J Korean Radiol Soc.  1998 Mar;38(3):459-463. 10.3348/jkrs.1998.38.3.459.

Spontaneous Pneumomediastinum on CT: Related Condition and its Clinical Significance

• Kim SH
• Im JG
• Seo JB
• Park JH
• Yeon KM
• Han MC

• KMID: 2201402
• DOI: http://doi.org/10.3348/jkrs.1998.38.3.459

Abstract

PURPOSE: To tabulate underlying disease and to assess the clinical significance of CT-diagnosed spontaneouspneumonediastinum.
MATERIALS AND METHODS
We retrospectively reviewed CT scans and medical records of 11consecutive patients with spontaneous pneumomediastinum, and analyzed their clinical history and course, and infive cases, pulmonary function. CT scans of 126 patients with idiopathic pulmonary fibrosis (IPF) collected whilethe 11 consecutive patients were being treated were analyzed for the prevalence of pneumomediastinum. We analyzedCT findings with respect to the amount and distribution of air in the mediastinum, and the presence or absence ofair outside the mediastinum.
RESULTS
In the 11 patients, underlying diseases were IPF (n=4), bronchiolitisobliterans organizing pneumonia (BOOP)(n=2), bronchiectasis (n=2), tuberculous tracheal stenosis (n=1), andpulmonary tuberculosis with bullous emphysema (n=1); there was one without associated disease. Of the 126 patientswith IPF, four (3.2%) showed spontaneous pneumomediastinum. All ten with underlying diseases had severe dyspnea.In five patients, a pulmonary function test showed marked impairment. Two of four patients with IPF and both withBOOP died within 2 months of CT scanning, whereas the remaining six showed clinical improvement. The detectionrate of pneumomediastinum on plain chest radiograph was 82% (9/11). CT showed that mediastinal air was mostfrequently found in the retrosternal space. There were four cases of pneumothorax and two of subcutaneousemphysema.
CONCLUSION
Spontaneous pneumomediastinum might be associated with idiopathic pulmonary fibrosis andmight be a poor prognostic factor in patients with IPF or BOOP.

Keyword

Pneumomediastinum; Pneumothorax; Lung, fibrosis

MeSH Terms

Bronchiectasis
Cryptogenic Organizing Pneumonia
Emphysema
Humans
Idiopathic Pulmonary Fibrosis
Mediastinal Emphysema*
Mediastinum
Medical Records
Pneumonia
Pneumothorax
Prevalence
Radiography, Thoracic
Respiratory Function Tests
Retrospective Studies
Tomography, X-Ray Computed
Tracheal Stenosis
Tuberculosis

Figure

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  Fig. 1. A 38-year-old man (patient 5) with pneumomediastinum and pathologically proven bronchiolitis obliterans organizing pneumonia. High-resolution CT shows multiple air bubbles in retrosternal, preaortic area (arrow). Dense and multiple patch consolidations and associated pneumothorax (arrowhead) are also seen. The patient was expired 40 days after CT scan.

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  Fig. 2. A 62-year-old man (patient 2) with pneumomediastinum and idiopathic pulmonary fibrosis. High-resolution CT shows multiple linear air densities surrounding the great vessels in mediastinum (arrow) and associated pneumothorax (arrowhead) in left hemithorax. Honeycomb appearance are well visualized in the peripheral portion of the lung. PFT revealed severe restrictive and obstructive pattern. The patient showed stationary outcome after treatment.

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  Fig. 3. An 18-year-old man (patient 11) without any associated respiratory disease: multiple air pocket in subcarinal (arrow) and preaortic area (arrowhead) are well documented. Note the normal lung parenchyma. The patient had history of playing basketball for 2 hours just before symptom onset.

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