title: Spontaneous Pneumomediastinum as a Potential Predictor of Mortality in Patients with Idiopathic Pulmonary Fibrosis.
abstract: BACKGROUND
  Spontaneous pneumomediastinum (PM) is a rare event in patients with idiopathic pulmonary fibrosis (IPF) with unknown prognostic implications.
  
  
  OBJECTIVE
  To analyze the incidence and prognostic impact of PM in a cohort of patients with IPF.
  
  
  METHODS
  PM diagnosed by computed tomography was identified retrospectively in the clinical and radiological records of 182 patients with IPF who were admitted to our center between August 2006 and July 2013. PM patients were compared to matched IPF patients not affected by PM and analyzed for survival.
  
  
  RESULTS
  PM occurred in 9/182 IPF patients [5%; 6 males; median age: 63 years; median percent predicted of vital capacity (VC%) at baseline: 53%]. The median time between IPF diagnosis and PM occurrence was 3 months (interquartile range: 0-33). The control group included 36 IPF patients (28 males; median age: 69 years; VC% at baseline: 57%). In a multivariate Cox regression analysis, PM was a significant predictor of mortality [hazard ratio (HR): 3.0; p = 0.032]. Considering only patients experiencing PM at the time of IPF diagnosis (n = 4), PM was a strongly significant predictor of mortality in multivariate analysis (HR: 6.4; p = 0.007).
  
  
  CONCLUSIONS
  Spontaneous PM is a rare but serious complication in patients with IPF and may be considered as a potential predictor of mortality.
authors.affiliation: Radiology Unit, Department of Radiological Functions, x2018;Guglielmo da Saliceto' Hospital, Piacenza, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Colombi
authors.forename: Svenja
authors.initials: S
authors.lastname: Ehlers-Tenenbaum
authors.forename: Karin
authors.initials: K
authors.lastname: Palmowski
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.forename: Nicola
authors.initials: N
authors.lastname: Sverzellati
authors.forename: Mario
authors.initials: M
authors.lastname: Silva
authors.forename: Monika
authors.initials: M
authors.lastname: Eichinger
authors.forename: Michael
authors.initials: M
authors.lastname: Kreuter
mesh_terms: D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies