From the Research
Pneumomediastinum is not typically caused by a specific organism, but rather results from air leaking into the mediastinum due to physical factors, and treatment should focus on addressing the underlying cause with supportive care, rather than targeting a specific organism. The most common causes of pneumomediastinum include trauma, excessive coughing, vomiting, asthma exacerbations, or barotrauma from mechanical ventilation 1. In rare cases where pneumomediastinum is associated with infection, it may be due to gas-producing organisms like Clostridium species, particularly in necrotizing infections, or other potential infectious causes such as tuberculosis or fungal infections that erode into airways or esophagus 2.
Key Points to Consider
- The pathophysiology of pneumomediastinum involves air escaping from ruptured alveoli, traveling along bronchovascular sheaths into the mediastinum (Macklin effect), or directly entering the mediastinum through perforations in the trachea, bronchi, or esophagus 3.
- Treatment focuses on addressing the underlying cause rather than targeting a specific organism, with most cases resolving spontaneously with supportive care including oxygen therapy, pain management, and rest 4.
- Antibiotics are only indicated if there's evidence of concurrent infection, and hospitalization may not be necessary for all patients, especially those with mild symptoms and no signs of complications 5.
- Predictors of esophageal injury in patients with pneumomediastinum include instrumentation, pleural effusion, and vomiting, while previous instrumentation is a significant predictor of airway injury 2.
Management Approach
- A conservative approach with supportive care is often sufficient for patients with pneumomediastinum, and the use of prophyltic antibiotics is not recommended unless there is evidence of concurrent infection 4.
- Patients should be monitored for signs of complications, such as tension pneumomediastinum, delayed pneumothorax, airway compromise, and mediastinitis, and treated promptly if they occur 3.
- A diagnostic algorithmic approach is necessary to rule out severe secondary entities and consequences that need urgent treatment, and to guide the management of patients with pneumomediastinum 5.