From the Guidelines
A small amount of pneumomediastinum is a cause for concern and warrants prompt medical evaluation. Pneumomediastinum is a condition where air is present in the mediastinum, and even small amounts can indicate an underlying issue that requires assessment. The presence of air in the mediastinum can be a sign of a more serious condition, such as a perforated esophagus or airway, and requires immediate attention. While the study by 1 suggests that observation alone may be sufficient for small, closed, mildly symptomatic spontaneous pneumothoraces, this does not directly apply to pneumomediastinum.
Key considerations in the management of pneumomediastinum include:
- Determining the underlying cause of the condition
- Assessing the severity of symptoms, such as chest pain, difficulty breathing, or voice changes
- Providing supportive care, such as oxygen therapy and pain management
- Ruling out serious complications, such as perforation of the esophagus or airways
It is essential to seek medical attention promptly if diagnosed with pneumomediastinum, as delaying evaluation and treatment can lead to worsening of symptoms and increased risk of complications. The study by 1 highlights the importance of monitoring patients with small pneumothoraces for signs of worsening symptoms, and similarly, patients with pneumomediastinum should be closely monitored for any changes in their condition.
In terms of management, there is no specific medication regimen for pneumomediastinum itself, and treatment depends on the underlying cause and severity of the condition. However, rest, oxygen therapy, and pain management may be necessary to support the patient while the underlying cause is being investigated and treated. Ultimately, prompt medical evaluation is necessary to determine the cause and appropriate treatment for pneumomediastinum, and to prevent potential complications.
From the Research
Pneumomediastinum Overview
- Pneumomediastinum is a condition where air is present in the mediastinum, which can result from physical trauma or situations that lead to air escaping from the lungs, airways, or bowel into the chest cavity 2.
- It is a rare condition that can be diagnosed via chest X-ray or CT scanning of the thorax, with main symptoms including severe central chest pain, labored breathing, voice distortion, and subcutaneous emphysema 2.
Treatment and Prognosis
- Most pneumomediastinums are treated conservatively, as the tissues in the mediastinum will slowly resorb the air in the cavity 2.
- Patients with spontaneous pneumomediastinum typically experience self-limited disease, and efforts should be made to minimize low-yield invasive testing 3.
- In some cases, pneumomediastinum can be associated with more severe complications, such as pneumothorax, which may require active treatment with an acute chest drain 4.
Associated Conditions and Complications
- Pneumomediastinum can be associated with subcutaneous emphysema, pneumothorax, and pneumorrhachis (air within the spinal epidural space) 5.
- It can also be a complication of COVID-19 infection, particularly in patients with moderate or severe illness, high-flow oxygen therapy, and noninvasive ventilation 4.
- In rare cases, pneumomediastinum can be a complication of bronchial asthma, and although usually self-limiting, it can occasionally be life-threatening 6.
Management and Resolution
- Most patients with spontaneous pneumomediastinum can be treated on an outpatient basis after monitoring and education about potential complications 3.
- The condition can resolve spontaneously, with symptoms improving within a few days, and intraspinal air and pneumomediastinum resolving on follow-up chest computed tomography 5.