title: [An unusual pneumomediastinum case in a child caused by spontaneous bronchial rupture].
abstract: We report a case of spontaneous pneumomediastinum (SPM) in a 3 year-old child, admitted to the emergency department because he presented dyspnea for a few hours, after a paroxysm of cough. The SPM is rare in children; the term "spontaneous" is reserved for cases of pneumomediastinum that haven't a traumatic cause. SPM is seen most commonly in asthmatics and in any patient who induces a Valsalva maneuver. The clinical diagnosis is confirmed by chest radiograph. When the diagnosis is uncertain, the chest CT scan is considered the gold standard of imaging tests, capable of detecting pneumomediastinum even in patients with small amounts of mediastinal air. In this case CT images showed the cause: spontaneous bronchial rupture. The direct sign of bronchial injury is the contiguity of the luminal air with that in the mediastinum. In the literature SPM cases are very rare, at least in health patients without tracheobronchial anomalies. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously, such as in our patient. In this article we want to explain the main clinical, diagnostic and therapeutic aspects of SPM, because, even if it's rare in children, it must be considered in the differential diagnosis of dyspnea; then we want to demonstrate as, in this case, a TC scan was important to identifying the SPM cause: a bronchial rupture.
authors.affiliation: Unità Operativa di Pediatria e Neonatologia, Presidio Ospedaliero di Manerbio, Manerbio, Brescia.
authors.forename: G
authors.initials: G
authors.lastname: Cremaschini
authors.forename: G
authors.initials: G
authors.lastname: Sassi
authors.forename: S
authors.initials: S
authors.lastname: Tedoldi
authors.forename: A
authors.initials: A
authors.lastname: Corna
authors.forename: T
authors.initials: T
authors.lastname: Vaccaro
authors.forename: E
authors.initials: E
authors.lastname: Cipolletta
authors.forename: L
authors.initials: L
authors.lastname: Santella
authors.forename: G
authors.initials: G
authors.lastname: Tramaloni
authors.forename: E
authors.initials: E
authors.lastname: Cappellaro
authors.forename: P
authors.initials: P
authors.lastname: Caccia
authors.forename: M
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001980:Bronchi / Q000293:injuries*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008478:Mediastinal Emphysema / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D010102:Oxygen Inhalation Therapy; D013902:Radiography, Thoracic; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids