Chest
Clinical Investigations: PLEURAL DISEASESpontaneous Pneumomediastinum: A Benign Curiosity or a Significant Problem?
Section snippets
MATERIALS AND METHODS
Between July 1999 and October 2004, all patients who were admitted to the Austin and Box Hill Hospitals with a diagnosis of SPM were reviewed. Their files were assessed retrospectively, and their demographic details, precipitating factors, comorbidities, symptoms, signs, treatments, and outcomes were collated.
RESULTS
Eighteen patients were identified from a review of the hospital records. There were 14 men and 4 women, and the patients had a median age of 20 years (age range, 11 to 58 years).
DISCUSSION
The first physician to describe SPM and some of the predisposing factors was Laennec in the early 19th century,1 and the first report of a series of patients with SPM was in 1939 by Hamman.3 The pathognomonic sign of SPM (Hamman's sign) bears his name and is characterized by a crunching or bubbling sound that is synchronous with the heartbeat.
SPM has been described predominantly in young adult men, and its incidence has been reported as occurring in 1 in 8004 to 1 in 42,000 hospital admissions.1
CONCLUSIONS
SPM is a rare condition that is often seen in the primary care setting in the first instance. In our series, we have shown SPM to have an incidence of approximately 1 in 30,000 emergency department presentations. This diagnosis should be considered in younger people who present with pleuritic chest pain and look well otherwise, with normal vital signs. This especially applies to those with a recent history of the ingestion of ecstasy or speed.
These patients should undergo testing, as outlined in
REFERENCES (22)
Spontaneous pneumomediastinum.
Am J Surg
(1976)- et al.
Assessment of spontaneous mediastinum: experience with 12 patients.
Ann Thorac Surg
(2003) - et al.
Spontaneous pneumomediastinum: a report of 25 cases.
Chest
(1991) - et al.
Spontaneous pneumomediastinum: are we overinvestigating?
J Pediatr Surg
(2004) - et al.
Persistent pneumomediastinum in interstitial fibrosis associated with rheumatoid arthritis: treatment with high-concentration oxygen.
Chest
(2000) - et al.
Spontaneous pneumomediastinum: a rare benign entity.
J Thorac Cardiovasc Surg
(2003) - et al.
Boerhaave revisited: spontaneous esophageal perforation as a diagnostic masquerader.
Am J Med
(1989) Medical mediastinal emphysema.
Ann Intern Med
(1961)- et al.
Subcutaneous and mediastinal emphysema: pathophysiology, diagnosis and management.
Arch Intern Med
(1984) Spontaneous mediastinal emphysema.
Bull Johns Hopkins Hosp
(1939)
Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment.
Medicine
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