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, COPD, pneumonia, pneumothorax, Boerhaave syndrome, cystic fibrosis, mediastinitis, interstitial lung disease, or ARDS.

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