title: Spontaneous pneumomediastinum: Experience in 13 adult patients.
abstract: BACKGROUND
  Spontaneous pneumomediastinum is an uncommon disorder. There is a lack of information on spontaneous pneumomediastinum in India. We aimed to understand the clinical profile, hospital course, and long-term outcome of such patients.
  
  
  METHODS
  We retrospectively reviewed all patients (aged ≥15 years) diagnosed with spontaneous pneumomediastinum in the respiratory ward of a tertiary care hospital over a 7-year period from 2005.
  
  
  RESULTS
  Of the 3326 patients hospitalized during the study period, 13 (10 male) were diagnosed with spontaneous pneumomediastinum, constituting 0.39% of all hospitalizations. The median age was 37 years (interquartile range 20-55 years). The most common presenting symptom was dyspnea in 85% followed by neck swelling (69%), chest pain (69%) and cough (54%). Subcutaneous emphysema and preexisting lung diseases were identified in 11 (85%) patients each. Post-tubercular pulmonary sequelae (5 patients) and asthma (4 patients) were the most common underlying lung diseases. Pneumothorax was identified in 6 (46%) patients; 4 required tube thoracostomy. Chest radiography was diagnostic in 92% of patients. The median length of hospital stay was 9 days (interquartile range 6-12 days). No recurrence was reported in 11 patients followed up for a median of 1550 days (interquartile range 691-1909 days).
  
  
  CONCLUSIONS
  Spontaneous pneumomediastinum is a benign disorder, but underlying lung diseases and concomitant pneumothorax are likely to complicate the disease course. Exacerbation of post-tubercular obstructive airway disease is a common risk factor for spontaneous pneumomediastinum in a tuberculosis endemic country.
authors.affiliation: Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India panigrahimanoj75@gmail.com.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Panigrahi
authors.affiliation: Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Cherlopalli
authors.initials: C
authors.lastname: Suresh Kumar
authors.affiliation: Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Venugopal
authors.initials: V
authors.lastname: Jaganathan
authors.affiliation: Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Saka
authors.initials: S
authors.lastname: Vinod Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015505:Chest Tubes; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013907:Thoracostomy / Q000295:instrumentation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diagnosis; Mediastinal emphysema; Radiography; Risk factors; Tuberculosis; X-ray; computed tomography; differential; pulmonary; thoracic