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Spontaneous pneumomediastinum: an extensive work up is not required
*Charles Bakhos1, *Stevan Pupovac2, *Tom Fabian1
1Albany Medical Center, Albany, NY;2Albany Medical College, Albany, NY

Spontaneous pneumomediastinum is a rare entity usually caused by alveolar rupture and air tracking along the tracheobronchial tree. Despite its benign nature, an extensive work up is often undertaken to exclude hollow viscus perforation. The purpose of this study is to review our experience with this condition and examine the management strategy.
Retrospective case series
Tertiary university-based hospital, over a 5 year period (2007-2011)
All patients with radiographic pneumomediastinum
Main Outcome Measures:
Length of hospital stay, mortality, need for investigative procedures
Forty one patients were identified including 24 male (59%); mean age was 19.6 ± 9 years. Chest pain was the most common presenting symptom (66%), followed by dyspnea (49%) and neck pain (29%). Forceful coughing (27%) or vomiting (20%) were the most common eliciting factors, while no precipitating event was identified in 34% of patients. Computed tomography was performed in 32 patients (78%) and showed a pneumomediastinum that was not seen on chest roentogram in 7 patients. An esophagogram was performed in 16 patients (39%) and was invariably negative for a leak. No invasive procedure was performed except in 2 patients with significant neck complaints who underwent normal laryngoscopies. Thirty two patients (78%) were hospitalized for a mean of 1.8 ± 2.7 days. Only one patient required intubation for a severe asthma attack. No mortality was recorded.
Spontaneous pneumomediastinum is a benign entity and rarely correlates with true esophageal perforation. Additional investigation with an esophagogram or other invasive procedures should be performed selectively with the aim of expediting the patient’s care. The prognosis is excellent with conservative management and the risk of recurrence is low.

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