Yonsei Med J.  2015 Sep;56(5):1437-1442. 10.3349/ymj.2015.56.5.1437.

Spontaneous Pneumomediastinum: A Rare Disease Associated with Chest Pain in Adolescents

• Kim SH
• Huh J
• Song J
• Kang IS

• KMID: 2163641
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1437

Abstract

PURPOSE
Spontaneous pneumomediastinum (SPM) is a rare entity, with only a few cases reported, especially in adolescents. We aimed to analyze the clinical characteristics of SPM in adolescents and the diagnostic implications of computed tomography (CT) and esophagography therein.
MATERIALS AND METHODS
This retrospective descriptive study was conducted as a review of medical records of 416 adolescents (10-18 years of age) with chest pain from March 2005 to June 2013. Information on clinical presentation, methods of diagnosis, hospital stay, and outcomes were collected and analyzed.
RESULTS
Among adolescents complaining of chest pain, 11 patients had SPM (11/416, 2.64%). All patients presented with pleuritic chest pain, and 54.5% reported neck pain as the most common associated complaint. Clinical findings were nonspecific, and initial chest X-ray assessment was diagnostic only in three of 11 patients. However, reassessment of chest X-ray revealed diagnostic findings of SPM in five of the remaining eight patients. CT was diagnostic in all patients, while esophagography and echocardiogram were uninformative. Symptomatic improvement was noted within 2.45+/-1.2 hours (range, 0.5 to 4) after supportive care; mean hospital stay was 4.54+/-0.99 days (range, 2 to 6). No recurrence was observed.
CONCLUSION
SPM is a rare disease that should be considered in adolescent patients with pleuritic chest pain. Careful reading of initial chest X-rays is important to avoiding further unnecessary investigations. SPM is self-limited and treatment is supportive; nevertheless, if there are no indications of esophageal rupture, urgent esophagography is not recommended.

Keyword

Spontaneous pneumomediastinum; chest pain; adolescent

MeSH Terms

Adolescent
Analgesics/*therapeutic use
Chest Pain/diagnosis/*etiology
Child
Female
Follow-Up Studies
Humans
Length of Stay
Male
Mediastinal Emphysema/complications/*diagnosis/*therapy
Medical Records
*Oxygen Inhalation Therapy
Rare Diseases
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Treatment Outcome
Analgesics

Figure

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  Fig. 1 Spontaneous pneumomediastinum in a 16-year-old male patient. Postero-anterior radiograph demonstrates streaks of air outlining the mediastinal blood vessels, without evidence of rib fracture or pneumothorax.

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  Fig. 2 Spontaneous pneumomediastinum in a 16-year-old male patient. Chest CT scan clearly demonstrating air within the superior mediastinum.

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  Fig. 3 Spontaneous pneumomediastinum in a 16-year-old male patient. Chest CT scan clearly demonstrating air within the superior mediastinum.

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