Spontaneous pneumomediastinum in children and adolescents
- Ammar A Saadoon, MBChB, FRCPCH
Ammar A Saadoon, MBChB, FRCPCH
- Section of Pediatric Pulmonary, Department of Pediatrics
- School of Medicine, University of Alabama at Birmingham
- Ibrahim A Janahi, MD
Ibrahim A Janahi, MD
- Professor of Pediatrics
- Weill-Cornell Medical College, Qatar
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 SPM 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 . 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 thoracic surgery. Mechanical ventilation is a common cause of barotrauma and pneumomediastinum. Pneumomediastinum caused by mechanical ventilation is often considered a type of traumatic pneumomediastinum, rather than spontaneous pneumomediastinum. (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 patient's prognosis and management is driven by the underlying lung disease, if any, rather than by the SPM itself.
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], and the rate of SPM among children presenting for emergency treatment of asthma is between 0.3 and 5 percent . The wide range of reported incidence rates is probably due to differences in the diagnostic methods used and also to the severity of symptoms in the population studied. Many more cases are detected if patients presenting with sudden chest pain or shortness of breath are routinely screened for SPM. As an example, in a study employing routine screening of young adults admitted for unexplained chest pain or dyspnea, the incidence of SPM was 1:368 . Some studies suggest that SPM is often missed among children who present to an emergency department with chest pain [1,8].
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- Predisposing conditions or triggers
- CLINICAL PRESENTATION
- Physical examination
- - Chest radiograph
- - Ultrasonography
- Further evaluation for associated problems
- DIFFERENTIAL DIAGNOSIS
- Esophageal perforation
- SUMMARY AND RECOMMENDATIONS