Pneumomediastinum pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Trusha Tank, M.D.[2]
Overview
- Pneumomediastinum can happen when pressure rises in the lungs and causes the air sacs (alveoli) to rupture. Another possible cause is damage to the lungs or other nearby structures that allow air to leak into the center of the chest.
Pathophysiology
Anatomy
For information on anatomy of mediastinum, click here.
Pathogenesis
Spontaneous pneumomediastinum
- The pathophysiology of spontaneous pneumomediastinum is based on the existence of a pressure gradient between the alveoli and the lung interstitium.
- Sudden increase in intrathoracic pressure due to a specific triggering event such as Valsalva maneuver, vomiting, asthma exacerbation, physical activity may lead to alveolar rupture and the consequent escape of air into the interstitium.
- Once the air is in the lung interstitium it flows towards the hilum and the mediastinum along a pressure gradient between the lung periphery and the mediastinum[1].
- Predisposing factors of spontaneous pneumomediastinum are tobacco smoking, use of recreational drugs, past medical history of asthma, bronchial hyperreactivity and interstitial lung disease[2].
- One of the most important precipitating factors of spontaneous pneumomediastinum is the absence of any specific trigger.
- The other precipitating factors are physical exercise, vomiting, cough infection of the upper airways, inhalation of varnish fumes, ascent phase of a dive or hyperbaric treatment[3].
Spontaneous neonatal pneumomediastinum
- Spontaneous neonatal pneumomediastinum is associated with the aspiration of blood or meconium and birth-related trauma and it is more frequent in post-term newborns[4].
- Spontaneous neonatal pneumomediastinum may follow gas trapping associated with the neonatal respiratory distress syndrome, pneumonia, or the use of mechanical ventilation[5].
Secondary pneumomediastinum
- Secondary pneumomediastinum develops as a consequence of a distinct underlying pathology or thoracic/abdominal injury, resulting in the intrathoracic dissection of air through the mediastinal planes[6].
- Iatrogenic secondary pneumomediastinum may result from recent interventions in the tracheobronchial tree or GI tract such as endoscopies, intubation/extubation, surgical intervention such as thyroidectomy, tracheostomy.
- Secondary pneumomediastinum may also result from blunt or penetrating trauma, ventilator-induced barotrauma, mediastinitis, foreign body in aerodigestive tract, pulmonary cavitary abnormalities, PCP, Boerhaave syndrome, and amiodarone-induced pulmonary toxicity.
Genetics
There is no genetic predisposition to pneumomediastinum.
Associated Conditions
Conditions associated with [spontaneous pneumomediastinum] include[7]:
- [Interstitial lung disease]: Spontaneous pneumomediastinum is a rare complication of ILD.
- [Connective tissue disease]: Spontaneous pneumomediastinum is an uncommon manifestation of CTD[8]
- [Dermatomyocitis]: Pneumomediastinum is associated with the complication of vasculopathy appearing as skin lesions in DM[9].
Gross Pathology
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, Perna V, Rivas F (June 2007). "Spontaneous pneumomediastinum: 41 cases". Eur J Cardiothorac Surg. 31 (6): 1110–4. doi:10.1016/j.ejcts.2007.03.008. PMID 17420139.
- ↑ 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.
- ↑ López-Peláez, María F.; Roldán, José; Mateo, Salvador (2001). "Cervical Emphysema, Pneumomediastinum, and Pneumothorax Following Self-induced Oral Injury". Chest. 120 (1): 306–309. doi:10.1378/chest.120.1.306. ISSN 0012-3692.
- ↑ Zuppa, A. A.; D’Andrea, V.; Verrillo, G.; Riccardi, R.; Savarese, I.; Cavani, M.; Romagnoli, C. (2014). "Spontaneous neonatal pneumomediastinum: Radiological or clinical diagnosis?". Journal of Obstetrics and Gynaecology. 34 (2): 138–140. doi:10.3109/01443615.2013.830597. ISSN 0144-3615.
- ↑ Hacking, Doug; Stewart, Michael (2001). "Neonatal Pneumomediastinum". New England Journal of Medicine. 344 (24): 1839–1839. doi:10.1056/NEJM200106143442405. ISSN 0028-4793.
- ↑ Caceres, Manuel; Braud, Rebecca L.; Maekawa, Rosalba; Weiman, Darryl S.; Garrett, H. Edward (2009). "Secondary Pneumomediastinum: A Retrospective Comparative Analysis". Lung. 187 (5): 341–346. doi:10.1007/s00408-009-9164-4. ISSN 0341-2040.
- ↑ Le Goff, Benoit; Chérin, Patrick; Cantagrel, Alain; Gayraud, Martine; Hachulla, Eric; Laborde, Fyriel; Papo, Thomas; Sibilia, Jean; Zabraniecki, Laurent; Ravaud, Philippe; Puéchal, Xavier (2008). "Pneumomediastinum in interstitial lung disease associated with dermatomyositis and polymyositis". Arthritis Care & Research. 61 (1): 108–118. doi:10.1002/art.24372. ISSN 0004-3591.
- ↑ De Giacomi, Federica; Baqir, Misbah; Cox, Christian W.; Moua, Teng; Matteson, Eric L.; Ryu, Jay H. (2018). "Spontaneous Pneumomediastinum in Connective Tissue Diseases". JCR: Journal of Clinical Rheumatology: 1. doi:10.1097/RHU.0000000000000835. ISSN 1076-1608.
- ↑ Kono, H. (2000). "Pneumomediastinum in dermatomyositis: association with cutaneous vasculopathy". Annals of the Rheumatic Diseases. 59 (5): 372–376. doi:10.1136/ard.59.5.372. ISSN 0003-4967.