Abstract
Background
Spontaneous pneumomediastinum is defined as the presence of free air in the mediastinum
without any apparent concomitant factors or disease. It is uncommon but usually benign
and self-limiting. Generally, patients with spontaneous pneumomediastinum are admitted
to hospital, and occasionally, prophylactic antibiotics are administered to prevent
mediastinitis. The purpose of this study was to describe practices concerning the
feasibility of outpatient treatment and follow-up of spontaneous pneumomediastinum
and the necessity of prophylactic antibiotics.
Methods
We conducted this study in a single emergency medical center located in Kobe, Japan.
We retrospectively evaluated patients with spontaneous pneumomediastinum from January
2007 to December 2014. Spontaneous pneumomediastinum was defined as cases in which
pneumomediastinum did not occur in the setting of positive pressure ventilation or
severe trauma. All case records were carefully reviewed considering the demographic
data, symptoms, precipitating events, diagnostic workup performed, use of prophylactic
antibiotics, length of hospital stay, and complications.
Results
Thirty-four patients who satisfied the inclusion criteria were identified. Twenty-three
patients (67.6%) were followed up on an outpatient basis, and 11 patients (32.4%)
were admitted to the hospital, with a mean length of stay of 3.4 days. Prophylactic antibiotics were orally administered to 2 patients. None of the
patients developed complications, such as tension pneumomediastinum, delayed pneumothorax,
airway compromise, and mediastinitis.
Conclusion
Spontaneous pneumomediastinum is a benign condition presenting primarily in young
adults, with an uneventful recovery. Therefore, patients may recover from this condition
without admission or the need for prophylactic antibiotics.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: interpretation of the clinical literature in the light of laboratory experiment.Medicine. 1944; 23: 281-358
- Spontaneous pneumomediastinum: clinical and natural history.Ann Emerg Med. 1992; 21: 122
- Clinical features of medical pneumomediastinum.Ann Thorac Cardiovasc Surg. 2003; 9: 188-191
- Spontaneous pneumomediastinum: 41 cases.Eur J Cardiothorac Surg. 2007; 31: 1110-1114
- Management of spontaneous pneumomediastinum based on clinical experience of 25 cases.Respir Med. 2008; 102: 1329-1334
- Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients.Eur J Cardiothorac Surg. 2004; 25: 852-855
- Spontaneous mediastinal emphysema.Bull Johns Hopkins Hosp. 1939; 64: 1-21
- Inclusion of ‘minor’ trauma cases provides a better estimate of the total burden of injury: Queensland Trauma Registry provides a unique perspective.Injury. 2014; 45: 1236-1241
- Spontaneous pneumomediastinum: a report of 25 cases.Chest. 1991; 100: 93-95
- Spontaneous pneumomediastinum: an extensive workup is not required.J Am Coll Surg. 2014; 219: 713-717
- Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients.Eur J Cardiothorac Surg. 2010; 37: 573-575
- Spontaneous pneumomediastinum: time for consensus.N Am J Med Sci. 2013; 5: 460-464
- Spontaneous pneumomediastinum: a comparative study and review of the literature.Ann Thorac Surg. 2008; 86: 962-966
- Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases.Arch Bronconeumol. 2005; 41: 528-531
Article Info
Publication History
Published online: March 10, 2017
Accepted:
March 10,
2017
Received in revised form:
March 8,
2017
Received:
November 22,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
