Pneumomediastinum: Difference between revisions
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*If no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition | *If no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition | ||
==Causes== | ===Causes=== | ||
*Illegal drug use | *Illegal drug use | ||
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*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 | ||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Management== | ==Management== | ||
Revision as of 21:32, 6 December 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
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
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