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Pneumomediastinum
Classification and external resources

A CT scan showing air in the mediastinum
ICD-10 J98.2, P25.2
ICD-9 518.1, 770.2
DiseasesDB 29460
MedlinePlus 000084
eMedicine ped/1832 emerg/469
MeSH D008478

Pneumomediastinum (from Greek pneuma - "air", also known as mediastinal emphysema) is a condition in which air is present in the mediastinum. First described in 1819 by René Laennec,[1][2] the condition can result from physical trauma or other situations that lead to high pressure within the alveoli of the lung, causing them to burst and leak air into the chest cavity.

Contents

Presentation

Pneumomediastinum and right sided pneumothorax post first rib fracture in a mountain biking accident.

Pneumomediastinum is uncommon, it occurs when air leaks from any part of the lung or airways into the mediastinum and is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Subcutaneous emphysema is a symptom.

The diagnosis can be confirmed via chest X-ray showing a radiolucent outline around the heart and mediastinum or via CT scanning of the thorax.

Other Symptoms include laboured breathing, voice distortion (as with helium) If there is lung collapse, it is imperative the victim lies on the side of the collapse, although painful, this allows full inflation of the unaffected lung. 100% oxygen should be administered until help arrives.

Etiology

It is most commonly caused by:

  • Asthma or other conditions leading to alveolar rupture

It has also been associated with:

It can be induced to assist thoracoscopic surgery.[5]

It can be caused by a pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, such as when a SCUBA diver[6][7], a free-diver[8] or an airplane passenger[9] ascends or descends.

References

  1. ^ Laënnec RTH. De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur. 1st ed. Paris: Brosson & Chaudé; 1819.
  2. ^ Roguin A (2006). "Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope". Clinical medicine & research 4 (3): 230–5. doi:10.3121/cmr.4.3.230. PMID 17048358.  
  3. ^ Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A (2007). "Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia". Pediatric Radiology 37: 1286. doi:10.1007/s00247-007-0611-1. PMID 17899058.  
  4. ^ Hatzitolios A, Ntaios G (2007). "Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity". Lung 185: 373. doi:10.1007/s00408-007-9037-7. PMID 17909893.  
  5. ^ Utsumi T, Shiono H, Fukai I, Akashi A (2007). "Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum". Interactive cardiovascular and thoracic surgery 6 (3): 411–2. doi:10.1510/icvts.2006.147355. PMID 17669882.  
  6. ^ Tetzlaff K, Reuter M (1998). "Recurrent pulmonary barotrauma (PBT) in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives". Undersea Hyperb Med 25 (2): 127–8. PMID 9670439. http://archive.rubicon-foundation.org/2412. Retrieved 2008-06-05.  
  7. ^ Dr. Richard Moon, Diver's Alert Network Vice President and Medical Director, http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=40
  8. ^ Jacobson FL, Loring SH, Ferrigno M (2006). "Pneumomediastinum after lung packing". Undersea Hyperb Med 33 (5): 313–6. PMID 17091828. http://archive.rubicon-foundation.org/5045. Retrieved 2008-06-05.  
  9. ^ Nicol E, Davies G, Jayakumar P, Green ND (April 2007). "Pneumopericardium and pneumomediastinum in a passenger on a commercial flight". Aviat Space Environ Med 78 (4): 435–9. PMID 17484349. http://www.ingentaconnect.com/content/asma/asem/2007/00000078/00000004/art00014. Retrieved 2008-06-05.  

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