title: Management of spontaneous pneumomediastinum based on clinical experience of 25 cases.
abstract: OBJECTIVE
  Spontaneous pneumomediastinum (SPM) is a rare disorder that usually occurs in young individuals and has a self-limiting course and no recurrence in most cases. But actually in many cases, patients are undergo some examinations or some limitations. The purpose of this study was to evaluate the clinical characteristics and recommend appropriate management of SPM.
  
  
  METHODS
  Retrospective research of clinical records of a single institution.
  
  
  RESULTS
  Over 11 years, we diagnosed 25 patients (18 males) with SPM. Their average age was 20.1 years (range 13-28 years). Chest pain or neck symptoms were most frequent, and 17 patients (68%) had subcutaneous emphysema. In all cases, blood counts and C-reactive protein (CRP) were measured, and their mean values were 10,100+/-4600/mm(3) and 1.0+/-1.5 mg/dL, respectively. In 20 patients (80%), either leucocytosis or elevated CRP was observed. Twenty-four patients (96%) were admitted (average 7.8+/-4.1 days) and 20 of them were prescribed antibiotics or limited oral intake. The symptoms were self-limiting in all cases and disappeared on average 1.8+/-0.9 days after diagnosis. No recurrence was noted in the approximately 2 years follow-up period.
  
  
  CONCLUSIONS
  SPM is a self-limiting disease with mild inflammatory signs. For patients suspicious of SPM, shortened hospitalization for about 2 days with observation alone may be feasible, if their symptoms improve gradually. Otherwise, less invasive procedures, such as esophagram, should be performed immediately. Long-term follow-up is usually unnecessary. We propose a new algorithm for management of SPM based on clinical experience.
authors.affiliation: Division of Respiratory and Allergy Medicine, Komaki Municipal Hospital, 1-20 Johbuji, Komaki 485-8520, Japan. k-takada@komakihp.gr.jp
authors.forename: Kazuto
authors.initials: K
authors.lastname: Takada
authors.forename: Shuuichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Eiji
authors.initials: E
authors.lastname: Kojima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Masato
authors.initials: M
authors.lastname: Sizu
authors.forename: Shoutarou
authors.initials: S
authors.lastname: Okachi
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Ninomiya
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002985:Clinical Protocols; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult