Primary pneumomediastinum in pediatric patients: are hospitalizations and control x-rays necessary?

OBJECTIVE

Primary pneumomediastinum (PP) is an infrequent condition in pediatrics with no standardized management. The objective of this paper was to report our experience with PP and analyze the role of hospitalizations and radiological tests.

MATERIAL AND

METHODS

A retrospective study of pediatric patients with PP from 2013 to 2023 was carried out. Demographic, clinical, and radiological data was collected.

RESULTS

24 patients (54% of whom male) with a median age of 9.5 years (3.9-15.2) and a median weight of 32 kg (14.8-49.3) were included. The most frequent reasons for consultation were dyspnea (46%), chest pain (29%), and odynophagia (13%). Patients < 5 years old reported less chest pain (12.5% vs. 75%, p= 0.008) and had more respiratory infections (p= 0.032), with lower SpO2 (95% vs. 98.5%, p= 0.05). 19 (79%) patients required hospitalization, 9 of whom exclusively as a result of PP. Hospitalization was longer (5.5 vs. 3 days, p= 0.017) and aerosol treatment was more frequent (p= 0.005) in patients admitted due to concomitant pathologies. They all received conservative treatment. Early (< 24 h) pain control was achieved with oral analgesia, without complications or rehospitalizations in the first 30 days following discharge. Additional radiological tests, aside from the diagnostic chest X-ray, were carried out in 95.8% of the cases (95.8% X-rays, 12.5% chest CT-scan), with no changes in terms of patient management whatsoever. Subcutaneous emphysema was not significantly associated with more X-rays (3 vs. 1.5, p= 0.235). Median added radiation was 0.05 mSv (0.02-0.1) or 2.5 X-rays.

CONCLUSIONS

PP is a benign condition that can be conservatively treated. In the absence of intercurrent pathologies, hospitalization might prove unnecessary. Additional ionizing tests increase radiation while not adding a clear clinical benefit.