Pneumomediastinum: Difference between revisions
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==Causes== | ==Causes== | ||
* | *Illegal drug use | ||
# | #Inhaling cocaine | ||
# | #Smoking cocaine | ||
# | #Smoking marijuana | ||
* | *Vomiting | ||
* | *Retching | ||
* | *Coughing | ||
* | *Asthma | ||
* | *Esophageal rupture | ||
* | *Recent endoscopy | ||
* | *Trauma | ||
**Search for other more serious injuries (larynx, bronchus, esophagus) | **Search for other more serious injuries (larynx, bronchus, esophagus) | ||
==Clinical Features== | ==Clinical Features== | ||
* | *Chest pain | ||
** | **Voice change, cough, stridor | ||
* | *SubQ emphysema in chest wall, neck, face, abdomen, scrotum | ||
*"Hamman's Crunch" - crunching sound of heart during systole | *"Hamman's Crunch" - crunching sound of heart during systole | ||
==Workup== | ==Workup== | ||
*CXR | *CXR | ||
*Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated | *Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated | ||
==Management== | ==Management== | ||
* | *Supportive | ||
* | **No specific therapy for spontaneous pneumomediastinum | ||
* | *Treat underlying cause | ||
==Disposition== | ==Disposition== | ||
* | *Depends on underlying cause and severity of condition | ||
* | *Most pts with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged | ||
==See Also== | ==See Also== | ||
Revision as of 23:59, 30 October 2014
Background
- Usually occurs with sudden increase in intra-alveolar pressure causing alveolar rupture, air dissects into pulmonary interstitium and then into mediastinum, neck, or pericardium
- Life threatening cause is esophageal rupture
- If no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition
Causes
- Illegal drug use
- Inhaling cocaine
- Smoking cocaine
- Smoking marijuana
- Vomiting
- Retching
- Coughing
- Asthma
- Esophageal rupture
- Recent endoscopy
- Trauma
- Search for other more serious injuries (larynx, bronchus, esophagus)
Clinical Features
- Chest pain
- Voice change, cough, stridor
- SubQ emphysema in chest wall, neck, face, abdomen, scrotum
- "Hamman's Crunch" - crunching sound of heart during systole
Workup
- CXR
- Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated
Management
- Supportive
- No specific therapy for spontaneous pneumomediastinum
- Treat underlying cause
Disposition
- Depends on underlying cause and severity of condition
- Most pts with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged
See Also
Sources
Harwood-Nuss, Rosens