Spontaneous Pneumomediastinum: A Clinical Radiologic Analysis

SUMMARY Background Spontaneous pneumomediastinum is clinically distinct from pneumomediastinum occurring secondary to thoracic hollow organ perforation. The latter may be a catastrophic event requiring invasive intervention, but it is questionable whether such interventions are necessary in spontaneous pneumomediastinum. Limited data are available regarding the characteristics of history and radiologic manifestations in spontaneous pneumomediastinum. The present study aimed to systematically evaluate the initial and subsequent clinical and radiologic manifestations of spontaneous pneumomediastinum as well as the need for additional diagnostic procedures and therapy. Methods A retrospective study of patients with a diagnosis of spontaneous pneumomediastinum in a tertiary medical center from January 1990 to November 2006 was performed. The patients' clinical information and results of radiologic interventions were analyzed. Results A total of 42 patients were included. Spontaneous pneumomediastinum was diagnosed in all cases by chest films. A left pericardial airstrip was the most common initial manifestation. In this series, there was only one patient with a pneumothorax, and none of the patients developed pleural effusion or mediastinal fluid as shown by chest X-rays after the disease onset. Conclusion Spontaneous pneumomediastinum occurs mostly in non-elderly patients. Evaluation of typical clinical information and uncomplicated serial chest X-ray findings of spontaneous pneumomediastinum could avoid unnecessary invasive procedures and intensive care unit stays, which could put pressure on medical resources. A plain film X-ray is adequate for diagnosing spontaneous pneumomediastinum as long as the appropriate findings are sought and there is adequate application of lateral radiography.