Pneumomediastinum: Difference between revisions
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==Background== | ==Background== | ||
*usually occurs with sudden increase in intra-alveolar pressure causing alveolar rupture, air dissects into pulmonary interstitium and then into mediastinum, neck, or pericardium | *usually occurs with sudden increase in intra-alveolar pressure causing alveolar rupture, air dissects into pulmonary interstitium and then into mediastinum, neck, or pericardium | ||
*life threatening cause is esophageal rupture | *life threatening cause is esophageal rupture | ||
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==Causes== | ==Causes== | ||
*illegal drug use | *illegal drug use | ||
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*recent endoscopy | *recent endoscopy | ||
*trauma | *trauma | ||
**Search for other more serious injuries (larynx, bronchus, esophagus) | |||
==Clinical Features== | ==Clinical Features== | ||
*chest pain | *chest pain | ||
**voice change, cough, stridor | |||
*subQ emphysema in chest wall, neck, face, abdomen, scrotum | *subQ emphysema in chest wall, neck, face, abdomen, scrotum | ||
*"Hamman's Crunch" - crunching sound of heart during systole | *"Hamman's Crunch" - crunching sound of heart during systole | ||
==Workup== | ==Workup== | ||
*ABCs | *ABCs | ||
*CXR | *CXR | ||
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==Management== | ==Management== | ||
*supportive | *supportive | ||
*no specific therapy for spontaneous pneumomediastinum | *no specific therapy for spontaneous pneumomediastinum | ||
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==Disposition== | ==Disposition== | ||
*depends on underlying cause and severity of condition | *depends on underlying cause and severity of condition | ||
*most pt's with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged | *most pt's with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged | ||
==See Also== | |||
*[[Thoracic Trauma]] | |||
==Sources== | ==Sources== | ||
Harwood-Nuss, Rosens | Harwood-Nuss, Rosens | ||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 11:57, 27 March 2014
Background
- usually occurs with sudden increase in intra-alveolar pressure causing alveolar rupture, air dissects into pulmonary interstitium and then into mediastinum, neck, or pericardium
- life threatening cause is esophageal rupture
- if no hemodynamic or airway compromise present, spontaneous pneumomediastinum is not a life threatening condition
Causes
- illegal drug use
- inhaling cocaine
- smoking cocaine
- smoking marijuana
- vomiting
- retching
- asthma
- coughing
- esophageal rupture
- recent endoscopy
- trauma
- Search for other more serious injuries (larynx, bronchus, esophagus)
Clinical Features
- chest pain
- voice change, cough, stridor
- subQ emphysema in chest wall, neck, face, abdomen, scrotum
- "Hamman's Crunch" - crunching sound of heart during systole
Workup
- ABCs
- CXR
- Rule-out esophageal rupture by hx and exam or with esophagoscopy if indicated
Management
- supportive
- no specific therapy for spontaneous pneumomediastinum
- treat underlying cause
Disposition
- depends on underlying cause and severity of condition
- most pt's with spontaneous pneumomediastinum, not caused by trauma or esophageal rupture, can be safely discharged
See Also
Sources
Harwood-Nuss, Rosens