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Spontaneous pneumomediastinum in children and adolescents

Ammar A Saadoon, MBChB, FRCPCH
Ibrahim A Janahi, MD
Section Editor
Gregory Redding, MD
Deputy Editor
Alison G Hoppin, MD


Spontaneous pneumomediastinum (SPM) is uncommon in children. When it occurs, it is often associated with asthma. Like spontaneous pneumothorax, SPM mainly affects adolescent males with a tall, thin body habitus [1-3].

The pathogenesis, evaluation, and treatment of isolated spontaneous pneumomediastinum in children will be reviewed here. SPM associated with pneumothorax has a distinct pathogenesis, and its management is similar to that of the pneumothorax itself. Pneumomediastinum associated with trauma is discussed separately. (See "Spontaneous pneumothorax in children" and "Overview of intrathoracic injuries in children".)


Pneumomediastinum is defined as the presence of air or other gas in the mediastinum, and is also known as mediastinal emphysema [4]. Pneumomediastinum can be categorized as spontaneous (SPM) or traumatic. Traumatic pneumomediastinum is caused by blunt or penetrating trauma to the chest, or iatrogenic injury, such as that produced by mechanical ventilation or thoracic surgery. (See "Overview of intrathoracic injuries in children".)

Some authors distinguish between primary SPM (in which there is no underlying lung disease that would predispose the individual to air leak) and secondary SPM (in which there is an underlying airway disease, such as cystic fibrosis or asthma). The prognosis and management of SPM is similar for patients with or without underlying lung disease.


SPM is uncommon in children. The reported incidence varies widely, ranging from 1 in 800 to 1 in 42,000 adult and pediatric patients admitted to a hospital [5,6]. However, many more cases are detected if patients presenting with sudden chest pain or shortness of breath are routinely screened for SPM. As an example, a study employing routine screening reported an incidence of 1:368 medical admissions [1]. The rate of SPM among children presenting for emergency treatment of asthma is between 0.3 and 5 percent [7].


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Literature review current through: Sep 2016. | This topic last updated: Sep 10, 2015.
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