Pneumomediastinum

Abstract

Pneumomediastinum is a condition in which air is present in the mediastinum. This condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Pneumomediastinum is a rare situation and occurs when air leaks into the mediastinum. The diagnosis can be confirmed via chest X-ray or CT scanning of the thorax. The main symptom is usually severe central chest pain. Other symptoms include laboured breathing, voice distortion (as with helium) and subcutaneous emphysema, specifically affecting the face, neck, and chest. Pneumomediastinum can also be characterized by the shortness of breath that is typical of a respiratory system problem. It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart. The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively.

Keywords: Pneumothorax; pneumomediastinum; puncture; trauma.

Figure 1

Classification of pneumomediastinum.

Figure 2

Suggested treatment algorithm of pneumomediastinum.

Figure 3

Chest film of young male patient presented with chest pain. Plain chest film has shown mediastinal air tracking alongside the medial border of the descending aorta.

Figure 4

(A,B) CT scan of the same patient as in Figure 1 confirms the presence of mediastinal air outlining mediastinal organs.

Figure 5

This young patient presented with cough and chest pain. Chest film reveals surgical emphysema.

Figure 6

The CT chest of this patient revealed air in the anterior mediastinum.