Proc. 84 (5): 417–21. doi:10.1016/S0025-6196(11)60560-0. PMC 2676124. PMID 19411438.
- ↑ Dionísio, Patrícia; Martins, Luís; Moreira, Susana; Manique, Alda; Macedo, Rita; Caeiro, Fátima; Boal, Luísa; Bárbara, Cristina (2017). "Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years". Jornal Brasileiro de Pneumologia. 43 (2): 101–105. doi:10.1590/s1806-37562016000000052. ISSN 1806-3756.