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 exacerbations 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.
• Other frequent symptoms include dyspnea, cough, or pain in the neck.
• Uncomplicated spontaneous pneumomediastinum usually resolves by itself.
• Few incidents of recurrences have been reported.
• In the rare cases, significant amount of air is accumulated in the mediastinum, causing vessel or tracheal obstruction and inducing respective symptoms and signs of tamponade and decreased venous return.
• If left untreated, patients with pneumomediastinum may progress to develop death.

Complications

• 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.

Prognosis

• The prognosis depends on the associated and precipitating conditions of pneumomediastinum.
• Spontaneous pneumomediastinum has the most favorable prognosis. Spontaneous pneumomediastinum usually resolves by itself, but prolonged cases have also been reported (>2 months).