Tuberc Respir Dis.  2015 Oct;78(4):360-362. 10.4046/trd.2015.78.4.360.

Spontaneous Pneumomediastinum: An Unusual Pulmonary Complication in Anorexia Nervosa

• Lee KJ
• Yum HK
• Park IN

• KMID: 2320706
• DOI: http://doi.org/10.4046/trd.2015.78.4.360

Abstract

Spontaneous pneumomediastinum (PM) is an uncommon condition in which free air enters the mediastinum. This usually occurs either through esophageal tears after vigorous vomiting, or after alveolar rupture subsequent to a rapid increase in intra-alveolar pressure. Spontaneous PM is a rare entity in anorexia nervosa (AN) and self-induced vomiting is often the cause of PM in patients with AN. We experienced a case of spontaneous PM in an anorexic adolescent, in whom vomiting was not the cause of PM.

Keyword

Anorexia Nervosa; Mediastinal Emphysema; Subcutaneous Emphysema

MeSH Terms

Adolescent
Anorexia Nervosa*
Anorexia*
Diethylpropion
Humans
Mediastinal Emphysema*
Mediastinum
Rupture
Subcutaneous Emphysema
Tears
Vomiting
Diethylpropion

Figure

• 

  Figure 1 Chest X-ray at the time of admission (A) and on the 10th day of hospitalization (B). Marked improvement in diffuse soft tissue emphysema can be seen.

• 

  Figure 2 Computed tomography (CT) in the patient with mediastinal emphysema and subcutaneous emphysema in both axillae and lower neck regions. CT scan shows subcutaneous emphysema in the neck and mediastinal emphysema with extension into the intra-abdominal, retroperitoneal (A, B), and epidural regions. Arrow indicates epidural pneumatosis (C).

Reference

1. Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: overview and appearance on computed tomography. World J Radiol. 2014; 6:850–854.

2. Al-Mufarrej F, Badar J, Gharagozloo F, Tempesta B, Strother E, Margolis M. Spontaneous pneumomediastinum: diagnostic and therapeutic interventions. J Cardiothorac Surg. 2008; 3:59.

3. Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg. 2007; 31:1110–1114.

4. Overby KJ, Litt IF. Mediastinal emphysema in an adolescent with anorexia nervosa and self-induced emesis. Pediatrics. 1988; 81:134–136.

5. Folsom T, Realmuto G. Pneumomediastinum in an adolescent female with anorexia nervosa. Int J Eat Disord. 1984; 3:67–70.

6. van Veelen I, Hogeman PH, van Elburg A, Nielsen-Abbring FW, Heggelman BG, Mahieu HF. Pneumomediastinum: a rare complication of anorexia nervosa in children and adolescents: a case study and review of the literature. Eur J Pediatr. 2008; 167:171–174.

7. Lin LY, Kwok CF, Tang KT, Ho LT, Lin HD. Diffuse soft tissue emphysema in anorexia nervosa: a case report. Int J Eat Disord. 2005; 38:277–280.

8. Filosso PL, Garabello D, Lyberis P, Ruffini E, Oliaro A. Spontaneous pneumomediastinum: a rare complication of anorexia nervosa. J Thorac Cardiovasc Surg. 2010; 139:e79–e80.

9. Goldstein MA, Herzog DB, Misra M, Sagar P. Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain. N Engl J Med. 2008; 359:1272–1283.

10. Adson DE, Crow SJ, Mitchell JE. Spontaneous pneumothorax in anorexia nervosa. Psychosomatics. 1998; 39:162–164.

11. Corless JA, Delaney JC, Page RD. Simultaneous bilateral spontaneous pneumothoraces in a young woman with anorexia nervosa. Int J Eat Disord. 2001; 30:110–112.

12. Fergusson RJ, Shaw TR, Turnbull CM. Spontaneous pneumomediastinum: a complication of anorexia nervosa? Postgrad Med J. 1985; 61:815–817.

13. Coxson HO, Chan IH, Mayo JR, Hlynsky J, Nakano Y, Birmingham CL. Early emphysema in patients with anorexia nervosa. Am J Respir Crit Care Med. 2004; 170:748–752.

14. Massaro D, Massaro GD, Baras A, Hoffman EP, Clerch LB. Calorie-related rapid onset of alveolar loss, regeneration, and changes in mouse lung gene expression. Am J Physiol Lung Cell Mol Physiol. 2004; 286:L896–L906.

15. Winick M. Hunger disease: studies by the Jewish physicians in the Warsaw Ghetto. New York: Wiley;1979. p. 221–223.