title: Pediatric Spontaneous Pneumomediastinum: Narrative Literature Review.
abstract: BACKGROUND
  Described since 1939 in the adult population, spontaneous pneumomediastinum is less known in children. Because of its symptoms and a generally benign evolution, it is probably an underestimated diagnosis. However, it has to be considered in the differential diagnosis of acute thoracic pain.
  
  
  METHODS
  The incidence being low, we conducted a narrative literature review to identify the circumstances leading to a spontaneous pneumomediastinum, the most relevant signs and symptoms, investigations, as well as treatment recommendations.
  
  
  RESULTS
  Of 216 patients, 66.2% are boys, and mean ages range from 6.9 to 14 years. The most frequent comorbidity in children is asthma (22.2%), and the most common trigger factors are bronchospasm (49%), cough (45.6%), various respiratory tract infections, vomiting (10.3%), and foreign body aspiration (8.3%). It remains idiopathic in 33.3%. Relevant signs are chest pain (54.6%), neck pain and/or sore throat (53.3%), and dyspnea (41.2%). The most relevant sign is palpation of subcutaneous emphysema (66.4%). The classically described Hamman crunch is only present in 11.6%. Chest x-ray provides the right diagnosis in 99.5% of the patients. Pneumothorax is associated in 11.6%. Most patients are hospitalized (88.3%); treatment is based on oxygen therapy, painkillers, and rest. In some series, there can be up to 25.8% of patients requiring intensive care and 5.5% requiring drainage of associated pneumothorax. Survival rate is 92.5%, and long-term follow-up shows normal x-rays after 4 days and no recurrence.
  
  
  CONCLUSIONS
  Spontaneous pneumomediastinum is uncommon in children but must be considered in pediatric patients with acute chest and/or neck pain. History taking, physical examination, and standard chest x-ray are most often diagnostic, and there is rarely a need for other investigation.Hospitalization is not always indispensable; ambulatory management can be considered. Outcome is good, and follow-up can be clinical, therefore avoiding further x-rays.
authors: From the *Division of Pediatric Emergency Medicine, Department of Paediatrics, Children's Hospital; and †Division of Pediatric Intensive Care, Department of Paediatrics, CHUV, Lausanne; and ‡Division of Pediatric Emergency Medicine, Hôpital Cantonal, Fribourg, Switzerland.
authors: Celine Rey-Bellet
authors: CR
authors: Gasser
authors: Rachel
authors: R
authors: Pellaton
authors: Cosette Pharisa
authors: CP
authors: Rochat
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010612:Pharyngitis / Q000175:diagnosis / Q000209:etiology; D011030:Pneumothorax / Q000150:complications / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic / Q000379:methods*; D013352:Subcutaneous Emphysema / Q000150:complications / Q000175:diagnosis*; D016896:Treatment Outcome