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What Causes Pneumomediastinum?

Medically Reviewed by Melinda Ratini, DO, MS on May 27, 2021

Pneumomediastinum is a very rare condition that affects the respiratory system. It’s when air gets into the upper chest and starts accumulating, usually due to trauma or other illnesses that cause air to leak from the lungs.

This condition mainly affects young adults and male individuals.

Pneumomediastinum occurs more in young people because their mediastinum is made of loose tissue. As we age, our mediastina become fibrous. Air can penetrate loose tissue more easily than it can penetrate fibrous tissue.

Pneumomediastinum is a condition with two distinct types:

  • Secondary pneumomediastinum. This type of pneumomediastinum is caused by injury or damage to the mediastinum. It can be induced through trauma or injury, like being hit by a blunt object, or by complications during surgical procedures like chest operations.
  • Spontaneous pneumomediastinum. This type of pneumomediastinum occurs due to smoking or the use of recreational drugs (methamphetamines, cocaine, and marijuana). Spontaneous pneumomediastinum can occur in individuals who have no pre-existing medical conditions.

Causes of Pneumomediastinum

As mentioned above, the main causes of this condition are blunt force trauma or lung injury due to substance abuse or medical issues.

Injury to the airway can be caused by blunt trauma, explosions, or penetrating wounds.

Medical issues that may cause pneumomediastinum include:

Symptoms of Pneumomediastinum

Pneumomediastinum is mainly asymptomatic, which means that you may not notice any clear signs. However, those who have experienced pneumomediastinum have reported symptoms like:

  • Chest pain (triggered by taking deep breaths excess coughing)
  • Difficulty breathing
  • Throat pain
  • Difficulty swallowing
  • A change in your voice

Other signs may include fast breathing, a rapid heartbeat, low blood pressure, and air accumulating beneath your skin.

Diagnosis

Your doctor may do a series of examinations to look for indications of respiratory distress, cardiac dullness, neck cracking, or Hamman’s sign (a crunching sound in your upper chest).

You may receive:

  • A chest x-ray, which detects 90% of cases
  • A bronchoscopy to check whether there is an underlying respiratory condition.
  • In an emergency, an ultrasound.

Management and Treatment

Your doctor may decide to keep you in the hospital for about 24 hours for observation. Don’t be too worried ⁠— management of pneumomediastinum is mainly supportive care. Pneumomediastinum is self-limiting and goes away in 1-2 weeks, and it rarely recurs.

Supportive treatment helps treat pneumomediastinum. Your doctor may put you on oxygen and bed-rest to help with healing. This will also help your body reabsorb the air that has leaked.

The pain may be managed using analgesics or other drugs. The pain usually lasts for 1 or 2 days.

Make sure that, during your recovery period, you get enough rest. Don’t do too much exercise!‌ Inform your health care provider of any pre-existing conditions like chronic obstructive pulmonary disease and asthma.

Complications

In rare cases, pneumomediastinum may last for longer than two weeks and may lead to complications, like a collapsed lung, respiratory compromise, or pneumorrhachis, a condition in which air enters the spinal canal.

Conclusion

Pneumomediastinum is very rare and usually clears up over time. However, it’s always best to keep an eye on your respiratory health, especially if you’re experiencing pneumomediastinum symptoms or are recovering from it. ‌If you feel that something’s wrong, always consult your healthcare provider.

Show Sources

SOURCES:

‌American Journal of Roentgenology: “Pneumomediastinum: old signs and new signs.”

PULMONOLOGY JOURNAL: “Pneumothorax, pneumomediastinum and pneumopericardium complications arising from a case of wisdom tooth extraction.”

Clinical Medicine Journal: “COVID-19-associated pneumomediastinum.”

Iteen, A., Bianchi, W., Sharman, T. Pneumomediastinum. StatPearls Publishing, 2020.

‌Journal of Thoracic Disease: “Pneumomediastinum”.‌

The Korean Journal of Internal Medicine: “A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Young Adult.”

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