Diagnosis and treatment of spontaneous pneumomediastinum.

BACKGROUND

Due to its rarity there is no clear policy on the management of spontaneous pneumomediastinum (SPM).

METHODS

We treated 23 SPM patients between January 1 996 and November 2 006. There were 20 males and 3 females and their mean age was 27. Clinical records of the patients were collected and analyzed.

RESULTS

The most frequent symptoms were neck swelling (n = 20) and rhinolalia (n = 15). Onset of the symptoms was acute. A preceding factor was found in 19 (83 %) patients; these included vigorous cough, forced physical activity, vigorous sneezing and enormous efforts during spontaneous vaginal delivery. Chest X-ray was sufficient to show mediastinal free air in 18 patients. Computerized chest tomography showed pneumomediastinum in all patients. Twenty patients were treated expectantly. Subcutaneous air drainage was needed to drain massive subcutaneous emphysema in three patients.

CONCLUSIONS

Acute onset of typical symptoms, the existence of a preceding factor and the exclusion of other possible causes of pneumomediastinum with the help of CT are sufficient to make a diagnosis of SPM. A surgical intervention is generally not needed for the treatment of this entity.