title: Spontaneous pneumomediastinum: are we overinvestigating?
abstract: BACKGROUND
  Spontaneous pneumomediastinum (SPM) is uncommon in pediatrics. Because of the growing concern about the risks of radiation in children, the authors analyzed whether an extensive radiologic workup influences management and outcome.
  
  
  METHODS
  In a retrospective study from 1991 to 2003, 53 patients were diagnosed with SPM. Charts were reviewed for demographics, predisposing factors, presentation, investigation, and evolution. Pneumomediastinum occurring in the neonatal period or related to either pneumothorax, barotrauma, or trauma were excluded.
  
  
  RESULTS
  Of 53 cases, 26 (49%) were bronchospasm related, 11 (21%) had respiratory tract infections, and 8 (15%) were idiopathic. Four (7.5%) were caused by inhaled foreign bodies while other causes accounted for the remaining 7.5%. No esophageal perforations were identified. Presentations included dyspnea (64%), subcutaneous emphysema (60%), cough (45%), cervical or chest pain (42%), and Hamman's sign (19%). Postero-anterior chest x-rays (CXR) were diagnostic in all cases except one. Mean number of CXR per hospitalization was 3. Only 3 patients subsequently had pneumothorax, and none required pleural drainage. Of the 8 patients with idiopathic SPM, 5 underwent a barium swallow, and 2 had a chest CT scan; results of all were normal.
  
  
  CONCLUSIONS
  More than 70% of SPMs were related to bronchospasm or respiratory tract infections. Idiopathic SPMs deserve more attention because of the concern about esophageal perforation, although most investigations will be negative. SPM usually is a self-limited condition, and prognosis is related to the underlying disorder. Consequently, with clinical improvement, aggressive investigation and follow-up x-ray rarely is warranted.
authors.affiliation: Division of General Surgery, Ste-Justine Hospital, Montreal, Quebec, Canada.
authors.forename: Joyaube
authors.initials: J
authors.lastname: Chapdelaine
authors.forename: Mona
authors.initials: M
authors.lastname: Beaunoyer
authors.forename: Patrick
authors.initials: P
authors.lastname: Daigneault
authors.forename: Denis
authors.initials: D
authors.lastname: Bérubé
authors.forename: Andreana
authors.initials: A
authors.lastname: Bütter
authors.forename: Alain
authors.initials: A
authors.lastname: Ouimet
authors.forename: Dickens
authors.initials: D
authors.lastname: St-Vil
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors