Neumomediastino Espontaneo

Journal of Cardiothoracic Surgery
Research article

BioMed Central

Open Access

Spontaneous pneumomediastinum: diagnostic and therapeutic interventions
Faisal Al-Mufarrej*1, Jehangir Badar1, Farid Gharagozloo1,2, Barbara Tempesta2, Eric Strother1 and Marc Margolis1,2
Address: 1The George Washington University Medical Center, Department of Surgery, 2300 Eye Street NW, Washington, DC20037, USA and 2Washington Institute of Thoracic and Cardiovascular Surgery, 2175 K Street NW, Washington DC 20037, USA Email: Faisal Al-Mufarrej* - faisalmiam@gmail.com; Jehangir Badar - badarmd@hotmail.com; Farid Gharagozloo - gharagozloo@aol.com; Barbara Tempesta - BarbT61@aol.com; Eric Strother - strother4eeni@aol.com; Marc Margolis - msegrmargolis@comcast.net * Corresponding author

Published:3 November 2008 Journal of Cardiothoracic Surgery 2008, 3:59 doi:10.1186/1749-8090-3-59

Received: 29 August 2008 Accepted: 3 November 2008

This article is available from: http://www.cardiothoracicsurgery.org/content/3/1/59 © 2008 Al-Mufarrej et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Objectives: The objective of this case series is to review our experience with spontaneous pneumomediastinum, review the available literature, and refine the current clinical approach to this uncommon condition. Methods: The casenotes of all patients admitted to the George Washington University Medical Center with spontaneous pneumomediastinum from April 2005 to June 2008 were retrospectively reviewed, indentifying seventeen patients on whom various data was collected and analyzed. Results: The typical patient is a young man. The commonest presenting complaint is chest pain. Odynophagia and subcutaneous emphysema arecommon. Leucocytosis is uncommon. The need for swallow studies, antibiotics, and prolonged hospitalization is uncommon. Most patients have no recurrences or sequelae on long-term follow-up. Conclusion: Spontaneous pneumomediastinum is an uncommon, self-limiting condition. Due to concerns for the integrity of the aero-digestive tract, the finding of spontaneous pneumomediastinum usually results inunnecessary radiological investigations, dietary restriction and antibiotic administration with prolonged hospitalization.

Introduction
Pneumomediastinum or air in the mediastinum may originate from the esophagus, lungs, or bronchial tree. As suggested by a handful of small case series in the literature [14], spontaneous pneumomediastinum is an uncommon, self-limiting condition. It results fromalveolar ruptureotherwise known as the Macklin phenomenon. Alveolar rupture results from high intra-alveolar pressures, low peri-vascular pressures, or both. Air escaping from the alveoli tracks into the mediastinum during the breathing

cycle as the pressure in the mediastinum decreases relative the pulmonary parenchymal pressure. From there, air may track into the cervical subcutaneous tissues,epidural space [5], pericardium [6], and/or peritoneal cavity [7,8]. Spontaneous pneumomediastinum usually results from bronchial hyper-reactivity or barotraumas. Bronchial constriction may be due to asthma or inhalation [8] of toxic agents (e.g. cocaine) [9]. Barotrauma may occur with instrumentation, mechanical ventilation, or Valsalva's
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maneuver (expiration through resistance) that occurs with straining (e.g. during labor) or vomiting [5]. The finding of a pneumomediastinum usually places the integrity of the thoracic aero-digestive tract into question resulting in unnecessary radiological investigations, needless dietary...