title: Spontaneous pneumomediastinum: an extensive workup is not required.
abstract: BACKGROUND
  Spontaneous pneumomediastinum is a rare entity usually caused by alveolar rupture and air tracking along the tracheobronchial tree. Despite its benign nature, an extensive workup is often undertaken to exclude hollow viscus perforation. We sought to review our experience with this condition and examine the optimal management strategy.
  
  
  METHODS
  We conducted a retrospective review of all radiographic pneumomediastinum cases at a tertiary hospital between 2006 and 2011. The main outcomes measures included length of hospital stay, mortality, and need for investigative procedures.
  
  
  RESULTS
  Forty-nine patients with spontaneous pneumomediastinum were identified, including 26 male patients (53%). Mean age was 19 ± 9 years. Chest pain was the most common presenting symptom (65%), followed by dyspnea (51%). Forceful coughing (29%) or vomiting (16%) were the most common eliciting factors, and no precipitating event was identified in 41% of patients. Computed tomography was performed in 38 patients (78%) and showed a pneumomediastinum that was not seen on chest x-ray in 9 patients. Esophagography was performed in 17 patients (35%) and was invariably negative for a leak. Thirty-eight patients (78%) were hospitalized for a mean of 1.8 ± 2.6 days. No mortality was recorded. Compared with patients who presented with pneumomediastinum secondary to esophageal perforation, spontaneous pneumomediastinum patients were younger, had a lower white cell count, and were less likely to have a pleural effusion.
  
  
  CONCLUSIONS
  Spontaneous pneumomediastinum is a benign entity and rarely correlates with true esophageal perforation. Additional investigation with esophagography or other invasive procedures should be performed selectively with the aim of expediting the patient's care. The prognosis is excellent with conservative management and the risk for recurrence is low.
authors: Department of Surgery, Section of Thoracic Surgery, Albany Medical Center, Albany, NY. Electronic address: bakhosc@mail.amc.edu.
authors: Charles T
authors: CT
authors: Bakhos
authors: Albany Medical College, Albany, NY.
authors: Stevan S
authors: SS
authors: Pupovac
authors: Albany Medical College, Albany, NY.
authors: Ashar
authors: A
authors: Ata
authors: Department of Radiology, Albany Medical Center, Albany, NY.
authors: John P
authors: JP
authors: Fantauzzi
authors: Department of Surgery, Section of Thoracic Surgery, Albany Medical Center, Albany, NY.
authors: Thomas
authors: T
authors: Fabian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D019468:Disease Management; D004939:Esophageal Perforation / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011650:Pulmonary Alveoli; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D055815:Young Adult