A Clinical Study of Eight Children With Spontaneous Pneumomediastinum

Furuta Shigeyuki, Wakisaka Munechika, Kawase Hirokazu, Shima Hideki, Satoh Hideaki, Hamano Shiho, Nagae Hideki, Aoba Takeshi, Kitagawa Hiroaki

doi:10.11164/jjsps.48.4_722

Purpose: Spontaneous pneumomediasinum (SPM) is a rare disease entity. Those children suffering from SPM always complain of chest pain and discomfort, and their x-ray images demonstrate emphysematous change in the upper mediastinum without any causal lesions. We retrospectively examined the details of clinical presentation in SPM children treated at our institution to devise a guideline for the most appropriate management of these patients. Methods: We reviewed the hospital records of children admitted with diagnosed SPM to determine the clinical presentation of individual patients, and to review the treatment strategy. Results: The children's ages ranged from 13 to 16 years (mean: 15 years), and comprised 7 boys and one girl. Three of the 8 SPM children developed their symptoms spontaneously; however, symptoms developed in the remaining 5 patients were observed after they had shouted loudly during sports activity. The symptoms included pain in the neck (3 cases), throat (2) or chest (6), discomfort (2), and dysphagia (1). Subcutaneous emphysema was observed in 4 children. While pneumomediastinum was observed on plain radiographs in 6 (75%) of the 8 children, computed tomography revealed pneumomediastinum in all children, thus confirming the diagnosis. Esophagography was performed in 7 of the 8 children to rule out esophageal injuries. The mean length of hospital stay was 5 days, and all children achieved remission with conservative therapy without any episode of recurrence. Conclusions: Spontaneous pneumomediasinum is rare. It can be diagnosed by clinical symptoms and imaging. It is vital to differentiate SPM from tension pneumomediastinum or serious mediastinal emphysema associated with esophageal perforation. Diagnosed SPM patients should definitely be managed accordingly with no active medical treatment.

A Clinical Study of Eight Children With Spontaneous Pneumomediastinum

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