Case Report
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A Rare Cause of Chest Pain: Spontaneous Pneumomediastinum

Year 2021, Volume: 4 Issue: 3, 110 - 113, 30.09.2021

Abstract

Aim: Spontaneous pneumomediastinum (SPM) is the presence of free air in the mediastinum without any clear reason. It is a rare, self-limiting disease that occurs mostly in young men. Although radiographic imaging is usually sufficient for the diagnosis, thoracic computed tomography may be required in suspicious cases and to determine the etiology. The conservative approach is sufficient in the treatment.
In this report, we present a 23-year-old male patient who presented to the emergency department due to chest pain and was diagnosed with spontaneous pneumomediastinum.

Case: 23-year-old male patient presented to the emergency department with chest pain. His general condition was good, and he was conscious. Systemic physical examination and electrocardiogram were normal. Free air was detected in the paratracheal area on the posteroanterior (PA) chest X-ray. He was admitted to the thoracic surgery service for follow-up and treatment with the diagnosis of pneumomediastinum.

Conclusion: Spontaneous pneumomediastinum should definitely be considered in the differential diagnosis of young patients presenting to the emergency department with chest pain. Clinical suspicion is the most valuable step for the diagnosis of spontaneous pneumomediastinum. Although PA chest X-ray is mostly sufficient for diagnosis, thoracic computed tomography is necessary to determine the etiology and follow-up.

References

  • Caceres M, Ali SZ, Braud R, et al. Spontaneous Pneumomediastinum: A Comparative Study and Review of the Literature. Ann Thorac Surg. 2008;86(3):962-6.
  • Dajer-Fadel WL, Arguero-Sanchez R, Ibarra-Perez C, et al. Systematic review of spontaneous pneumomediastinum: a survey of 22 years’ data. Asian CardiovascThorac Ann. 2014;22(8):997-1002.
  • Ojhave S, Gaskin J. Spontaneous pneumomediastinum. BMJ Case Rep. 2018;2018:bcr2017222965.
  • Ødegaard KJ, Haavardsholm E, Husby A. Spontaneous pneumomediastinum. TidsskrNorLaegeforen. 2018;26:38(11).
  • Khadija C, Nahid Z, Hanane B, et al. Spontaneous pneumomediastinum: about 18 cases. Pan Afr Med J. 2018;31:75.
  • Takada K, Matsumoto S, Hiramatsu T, et al. Spontaneous pneumomediastinum: an algorithm for diagnosis and management. Ther Adv Respir Dis. 2009;3(6):301-307.
  • Song IH, Lee SY, Lee SJ, et al. Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg. 2017;65(5):280-284.
  • Fitzwater JW, Silva NN, Knight CG, et al. Management of spontaneous pneumomediastinum in children. J Pediatr Surg. 2015;50(6):983-6.
  • Campillo-Soto A, Coll-Salinas A, Soria-Aledo V, et al. Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases. Arch Bronconeumol. 2005;41(9):528-31.
  • Pekcan S, Gokturk B, Uygun Kucukapan H, et al. Spontaneous pneumomediastinum as a complication in human bocavirus infection. Pediatr Int. 2014;56(5):793-5.
  • Demirel A, Aynacı E, Özgül MA, et al. Primer spontan pnömomediastinum. Solunum. 2008;10: 71–73.
  • Kaneki T, Kubo K, Kawashima A, et al. Spontaneous pneumomediastinum in 33 patients: yield of chest computed tomography for the diagnosis of the mild type. Respiration. 2000;67(4):408-11.
  • Zylak CM, Standen JR, Barnes GR, et al. Pneumomediastinum Revisited. Radio Graphics. 2000;20(4):1043-57.
  • Göktekin MÇ. Evaluation of patients with spontaneous pneumomediastinum diagnosis in the emergency department. Cukurova Med J 2019;44(4):1155-1159.
  • Koullias GJ, Korkolis DP, Wang XJ, et al. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg. 2004;25:852–5.

Göğüs Ağrısının Nadir Bir Nedeni: Spontan Pnömomediastinum

Year 2021, Volume: 4 Issue: 3, 110 - 113, 30.09.2021

Abstract

Amaç: Spontan pnömomediastinum (SPM), kesin bir neden olmaksızın mediastende serbest hava bulunmasıdır. Çoğunlukla genç erkeklerde, nadir görülen, kendi kendini sınırlayan bir hastalıktır. Tanı için genellikle radyografik görüntüleme yeterli olmakla birlikte, şüpheli durumlarda ve etiyolojiyi belirlemek için toraks bilgisayarlı tomografi gerekebilir. Tedavide konservatif yaklaşım yeterlidir.
Bu yazıda göğüs ağrısı nedeniyle acil servise başvuran ve spontan pnömomediastinum tanısı konulan 23 yaşında erkek hasta sunuldu.

Olgu: 23 yaşında erkek hasta göğüs ağrısı şikayeti ile acil servise başvurdu. Genel durumu iyi, bilinci açıktı. Sistemik fizik muayene ve elektrokardiyogram normaldi. Posteroanterior (PA) akciğer grafisinde paratrakeal alanda serbest hava tespit edildi. Pnömomediastinum tanısıyla takip ve tedavi amacıyla göğüs cerrahisi servisine yatırıldı.

Sonuç: Acil servise göğüs ağrısı ile başvuran genç hastaların ayırıcı tanısında spontan pnömomediastinum mutlaka düşünülmelidir. Spontan pnömomediastinum tanısı için klinik şüphe en değerli adımdır. PA akciğer grafisi çoğunlukla tanı için yeterli olsa da etiyolojiyi belirlemek ve takip için toraks bilgisayarlı tomografi gereklidir.

References

  • Caceres M, Ali SZ, Braud R, et al. Spontaneous Pneumomediastinum: A Comparative Study and Review of the Literature. Ann Thorac Surg. 2008;86(3):962-6.
  • Dajer-Fadel WL, Arguero-Sanchez R, Ibarra-Perez C, et al. Systematic review of spontaneous pneumomediastinum: a survey of 22 years’ data. Asian CardiovascThorac Ann. 2014;22(8):997-1002.
  • Ojhave S, Gaskin J. Spontaneous pneumomediastinum. BMJ Case Rep. 2018;2018:bcr2017222965.
  • Ødegaard KJ, Haavardsholm E, Husby A. Spontaneous pneumomediastinum. TidsskrNorLaegeforen. 2018;26:38(11).
  • Khadija C, Nahid Z, Hanane B, et al. Spontaneous pneumomediastinum: about 18 cases. Pan Afr Med J. 2018;31:75.
  • Takada K, Matsumoto S, Hiramatsu T, et al. Spontaneous pneumomediastinum: an algorithm for diagnosis and management. Ther Adv Respir Dis. 2009;3(6):301-307.
  • Song IH, Lee SY, Lee SJ, et al. Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg. 2017;65(5):280-284.
  • Fitzwater JW, Silva NN, Knight CG, et al. Management of spontaneous pneumomediastinum in children. J Pediatr Surg. 2015;50(6):983-6.
  • Campillo-Soto A, Coll-Salinas A, Soria-Aledo V, et al. Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases. Arch Bronconeumol. 2005;41(9):528-31.
  • Pekcan S, Gokturk B, Uygun Kucukapan H, et al. Spontaneous pneumomediastinum as a complication in human bocavirus infection. Pediatr Int. 2014;56(5):793-5.
  • Demirel A, Aynacı E, Özgül MA, et al. Primer spontan pnömomediastinum. Solunum. 2008;10: 71–73.
  • Kaneki T, Kubo K, Kawashima A, et al. Spontaneous pneumomediastinum in 33 patients: yield of chest computed tomography for the diagnosis of the mild type. Respiration. 2000;67(4):408-11.
  • Zylak CM, Standen JR, Barnes GR, et al. Pneumomediastinum Revisited. Radio Graphics. 2000;20(4):1043-57.
  • Göktekin MÇ. Evaluation of patients with spontaneous pneumomediastinum diagnosis in the emergency department. Cukurova Med J 2019;44(4):1155-1159.
  • Koullias GJ, Korkolis DP, Wang XJ, et al. Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg. 2004;25:852–5.
There are 15 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Report
Authors

Özgür Önen 0000-0002-6905-2437

Sercan Aydın 0000-0002-7952-5891

Miraç Koç 0000-0003-1725-1597

Fatma Mutlu Kukul Güven 0000-0003-3755-6021

Publication Date September 30, 2021
Published in Issue Year 2021 Volume: 4 Issue: 3

Cite

AMA Önen Ö, Aydın S, Koç M, Kukul Güven FM. A Rare Cause of Chest Pain: Spontaneous Pneumomediastinum. Anatolian J Emerg Med. September 2021;4(3):110-113.