Spontaneous pneumomediastinum: Experience in 13 adult patients

• Published in: Asian cardiovascular & thoracic annals 2015-11, Vol.23 (9), p.1050-1055
• Main Authors: Panigrahi, Manoj K, Suresh Kumar, Cherlopalli, Jaganathan, Venugopal, Vinod Kumar, Saka
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Chest Tubes; Female; Humans; Length of Stay; Male; Mediastinal Emphysema - diagnosis; Mediastinal Emphysema - etiology; Mediastinal Emphysema - therapy; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Factors; Tertiary Care Centers; Thoracostomy - instrumentation; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/0218492315606303

Background Spontaneous pneumomediastinum is an uncommon disorder. There is a lack of information on spontaneous pneumomediastinum in India. We aimed to understand the clinical profile, hospital course, and long-term outcome of such patients. Methods We retrospectively reviewed all patients (aged ≥15 years) diagnosed with spontaneous pneumomediastinum in the respiratory ward of a tertiary care hospital over a 7-year period from 2005. Results Of the 3326 patients hospitalized during the study period, 13 (10 male) were diagnosed with spontaneous pneumomediastinum, constituting 0.39% of all hospitalizations. The median age was 37 years (interquartile range 20–55 years). The most common presenting symptom was dyspnea in 85% followed by neck swelling (69%), chest pain (69%) and cough (54%). Subcutaneous emphysema and preexisting lung diseases were identified in 11 (85%) patients each. Post-tubercular pulmonary sequelae (5 patients) and asthma (4 patients) were the most common underlying lung diseases. Pneumothorax was identified in 6 (46%) patients; 4 required tube thoracostomy. Chest radiography was diagnostic in 92% of patients. The median length of hospital stay was 9 days (interquartile range 6–12 days). No recurrence was reported in 11 patients followed up for a median of 1550 days (interquartile range 691–1909 days). Conclusions Spontaneous pneumomediastinum is a benign disorder, but underlying lung diseases and concomitant pneumothorax are likely to complicate the disease course. Exacerbation of post-tubercular obstructive airway disease is a common risk factor for spontaneous pneumomediastinum in a tuberculosis endemic country.