title: Spontaneous Pneumomediastinum: A Rare Disease Associated with Chest Pain in Adolescents.
abstract: OBJECTIVE
  Spontaneous pneumomediastinum (SPM) is a rare entity, with only a few cases reported, especially in adolescents. We aimed to analyze the clinical characteristics of SPM in adolescents and the diagnostic implications of computed tomography (CT) and esophagography therein.
  
  
  METHODS
  This retrospective descriptive study was conducted as a review of medical records of 416 adolescents (10-18 years of age) with chest pain from March 2005 to June 2013. Information on clinical presentation, methods of diagnosis, hospital stay, and outcomes were collected and analyzed.
  
  
  RESULTS
  Among adolescents complaining of chest pain, 11 patients had SPM (11/416, 2.64%). All patients presented with pleuritic chest pain, and 54.5% reported neck pain as the most common associated complaint. Clinical findings were nonspecific, and initial chest X-ray assessment was diagnostic only in three of 11 patients. However, reassessment of chest X-ray revealed diagnostic findings of SPM in five of the remaining eight patients. CT was diagnostic in all patients, while esophagography and echocardiogram were uninformative. Symptomatic improvement was noted within 2.45±1.2 hours (range, 0.5 to 4) after supportive care; mean hospital stay was 4.54±0.99 days (range, 2 to 6). No recurrence was observed.
  
  
  CONCLUSIONS
  SPM is a rare disease that should be considered in adolescent patients with pleuritic chest pain. Careful reading of initial chest X-rays is important to avoiding further unnecessary investigations. SPM is self-limited and treatment is supportive; nevertheless, if there are no indications of esophageal rupture, urgent esophagography is not recommended.
authors.affiliation: Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. herzhuh@skku.edu.
authors.forename: June
authors.initials: J
authors.lastname: Huh
authors.affiliation: Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: I-Seok
authors.initials: IS
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008499:Medical Records; D010102:Oxygen Inhalation Therapy; D035583:Rare Diseases; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Spontaneous pneumomediastinum; adolescent; chest pain