%0 Journal Article
%T Spontaneous pneumomediastinum: diagnostic and therapeutic interventions
%A Faisal Al-Mufarrej
%A Jehangir Badar
%A Farid Gharagozloo
%A Barbara Tempesta
%A Eric Strother
%A Marc Margolis
%J Journal of Cardiothoracic Surgery
%D 2008
%I BioMed Central
%R 10.1186/1749-8090-3-59
%X The case notes 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.The typical patient is a young man. The commonest presenting complaint is chest pain. Odynophagia and subcutaneous emphysema are common. 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.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 in unnecessary radiological investigations, dietary restriction and antibiotic administration with prolonged hospitalization.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 [1-4], spontaneous pneumomediastinum is an uncommon, self-limiting condition. It results from alveolar rupture-otherwise 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 maneuver (expiration through resistance) that occurs with straining (e.g. during labor) or v
%U http://www.cardiothoracicsurgery.org/content/3/1/59