Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease. Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited. A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper
Adult ; Blood Gas Analysis ; Case Report ; Follow-Up Studies ; Human ; Male ; Mediastinal Emphysema/*complications/*radiography ; Pneumopericardium/*complications/*radiography ; Radiography, Thoracic ; Remission, Spontaneous ; Tomography, X-Ray Computed

A 30-year-old primipara at 41 weeks gestation was admitted with regular labor pain and delivered a healthy male infant without complications except for a 4th degree tear of perineum. Two hours after delivery, she complained of sore throat and developed mild swelling of left side face, neck and upper chest. A chest radiography showed mild subcutaneous emphysema of neck. There was no pneumomediastinum and pneumothorax. She was managed conservatively and discharged without any complication at the 6th postpartum day. We report a rare case of subcutaneous emphysema with a brief review of literatures that presented shortly after vaginal delivery without complications except for a 4th degree perineal tear and resolved without special treatment.
Adult ; Female ; Humans ; Infant ; Labor Pain ; Male ; Mediastinal Emphysema ; Neck ; Obstetric Labor Complications ; Perineum ; Pharyngitis ; Pneumothorax ; Postpartum Period ; Pregnancy ; Radiography ; Subcutaneous Emphysema* ; Thorax ; Vacuum*

Pneumomediastinum and subcutaneous emphysema generally occurs following trauma to the esophagus or lung. It also occurs spontaneously in such situations of elevating intra- thoracic pressure as asthma, excessive coughing or forceful straining. We report here on the rare case of a man who experienced the signs of pneumomediastinum and subcutaneous emphysema after a prolonged bout of intractable hiccup as the initial presenting symptoms of multiple sclerosis.
Adult ; Brain/pathology ; Hiccup/*complications/etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinal Emphysema/*etiology/radiography ; Multiple Sclerosis/*complications/diagnosis ; Subcutaneous Emphysema/etiology ; Thoracic Vertebrae/pathology ; Tomography, X-Ray Computed

OBJECTIVETo analyze the diagnosis, treatment and prognosis of spontaneous pneumomediastinum (SPM) in children.

METHODA retrospective analysis of the clinical data of 18 children diagnosed with SPM in Yuying Children's Hospital Affiliated to Wenzhou Medical University from December 2007 to February 2013 was performed. Information of the sequelae and recurrence of SPM was obtained by telephone follow-up. SPM was diagnosed according to Versteegh's standard. SPM cases due to mechanical ventilation, trauma, inhaled foreign body or as a result of the underlying disease were not included. Also cases of secondary pneumothorax pneumomediastinum and neonatal mediastinal emphysema were excluded.

RESULTFifteen of 18 cases were boys and 3 were girls, the range of age was from 9 to 17 years. Predisposing factors included sport activities, severe cough or without a known cause. Clinical manifestations included chest pain, chest tightness, dyspnea, neck pain, back pain, foreign body sensation or pain on swallowing, throat pain of swelling. Chest CT of 18 cases showed pneumomediastinum, 8 cases displayed varied degrees of air in neck, chest; 18 cases of SPM responded well to bed rest, oxygen, antitussive and anti-infection treatment. Fifteen cases received chest CT or X-ray inspection after therapy, showing that the pneumomediastinum disappeared or significantly absorbed, 3 cases improved in clinical symptom. Among 18 patients, telephone follow-up of 14 were successful and 4 cases were lost. An average follow-up time was (24 ± 17) months. None of the cases had any serious consequences, and recurrence happened in one case.

CONCLUSIONChildren's spontaneous pneumomediastinum is a benign disease. When a child has chest pain or chest tightness, SPM should be considered after excluding the common diseases. SPM can be diagnosed in association with clinical feature and chest CT examination. Patients respond well to conservative therapy and most of them had no severe sequelae.

Adolescent ; Chest Pain ; diagnosis ; etiology ; Child ; Dyspnea ; diagnosis ; etiology ; Female ; Follow-Up Studies ; Humans ; Male ; Mediastinal Emphysema ; complications ; diagnosis ; therapy ; Oxygen Inhalation Therapy ; Prognosis ; Radiography, Thoracic ; Recurrence ; Subcutaneous Emphysema ; diagnosis ; etiology ; Tomography, X-Ray Computed