From the Guidelines
Pneumomediastinum does not typically cause elevated liver function tests (LFTs). There is no direct physiological mechanism by which air in the mediastinum would affect liver enzyme production or release. Pneumomediastinum primarily affects the chest area and respiratory system, while LFTs reflect liver health and function.
Key Points to Consider
- The provided evidence 1 does not suggest a direct link between pneumomediastinum and elevated LFTs.
- Elevated LFTs are more commonly associated with liver diseases, such as hepatitis, cirrhosis, and cholestasis, as discussed in the guidelines on abnormal liver function tests 1.
- The American College of Radiology's appropriateness criteria for abnormal liver function tests 1 focus on identifying the underlying causes of elevated LFTs, such as hepatocellular injury, cholestasis, or bile duct obstruction, but do not mention pneumomediastinum as a cause.
- In clinical practice, if a patient presents with pneumomediastinum and elevated LFTs, it would be prudent to investigate for underlying causes that could explain both findings, rather than assuming a direct causal relationship between the two. The management would focus on treating the pneumomediastinum and identifying and addressing the cause of the elevated LFTs separately.
Clinical Implications
- Clinicians should not assume that pneumomediastinum is the cause of elevated LFTs without further investigation.
- A thorough evaluation of the patient's clinical history, laboratory results, and imaging studies is necessary to determine the underlying cause of elevated LFTs.
- Treatment should be focused on addressing the underlying cause of the elevated LFTs, rather than attributing it to the pneumomediastinum.
From the Research
Pneumomediastinum and Liver Function Tests (LFTs)
- There is no direct evidence in the provided studies that pneumomediastinum causes elevated Liver Function Tests (LFTs) 2, 3, 4, 5, 6.
- Study 4 discusses spontaneous pneumomediastinum (SPM) and its clinical significance, but it does not mention any association with elevated LFTs.
- Studies 2 and 3 discuss the evaluation and management of patients with elevated LFTs, but they do not mention pneumomediastinum as a potential cause.
- Study 6 investigates the elevation of LFTs after laparoscopic gastrectomy using a Nathanson liver retractor, but it does not discuss pneumomediastinum.
- Study 5 introduces an intelligent Liver Function Testing (iLFT) pathway to improve early diagnosis of liver disease, but it does not mention pneumomediastinum.
Potential Causes of Elevated LFTs
- Elevated LFTs can be caused by various factors, including acute hepatitis, acute liver failure, drug-induced liver injury, and exacerbations of pre-existing liver diseases 2, 3.
- Study 6 suggests that laparoscopic gastrectomy using a Nathanson liver retractor can cause elevation of LFTs, possibly due to liver damage by direct retraction.
- Study 3 mentions that abnormal liver function tests are found in the majority of critically ill patients and are associated with increased mortality.