WWWTP #14 Answer…

December 10, 2013

WWWTP


Adolescent male with asthma…presents with throat pain, difficulty swallowing, and dyspnea.  WWWTP?

Pneumomediastinum

This patient has subcutaneous emphysema in the upper neck and air in the upper mediastinum (see arrows above).  The patient had a CT chest further delineating the mediastinal air:

Pneumomediastinum 2 Pneumomediastinum 3

Spontaneous pneumomediastinum (SPM) is a rare consequence of asthma.  It is most often seen in thin, adolescent males (1).  The proposed pathogenesis is air leaking due to small alveolar rupture with air escaping into the bronchovascular sheath.  The exact prevalence is difficult to establish but has been proposed in 0.3% of asthmatic patients presenting to the ED.

SPM, when not complicated by pneumothorax, is usually a self-limited condition that corrects when the underlying pathology (usually asthma) is treated.  It rarely can result in massive pneumomediastinum requiring surgical intervention to release the air.

SPM should not be confused with traumatic pneumomediastinum, this is a different pathology and many times causes much more morbidity.

Author:  Russell Jones, MD

References

1.  Saadoon AA, Janahi IA.  Spontaneous pneumomediastinum in adolescents and children.  http://www.uptodate.com.  Last updated 11/2013.  Accessed 11/2013.

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EMREMS: Radiology in Emergency Medicine

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