From the Guidelines
Pneumomediastinum is primarily caused by air leaking into the mediastinum due to conditions such as trauma, medical procedures, or underlying lung diseases, as supported by the most recent evidence 1.
Causes of Pneumomediastinum
The causes of pneumomediastinum can be categorized into several groups, including:
- Trauma to the chest or neck
- Medical procedures like mechanical ventilation, bronchoscopy, or dental procedures
- Underlying lung diseases such as interstitial lung disease, COPD, or tuberculosis
- Forceful vomiting (Boerhaave syndrome)
- Vigorous coughing
- Asthma exacerbations
- Excessive physical exertion
- Esophageal perforation
- Tracheal injury
- Recreational activities like scuba diving or cocaine inhalation
Mechanism of Pneumomediastinum
The fundamental mechanism involves alveolar rupture due to increased pressure, allowing air to track along bronchovascular sheaths into the mediastinum (Macklin effect) 1.
Management of Pneumomediastinum
Most cases of pneumomediastinum resolve with conservative management, including rest, oxygen therapy, and pain control, though the underlying cause must be addressed 1. Severe cases may require chest tube placement or surgical intervention.
Recent Guidelines
Recent guidelines from the British Thoracic Society emphasize the importance of proper management of pneumothorax, which can be related to pneumomediastinum, and recommend the use of high-volume, low-pressure suction systems for chest drain management 1.
From the Research
Causes of Pneumomediastinum
The causes of pneumomediastinum, a condition characterized by air leakage into the mediastinum, can be varied. Some of the identified causes include:
- Physical trauma, which can lead to air escaping from the lungs, airways, or bowel into the chest cavity 2
- Consumption of illegal drugs, such as cocaine, which can cause diffuse alveolar damage and lead to pneumomediastinum 3
- Severe asthma attacks, which can result in spontaneous pneumomediastinum 4
- Blunt trauma to the thoracic and neck area, which can cause pneumomediastinum, although the clinical significance of this finding is poorly defined 5
Predisposing Factors
Certain factors can predispose individuals to developing pneumomediastinum, including:
- Occasional consumption of cocaine, which can increase the risk of spontaneous pneumomediastinum 3
- Severe respiratory conditions, such as asthma, which can lead to pneumomediastinum 4
- Trauma to the chest or neck area, which can cause air leakage into the mediastinum 2, 5
Pathophysiology
The pathophysiology of pneumomediastinum involves the leakage of air into the mediastinum, which can be caused by a variety of factors, including physical trauma, respiratory conditions, and consumption of certain substances 2, 6, 3, 4, 5