Idiopathic Spontaneous Pneumomediastinum: Radiologic and Clinical Features

Kim, Mi Young; Kim, Su Young; Kim, Yong Hoon; Hwang, Yoon Joon; Seo, Jung Wook; Han, Yoon Hee; Cha, Soon Joo; Hur, Gham

Abstract

PURPOSE: To evaluate the clinical presentations, radiological characteristics, and natural history of healthy adolescents presenting with idiopathic spontaneous pneumomediastinum.
MATERIALS AND METHODS
We retrospectively reviewed the simple radiographs of 14 consecutive patients (11 males) with spontaneous pneumomediastinum, who were examined over a period of 8 years, and analyzed their clinical history, radiographic findings including distribution, combined subcutaneous emphysema, mediastinal widening, pneumothorax, pleural effusion, and resolving period on follow up chest radiographs. We also obtained CT images of 7 patients for the assessment of additional information.
RESULTS
The most common complaint at the time of presentation was chest pain and chest discomfort (8/14), followed by neck discomfort (6/14). The chest radiograph was of diagnostic value in all cases. The main distribution of the pneumomediastinum was cervical (14/14), upper lung (13/14) and lower lung (6/14). Combined subcutaneous emphysema was observed in 6 patients. However, there were no cases of mediastinal widening, pneumothorax or pleural effusion. Complete resolution of the pneumomediastinum on the radiograph was observed after 10 days (mean 5.6), following purely conservative treatment. There was no additional information on the CT images, as compared with that on the radiographs.
Conclusions
Idiopathic spontaneous pneumomediastinum is a benign entity that usually goes undiagnosed, but which responds very well to conservative treatment.