From the Guidelines
Pneumomediastinum typically presents with chest pain, dyspnea, neck pain and swelling, subcutaneous emphysema, and Hamman's sign, which are crucial signs and symptoms for clinicians to recognize in order to promptly diagnose and manage the condition. The most common symptom is chest pain, typically central and sometimes radiating to the neck or back, which may worsen with breathing or swallowing. Dyspnea (shortness of breath) is frequently reported, ranging from mild to severe depending on the extent of the condition. Patients often experience neck pain and swelling, and subcutaneous emphysema may be present, causing a crackling sensation when touching the skin of the chest or neck (crepitus). Hamman's sign—a crunching sound synchronized with heartbeats heard on auscultation—is a pathognomonic finding. Voice changes such as hoarseness may occur, and some patients report difficulty swallowing (dysphagia). In severe cases, patients might develop tachycardia, tachypnea, or cyanosis. These symptoms arise because air leaks into the mediastinum, typically from alveolar rupture allowing air to track along bronchovascular sheaths into the mediastinum, or from direct trauma to the airways, esophagus, or chest wall. Although the provided studies do not directly address the signs and symptoms of pneumomediastinum, the clinical presentation can be inferred from general medical knowledge and the understanding of similar conditions such as pneumothorax, as discussed in studies like 1 and 1. Prompt recognition of these signs is crucial as pneumomediastinum can occasionally lead to serious complications like tension pneumomediastinum or indicate underlying conditions requiring urgent intervention. Key points to consider in the diagnosis and management of pneumomediastinum include:
- Chest pain and dyspnea as primary symptoms
- Presence of subcutaneous emphysema and Hamman's sign
- Potential for severe complications if not promptly recognized and managed
- Importance of considering pneumomediastinum in the differential diagnosis of chest pain and shortness of breath, especially in patients with underlying lung disease or trauma, as hinted at in studies discussing pleural procedures during the COVID-19 pandemic 1.
From the Research
Signs and Symptoms of Pneumomediastinum
- Chest pain is a common symptom, reported in 50 cases (78.1%) in a study by 2 and also mentioned as the main symptom in 3
- Neck pain is another frequent complaint, experienced by 35 cases (54.7%) in the study by 2
- Dyspnea, or shortness of breath, is reported in 18 cases (28.1%) by 2 and is also a common presenting symptom according to 4
- Odynophagia, or painful swallowing, is experienced by 9 cases (14.1%) in the study by 2
- Subcutaneous emphysema, characterized by air in the tissues, is a common exam finding, reported in 17 patients (68%) by 5 and in 35.4% of patients according to 4
- Hamman's sign, a "crunching" sound timed with the cardiac cycle, is a less common finding, reported in only 5.9% of patients by 4
- Voice distortion, similar to the effect of inhaling helium, is also a symptom of pneumomediastinum, as mentioned in 3
- Laboured breathing and increased intrapulmonary pressure on venous flow to the heart, which can mimic cardiac tamponade, are additional symptoms and complications associated with pneumomediastinum, as discussed in 3 and 6