Pneumomediastinum

Pneumomediastinum occurs when air leaks into the mediastinum. The mediastinum is the area between the lungs, just behind the breastbone. This space contains the heart, aorta, venae cavae, esophagus, and thymus.

CAUSES

Pneumomediastinum can occur on its own (spontaneous), or it can occur following an injury (traumatic). Pneumomediastinum is usually caused by a condition or injury that forces air to leak out of the lungs and into the mediastinum. Common conditions and injuries that lead to pneumomediastinum include:

  • Childbirth.

  • Chest or abdominal injuries, such as blunt or penetrating trauma.

  • Asthma. This may predispose you to developing spontaneous pneumomediastinum.

  • Problems during scuba diving.

  • Problems during the use of a breathing machine (ventilator).

  • Inhaling illegal drugs or chemicals.

  • Infections in the face, neck, chest, or abdomen.

  • Extreme strain during coughing or vomiting.

  • A hole in the intestine or esophagus.

  • Ingesting a corrosive solvent.

  • Accidental perforation of the lung or intestine during surgery or a medical procedure.

  • Accidentally breathing an object into the airway.

SYMPTOMS

In some cases, there may be no symptoms. A lack of symptoms is more likely with spontaneous pneumomediastinum. When symptoms are present, they may include:

  • Chest pain, which may run into the neck, shoulder, back, or arms.

  • Increased pain when moving, swallowing, or taking a deep breath.

  • Problems swallowing.

  • Problems speaking.

  • Vocal changes.

  • Shortness of breath.

  • Fever.

  • Throat or jaw pain.

DIAGNOSIS

Your caregiver may suspect pneumomediastinum based on your symptoms and a physical exam. If needed, imaging tests such as a chest X-ray exam or computed tomography (CT) may be done.

TREATMENT

Spontaneous pneumomediastinum often gets better without any treatment. Your body will slowly reabsorb the air. In more severe cases, treatment is aimed at addressing the underlying cause. This may include antibiotic medicines to treat an infection. In very severe cases, the air may build up and start to put pressure on the heart or lungs. In this case, you will need to stay in the hospital. One of the following procedures may be needed:

  • Needle aspiration. A needle is inserted into the mediastinum to withdraw the trapped air.

  • Chest tube placement. This may be done if you have a collapsed lung.

  • Surgery to repair a hole in the intestine or esophagus.

HOME CARE INSTRUCTIONS

  • Until your caregiver says it is okay, you should avoid:

  • Air travel.

  • Scuba diving.

  • High altitudes.

  • Hard physical work.

  • Exercise.

  • Do not smoke.

  • Do not use illegal drugs.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have worsening pain in the chest, neck, jaw, or arms.

  • You have trouble breathing.

  • You have new problems with speaking or swallowing.

  • You have a fever.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.