title: [Pneumomediastinum - a case report].
abstract: Pneumomediastinum is a rare disorder which often occurs without symptoms. It is sometimes a result of an injury but most often it is spontaneous. Pneumothorax may be iatrogenic; one of the reasons might be tracheotomy. Pneumomediastinum in some cases may be the threat to life and health. In this rare cases surgical intervention is needed, however pneumomediastinum is usually spontaneously absorbed.
  
  
  OBJECTIVE
  The aim of this study was to present the differential diagnosis of pneumomediastinum based on the case of a 60-year-old woman with tracheostomy, diagnosed eight years ago with generalized irreversible narrowing of the trachea and bronchi (suspicion of tracheobronchopathia osteochondroplastica).
  
  
  METHODS
  Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.
  
  
  CONCLUSIONS
  Patient complained of increasing shortness of breath, dry cough and symptoms of upper respiratory tract infections for 2 weeks. In chest CT pneumomediastinum was detected. During bronchoscopy and endoscopic examination of trachea and larynx, no focal lesions of upper respiratory tract and bronchi were detected. By using noninvasive treatment, clinical improvement was achieved. In control chest CT, significant resorption of the air from the mediastinum was detected. Pneumomediastinum occurs often without characteristic symptoms or can be asymptomatic and it is discovered incidentally. If there is no obvious trauma, the cause is usually unknown. In the presented case, after exclusion of the majority of possible causes, we suspected that pneumomediastinum was a complication of tracheotomy but it was not confirmed in endoscopy. It might have been a complication of severe coughing in the course of upper respiratory tract infection or it might have been spontaneous.
authors: Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology.
authors: Katarzyna
authors: K
authors: Szmygin-Milanowska
authors: Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology.
authors: Anna
authors: A
authors: Grzywa-Celińska
authors: Medical University of Lublin, Poland: Students Scientific Association at Department of Pneumonology, Oncology and Allergology.
authors: Adam
authors: A
authors: Krusiński
authors: Medical University of Lublin, Poland: Students Scientific Association at Department of Pneumonology, Oncology and Allergology.
authors: Magdalena
authors: M
authors: Cielma
authors: Medical University of Lublin, Poland: Chair and Department of Otolaryngology and Laryngological Oncolog.
authors: Agnieszka
authors: A
authors: Wawrzecka
authors: Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology; Chair of Internal Medicine and Department of Internal Medicine in Nursing.
authors: Justyna
authors: J
authors: Emeryk-Maksymiuk
authors: Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology.
authors: Janusz
authors: J
authors: Milanowski
mesh_terms: D001999:Bronchoscopy; D003937:Diagnosis, Differential; D004724:Endoscopy; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: pneumomediastinum; tracheostomy; tracheotomy