Mediastinal emphysema complicating diabetic ketoacidosis: plea for conservative diagnostic approach.
BACKGROUND
Spontaneous pneumomediastinum has been infrequently reported as a complication of diabetic ketoacidosis. Evidence-based guidelines are currently not available to help in choosing the best diagnostic approach.


METHODS
We conducted a systematic review of the literature and looked for diagnostic clues that might indicate the need for a work-up to rule out oesophageal perforation.


RESULTS
In all 56 published cases of spontaneous pneumomediastinum associated with diabetic ketoacidosis, the condition was self-limiting. We report one additional case of a 31-year-old female who presented with a spontaneous pneumomediastinum and also epidural pneumatosis, complicating diabetic ketoacidosis.


CONCLUSIONS
Important pathology, such as oesophageal rupture, was not detected in any of the reported cases, and we suggest a restrictive diagnostic work-up.
Department of Internal Medicine, Division of Pulmonary Medicine & Tuberculosis, University Medical Centre Groningen, University of Groningen, the Netherlands.
R G
RG
Pauw
T S
TS
van der Werf
H M
HM
van Dullemen
R P F
RP
Dullaart
D000328:Adult; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*