From the Guidelines
Management of pneumomediastinum typically involves conservative management, with treatment focused on underlying causes and supportive care.
Treatment Options
- Conservative management is often the initial approach, with monitoring and supportive care as needed.
- In some cases, thoracic surgery may be considered, particularly if there is an underlying condition that requires surgical intervention 1.
- Ambulatory treatment using a purpose-made device containing a one-way valve, or Heimlich valve attached to chest drain, may also be an option for outpatient management 1.
Underlying Causes
- Treatment of underlying causes, such as spontaneous pneumothorax, is crucial in managing pneumomediastinum.
- Chemical pleurodesis via chest tube or thoracic surgery may be considered to reduce the risk of recurrence in patients with spontaneous pneumothorax 1.
Clinical Considerations
- Persistent air leaks may require earlier surgical intervention, particularly in cases of secondary pneumothorax 1.
- Respiratory physician care and thoracic surgical opinion are recommended for patients with difficult pneumothoraces 1.
From the Research
Management of Pneumomediastinum
The management of pneumomediastinum can be conservative or surgical, depending on the severity of the condition and the presence of complications.
- Conservative management is typically used for patients with spontaneous pneumomediastinum, who often have a self-limiting course and no recurrence in most cases 2.
- Surgical management is necessary in cases of extensive subcutaneous emphysema, cardiac or airway compression, or tension pneumomediastinum, which can be life-threatening 3, 4.
- Surgical decompression with drainage is the key point of treatment for tension pneumomediastinum, and various surgical procedures have been reported in the literature 4.
- Cervical mediastinotomy is one of the operative methods of choice in the presence of tension pneumomediastinum, allowing for effective decompression of the mediastinal structures and improving the condition of the affected patients 4.
Treatment Approach
The treatment approach for pneumomediastinum depends on the underlying cause and the presence of complications.
- For patients with spontaneous pneumomediastinum, symptomatic management without the aggressive use of antibiotics or diet restriction is often sufficient 5.
- Hospital length of stay may be minimized on a case-by-case basis, and outpatient follow-up may be safely limited to those at highest risk of recurrence 5.
- In cases of secondary pneumomediastinum, the treatment approach depends on the underlying cause, and may involve surgical intervention or other treatments 6.
Diagnostic Evaluation
A thorough diagnostic evaluation is necessary to distinguish primary spontaneous pneumomediastinum from secondary causes, especially esophageal perforation.
- Understanding the clinical history, including symptoms such as coughing or forceful vomiting, is critical to help elucidate the etiology and guide management of pneumomediastinum 5.
- Patients who present with forceful vomiting or retching should be considered with a higher degree of suspicion for secondary causes of pneumomediastinum, specifically esophageal perforation 5.