Pneumomediastinum

Pneumomediastinum

Pneumomediastinum is the presence of air in the mediastinum. This is the area of the body that is between the lungs and behind the breastbone. Mild cases of this condition may not cause problems.

Severe cases can interfere with the normal functions of your heart and lungs.

Pneumomediastinum is gas within the mediastinum. On imaging, one sees streaky linear or curvilinear lucent, very low attenuation, or very low signal intensity gas in the mediastinum that outlines mediastinal structures. Although pneumopericardium (gas within the pericardial space) is confined to the distribution of the pericardial reflection, pneumomediastinum may occur anywhere within the mediastinum. The causes of pneumomediastinum include:

• • Air trapping from obstructive lung disease such as emphysema or asthma.
• • Straining against a closed glottis from vomiting, parturition, weightlifting, or marijuana use.
• • Blunt/penetrating trauma or iatrogenic injury to the trachea, bronchi, or esophagus.
• • Barotrauma from mechanical ventilation, sudden decrease in atmospheric pressure, or coughing.
• • Erosion of the trachea or esophagus by tumor.
• • Esophageal rupture from Boerhaave syndrome, alcoholism, or diabetic ketoacidosis.
• • Extension of gas from pneumothorax, pneumoperitoneum, or pneumoretroperitoneum.
• • Recent thoracic surgery.

What are the causes?

This condition happens when air leaks out of your lungs, airways, or intestines and into your mediastinum. This condition may be caused by:

• Childbirth.
• An injury to your chest, lung, intestine, esophagus, or abdomen.
• Asthma.
• Rapid ascent during scuba diving.
• Use of a breathing machine (ventilator).
• Inhaling or ingesting certain drugs or chemicals.
• An infection in your face, neck, chest, or abdomen.
• Extreme strain during coughing or vomiting.
• Breathing an object into an airway.

This condition can also occur without a cause.

What are the symptoms of Pneumomediastinum?

Symptoms of Pneumomediastinum include:

• Chest pain. The pain may run into your neck, shoulder, back, or arms.
• Increased pain when you move, swallow, or take a deep breath.
• Problems swallowing.
• Problems speaking.
• Changes in your voice.
• Shortness of breath.
• Fever.
• Throat or jaw pain.

Some people have no symptoms. This is often the case if the condition occurred on its own.

How is Pneumomediastinum diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• A physical exam.
• Imaging tests, such as a chest X-ray or CT scan.

How is Pneumomediastinum treated?

Treatment depends on how severe the condition is and whether there are complications.

• If your condition is mild, you may not need treatment. Your body may slowly reabsorb the air in your mediastinum. You will stay in the hospital for observation and get medicine for pain, if you have pain.
• If your condition is severe, or if the air starts to put pressure on your heart or lungs, you may need:
  • Treatment for the underlying cause.
  • One or more of the following procedures:
    • Needle aspiration. In this procedure, a needle is used to remove trapped air.
    • Chest tube placement. This may be done if your lung collapses.
    • Surgery. This may be done to repair a hole in your intestine or esophagus.

Follow these instructions at home:

• Until your health care provider says it is okay, avoid:
  • Air travel.
  • Scuba diving.
  • High altitudes.
  • Hard physical work.
  • Exercise.
• Avoid any movements that make you strain your muscles. Try not to cough, laugh hard, or lift anything heavy.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Do not use illegal drugs.
• Take over-the-counter and prescription medicines only as told by your health care provider.

Contact a health care provider if:

• You have a fever.

Get help right away if you have:

• Worsening pain in your chest, neck, jaw, or arms.
• Trouble breathing.
• New problems with speaking or swallowing.

Summary

• Pneumomediastinum is the presence of air in the mediastinum. This is the area of the body that is between the lungs and behind the breastbone. This can happen if air leaks out of your lungs, airways, or intestines and into your mediastinum.
• Symptoms may include chest, throat or jaw pain, increased pain when you move, swallow, or take a deep breath, changes in your voice, shortness of breath, and fever.
• Treatment depends on how severe your condition is and if there are complications.