Pneumomediastinum physical examination

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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

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, emphysema, pneumothorax, Boerhaave syndrome or ARDS.

Vital Signs

• Tachycardia with regular pulse

Appearance of the Patient

• Patients with spontaneous pneumomediastinum usually appear normal.
• Patients with pneumomediastinum secondary to an exacerbation of asthma is usually dyspnic and in distress.

Palpation

the presence of subcutaneous crepitations

Skin

• Skin examination of patients with primary spontaneous pneumothorax is usually normal.

HEENT

• HEENT examination of patients with primary spontaneous pneumothorax is usually normal.

Neck

• Jugular venous distension

Lungs

• Decreased chest expansion
• Lungs are hyperresonant
• Egophony present

Heart

• Cardiovascular examination of patients with pneumothorax is usually normal.

Abdomen

• Abdominal examination of patients with pneumothorax is usually normal.

Back

• Back examination of patients with pneumothorax is usually normal.

Genitourinary

• Genitourinary examination of patients with pneumothorax is usually normal.

Neuromuscular

• Neuromuscular examination of patients with pneumothorax is usually normal.

Extremities

• Cyanosis