UMEM Educational Pearls

Category: Critical Care

Title: Spontaneous pneumomediastinum

Keywords: spontaneous pneumomediastinum (PubMed Search)

Posted: 2/12/2008 by Mike Winters, MD (Updated: 10/24/2020)
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Spontaneous Pneumomediastinum

  • Spontaneous pneumomediastinum is largely a benign disease typically seen in young males ages 18-21 years
  • It is typically caused by activities that increase alveolar pressure such as coughing, sneezing, vomiting, inhalational drug use, and Valsalva maneuver
  • The most common symptoms include chest pain and dyspnea; chest pain is usually centrally located, may radiate to the neck, and may be worse with inspiration
  • CT scan is the "gold standard"; CXR is a good place to start but it is normal in up to 30% of cases
  • The vast majority of patients do not require admission or supplemental O2
  • Advise patients to avoid strenuous activity until after symptom resolution (typically takes about 2 weeks)
  • Any patient with a fever, elevated WBC count, hemodynamic instability, severe dysphagia or odynophagia should first be evaluated for infectious mediastinitis or esophageal perforation (spont. pneumomediastinum is a diagnosis of exclusion in these patients)