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Pneumomediastinum, Emergency Medicine

Matthew D. Bitner Reviewed 06/2017
 


Basics

Description

  • Presence of free air or gas within the mediastinum (mediastinal emphysema)

  • May originate from esophagus, lungs, or bronchial tree (aerodigestive process)

  • May occur spontaneously (prima...

Diagnosis

Signs and Symptoms

  • Chest pain (most common symptom in multiple series):

    • Sharp

    • Pleuritic

    • Retrosternal

    • Radiating to back and arms

    • Often positional

  • Dyspnea

  • Neck pain:

    • Occurs in association with dissecti...

Treatment

Pre-Hospital

  • Resuscitation of the acutely ill patient (as in the patient with septic mediastinitis)

  • In the appropriate setting, standard care of the trauma patient

  • Withhold PO intake

  • Rapid patie...

Follow-Up

Disposition

Admission Criteria

  • Secondary pneumomediastinum

  • Associated pneumothorax

  • Possibility of esophageal rupture has not been excluded

  • Abnormal vital signs

  • Ill/toxic-appearing patient

  • Intractab...

Pearls and Pitfalls

  • Ensure that underlying causes are excluded.

  • Be aware of typical presenting features (chest pain, dyspnea, and neck swelling), pre-existing conditions, and precipitating factors asso...

Additional Reading

  • Al-Mufarrej  F, Badar  J, Gharagozloo  F, et al. Spontaneous pneumomediastinum: Diagnostic and therapeutic interventions. J Cardiothorac Surg.  2008;3:59.

  • Caceres  M, Ali  SZ, B...

Acknowledgment

The author gratefully acknowledges the contributions of Jennifer De la Pena and Leon D. Sanchez for previouseditions of this chapter. 

Codes

ICD9

518.1 Interstitial emphysema 

ICD10

J98.2 Interstitial emphysema 

SNOMED

  • 16838000 Mediastinal emphysema (disorder)

  • 427445002 Tension pneumomediastinum (disorder)

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