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Pneumomediastinum

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Air in the mediastinum.

Most common cause is rupture of the alveoli (air then enters the interstitial tissues and tracks to the mediastinum). Causes include:

  • raised intrapulmonary pressures e.g. vomiting, asthma, coughing
  • positive pressure mechanical ventilation

Other causes include:

  • penetrating neck injury
  • oesophageal and bronchial rupture

Clinical features:

  • may be asymptomatic
  • chest pain that is worse on swallowing or breathing
  • crunching sound coincident with each heart beat

Chest X-ray:

  • air in the upper mediastinum, around the heart, or within the soft tissues of the neck
  • pneumothorax in 30% of cases

Treatment:

  • treat underlying cause
  • treatment with high concentration inspiratory oxygen can hasten resolution

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