Overview
What is pneumomediastinum (PM)?
How is spontaneous pneumomediastinum (PM) distinguished from pneumomediastinum (PM)?
What are possible complications of pneumomediastinum (PM)?
What is the pathophysiology of pneumomediastinum (PM)?
What are the sequence of events in the development of pneumomediastinum (PM)?
What is the role of the dissection of free air in the pathophysiology of pneumomediastinum (PM)?
What are causes of secondary spontaneous pneumomediastinum (PM)?
What is the prevalence of pneumomediastinum (PM) in the US?
What is the prevalence of pneumomediastinum (PM) in patients with blunt chest drama?
What is the prevalence of pneumomediastinum (PM) in children receiving mechanical ventilation?
What is the prevalence of pneumomediastinum (PM) among Israelis?
Which age groups are at increased risk for pneumomediastinum (PM)?
Which factor affects the morbidity of pneumomediastinum (PM)?
What is the mortality rate of pneumomediastinum (PM)?
What are the most common morbidities of pneumomediastinum (PM)?
How does the prevalence of pneumomediastinum (PM) vary by sex?
How does the prevalence of pneumomediastinum (PM) vary by age?
Presentation
What are the symptoms of pneumomediastinum (PM)?
How is chest pain characterized in pneumomediastinum (PM)?
What is the prevalence of chest pain in patients with pneumomediastinum (PM) and asthma?
What is the prevalence of chest pain in pneumomediastinum (PM)?
What does dyspnea suggest in patients with pneumomediastinum (PM)?
What does fever suggest in patients with pneumomediastinum (PM)?
How frequently is dysphonia presented in pneumomediastinum (PM)?
What are the initial head and neck symptoms of pneumomediastinum (PM)?
What is the prevalence of jaw pain in pneumomediastinum (PM)?
What are symptoms of spontaneous pneumomediastinum?
What are triggering factors of pneumomediastinum (PM)?
What are less common risk factors for pneumomediastinum (PM)?
What is the role of anorexia nervosa in pneumomediastinum (PM)?
What is the role of hyperpnea in pneumomediastinum (PM)?
What is the role of menstruation in pneumomediastinum (PM)?
What should be the focus of history in adolescents with suspected pneumomediastinum (PM)?
What is the role of inhalant abuse in pneumomediastinum (PM)?
Why is cocaine use a risk factor for pneumomediastinum (PM)?
What is the prevalence of subcutaneous emphysema in pneumomediastinum (PM)?
What is the Hamman sign in pneumomediastinum (PM)?
What are the signs of pneumothorax in pneumomediastinum (PM)?
What is the role of asthma in the etiology of pneumomediastinum (PM)?
What is the role of pulse oximetry in the evaluation of pneumomediastinum (PM)?
Which respiratory maneuvers are associated with spontaneous pneumomediastinum (PM)?
What causes elevated alveolar pressure in pneumomediastinum (PM)?
What is the role of strenuous athletic activities in the etiology of pneumomediastinum (PM)?
What is the role of spirometry in the etiology of pneumomediastinum (PM)?
Which respiratory diseases increase the risk of pneumomediastinum (PM)?
What is the role of respiratory tract infections in the etiology of pneumomediastinum (PM)?
What respiratory complication is associated with pneumomediastinum (PM)?
What is the role of injury in the etiology of pneumomediastinum (PM)?
Which organ injuries may lead to pneumomediastinum (PM)?
What are unusual causes of pneumomediastinum (PM)?
DDX
What are the differential diagnoses for Pneumomediastinum?
Workup
Which lab studies are performed in the evaluation of pneumomediastinum (PM)?
What is the role of cardiac enzymes in the evaluation of pneumomediastinum (PM)?
What is the role of drug testing in the evaluation of pneumomediastinum (PM)?
What is the role of chest radiography in the evaluation of pneumomediastinum (PM)?
Which findings on chest radiography suggest pneumomediastinum (PM)?
What are the characteristic features of pneumomediastinum (PM) seen on chest radiography?
What is the role of chest CT scanning in the diagnosis of pneumomediastinum (PM)?
How is spontaneous pneumomediastinum differentiated from secondary pneumomediastinum on chest CT?
Which coexisting illness with pneumomediastinum (PM) may be identified with CT scanning?
How is chest CT scanning used to predict mortality in pneumomediastinum (PM)?
What is the role of contrast radiography studies in the workup of pneumomediastinum (PM)?
What is the role of MRI in the workup of pneumomediastinum (PM)?
What is the role of ultrasonography in the workup of pneumomediastinum (PM)?
What is the role of spirometry in the workup of pneumomediastinum (PM)?
What is the role of electrocardiography in the workup of pneumomediastinum (PM?
When is placement of a chest tube indicated in the evaluation of pneumomediastinum (PM)?
When is a bronchoscopy indicated in the evaluation of pneumomediastinum (PM)?
What is the role of esophagoscopy in the evaluation of pneumomediastinum (PM)?
Treatment
What is the natural course of pneumomediastinum (PM)?
What is the role of mechanical ventilation (MV) in the management of pneumomediastinum (PM)?
What is the role of nitrogen washout in the treatment of pneumomediastinum (PM)?
What is the role of analgesics in the treatment of pneumomediastinum (PM)?
What is the role of surgery in the treatment of pneumomediastinum (PM)?
What is the role of mediastinoscopy in the treatment of pneumomediastinum (PM)?
What is the role of mediastinal drainage tubes in the treatment of pneumomediastinum (PM)?
Which dietary modifications are beneficial in the treatment of pneumomediastinum (PM)?
Which activity modifications are beneficial in the treatment of pneumomediastinum (PM)?
Medications
Which medications are used in the treatment of pneumomediastinum (PM)?
Follow-up
What are the general treatment guidelines for pneumomediastinum (PM)?
Which physical activities should be avoided following treatment for pneumomediastinum (PM)?
What is the association of pregnancy with pneumomediastinum (PM)?
What is the role of vaccinations in the management of pneumomediastinum (PM)?
What is included in inpatient care for pneumomediastinum (PM)?
How is esophageal perforation treated in pneumomediastinum (PM)?
Which medical therapy is indicated for the treatment of pneumomediastinum (PM)?
What is the role of antitussives in the management of pneumomediastinum (PM)?
When is transfer to the intensive care unit indicated for the treatment of pneumomediastinum (PM)?
Which activities are high risk for pneumomediastinum (PM)?
Which behaviors may cause pneumomediastinum (PM)?
Which substances should be avoided to reduce the risk of pneumomediastinum (PM)?
What are the possible complications of pneumomediastinum (PM)?
What are the complications of tension pneumomediastinum (PM)?
What are the complications of pneumomediastinum (PM) following vomiting?
What conditions associated with pneumomediastinum (PM) may cause complications?
What is the prognosis of pneumomediastinum (PM)?
What is included in patient education about pneumomediastinum (PM)?
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This chest radiograph (posteroanterior and lateral view) is from a 3-year-old girl with a history of prematurity, chronic lung disease, and asthma who presented with a viral pneumonitis and persistent cough. On the posteroanterior view, a pneumomediastinum (arrow) is noted. Also, extensive subcutaneous air is observed.
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The chest radiograph is taken from an adolescent girl with status asthmaticus who was intubated for respiratory failure. A rim of air consistent with a pneumomediastinum may be observed along the upper left border of the heart. Subcutaneous air is observed in the soft tissues of the neck. She required very high peak inspiratory pressures (50 cm H2), which in conjunction with marked air trapping due to her asthma, caused alveolar rupture, allowing air to track to the mediastinum. A central venous line was placed.
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On the lateral radiograph from the patient in Media file 2, anterior mediastinal air is observed. Left lower lobe atelectasis is also present. The child was asymptomatic and was discharged 2 days later.
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Chest radiographs in anteroposterior (AP) and lateral projections obtained in a 9-year-old girl with wheezing and pneumonitis. The arrows highlight the "spinnaker sail sign" in which free mediastinal air lifts the thymus off of the heart and major vessels.
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Subcutaneous emphysema and pneumothorax.