Pneumomediastinum: Difference between revisions
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==Sources== | ==Sources== | ||
Harwood-Nuss, Rosens | Harwood-Nuss, Rosens | ||
[[Category:Pulm]] | |||
==Background== | |||
*Also known as mediastinal emphysema | |||
*Definition: air present in the mediastinum | |||
===Causes=== | |||
*[[Esophageal rupture]] | |||
*[[Asthma]]/[[COPD]] | |||
*Bowel rupture or other cause of air in abdominal cavity (tracts up into the chest) | |||
*[[Mycoplasma pneumoniae]] [[pneumonia]] | |||
*Environmental [[barotrauma]] (e.g. [[Scuba diving emergencies|scuba diving]], [[Commercial in-flight medical emergencies|flight]]) | |||
*Iatrogenic (e.g. during thoroscopy/VATS) | |||
*Blunt [[chest trauma]] | |||
==Clinical Features== | |||
*[[Chest pain]] | |||
*[[Dyspnea]] | |||
*Voice distortion | |||
*[[Subcutaneous emphysema]], especially of face, neck, and chest.<ref>Quresi SA, Tilyard A (2008). "Unusual Presentation of Spontaneous Mediastinum: A Case Report". ''Cases Journal'' 1:349. doi:10.1186/1757-1626-1-349.</ref> | |||
*"Crunching" sound on auscultation, timed with the cardiac cycle (Hamman's crunch) | |||
*May mimic [[cardiac tamponade]]<ref>Beg MH, Reyazuddin, Ansari MM (1988). "Traumatic tension Pneumomediastinum Mimicking Cardiac Tamponade". ''Thorax'' 43:576-677. doi: 10.1136/thx.43.7.576.</ref> | |||
==Differential Diagnosis== | |||
==Diagnosis== | |||
[[File:Subcutaneous emphysema chest cropped.jpg|thumb]] | |||
[[File:PneumoMediastinum2008.jpg|thumb|Traumatic pneumomediastinum and right sided pneumothorax with first rib fracture.]] | |||
[[File:Pneumomediastinum-003.jpg|thumb|Pneumomediastinum with Angel wing sign]] | |||
*[[CXR]] or chest CT | |||
**Radiolucent outline around the heart and mediastinum | |||
==Management== | |||
*[[Supplemental oxygen]] with [[non-rebreather]] | |||
==Disposition== | |||
==See Also== | |||
*[[Pneumothorax (main)]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 23:39, 13 May 2015
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
- AP/PA - Ring around right pulmonary artery, air along L heart border, air in upper chest/neck soft tissue
- Lateral - air along anterior heart border
- Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
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
Background
- Also known as mediastinal emphysema
- Definition: air present in the mediastinum
Causes
- Esophageal rupture
- Asthma/COPD
- Bowel rupture or other cause of air in abdominal cavity (tracts up into the chest)
- Mycoplasma pneumoniae pneumonia
- Environmental barotrauma (e.g. scuba diving, flight)
- Iatrogenic (e.g. during thoroscopy/VATS)
- Blunt chest trauma
Clinical Features
- Chest pain
- Dyspnea
- Voice distortion
- Subcutaneous emphysema, especially of face, neck, and chest.[1]
- "Crunching" sound on auscultation, timed with the cardiac cycle (Hamman's crunch)
- May mimic cardiac tamponade[2]
Differential Diagnosis
Diagnosis
- CXR or chest CT
- Radiolucent outline around the heart and mediastinum
Management