Pneumomediastinum: Difference between revisions
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==Background== | ==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 Perforation|esophageal rupture]] | ||
* | *If no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition | ||
==Causes== | ==Causes== | ||
Revision as of 23:58, 30 October 2014
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
- asthma
- coughing
- 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
- ABCs
- CXR
- Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated
Management
- supportive
- no specific therapy for spontaneous pneumomediastinum
- treat underlying cause
Disposition
- depends on underlying cause and severity of condition
- most pt's with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged
See Also
Sources
Harwood-Nuss, Rosens