As a result of pneumomediastinum, air accumulates between the lungs in the mediastinum, the space between the lungs in the chest. It can originate from different sources, including the lungs, esophagus, or airways, and accumulate in the mediastinum, causing complications.
Causes
There are several factors that can cause pneumomediastinum, including:
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Pneumomediastinum may occur spontaneously without any apparent cause, especially in young adults, and may be associated with activities that increase intra-thoracic pressure, such as heavy lifting.
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Air can leak into the mediastinum after blunt or penetrating chest trauma, such as a car accident or stab wound.
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If the airways or surrounding tissues are damaged, certain medical procedures, such as mechanical ventilation, bronchoscopy, or esophageal dilation, can also cause pneumomediastinum.
Symptoms
Pneumomediastinum symptoms include:
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Sharp or stabbing chest pain that worsens with deep breathing or swallowing.
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The presence of air in the soft tissues causes a characteristic crackling sensation or sound under the skin, especially around the neck or upper chest.
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Depending on the extent of air accumulation, dyspnea can range from mild to severe.
Diagnosis
A pneumomediastinum diagnosis typically involves a medical history, physical examination, and imaging studies. Common diagnostic tests may include:
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A chest X-ray can reveal the presence of air in the mediastinum or subcutaneous tissues.
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Using a computed tomography (CT) scan, a more detailed image of the mediastinum and surrounding structures can be obtained, allowing for a more precise diagnosis.
Treatment
In mild cases, conservative management may suffice, including rest, pain relief, and close monitoring for signs of progression.
There may be a need for medical intervention in more severe cases or those that are associated with complications, such as tension pneumomediastinum or pneumothorax. Procedures such as needle decompression or chest tube placement can be used to relieve pressure and remove excess air from the mediastinum.
Prevention
When performing activities that may increase the likelihood of air leakage into the mediastinum, it is important to avoid risk factors and take precautions to prevent pneumomediastinum. To minimize the risk of injury to the airways or surrounding tissues, it is important to use proper lifting techniques, avoid behaviors that increase intra-thoracic pressure, and perform medical procedures carefully.
