Chest
Volume 128, Issue 5, November 2005, Pages 3298-3302
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Clinical Investigations: PLEURAL DISEASE
Spontaneous Pneumomediastinum: A Benign Curiosity or a Significant Problem?

https://doi.org/10.1378/chest.128.5.3298Get rights and content

Objective: To identify the significance of spontaneous pneumomediastinum (SPM) and to optimize its management.

Methods: A retrospective analysis was undertaken of all patients presenting with SPM over a 5-year period. Eighteen patients were identified, and information on their presentations, initial diagnoses, comorbidities, investigations, clinical courses, length of hospital stays, and outcomes were collated.

Setting: The emergency department referrals of two major Melbourne teaching hospitals.

Results: SPM is an uncommon condition presenting in approximately 1 in 30,000 emergency department referrals. The typical patient identified from this study is a young man who is likely to have a history of asthma, and who is also likely to smoke or to use illicit drugs. The most common presentation is nonspecific pleuritic chest pain with dyspnea. Complications are rare, and the clinical course benign, but the possibility of a ruptured viscus or an initial misdiagnosis often leads to a great number of investigations. A proposed algorithm of management is given. Other serious and potentially life-threatening conditions, such as Boerhaave syndrome need to be excluded.

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

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