Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients.
BACKGROUND
Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children. Although it is mainly benign, some cases may be fatal. Due to the rare nature of this clinical entity, proper assessment and management have been poorly studied so far. Here, we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.


METHODS
We retrospectively reviewed children with PM secondary to FBA, who were treated in Beijing Children's Hospital from January 2010 to December 2015. All patients were stratified according to the degree of dyspnea on admission, and interventions were given accordingly. Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients. For patients in acute respiratory distress, emergent air evacuation and/or resuscitations were performed first. Admission data, interventions, and clinical outcomes were recorded.


RESULTS
A total of 39 patients were included in this study. The clinical severity was divided into three grades (Grades I, II, and III) according to the degree of dyspnea. Thirty-one patients were in Grade I dyspnea, and they simply underwent bronchoscopic FBs removals. PM resolved spontaneously and all patients recovered uneventfully. Six patients were in Grade II dyspnea, and emergent drainage preceded rigid bronchoscopy. They all recovered uneventfully under close observation. Two exhausted patients were in Grade III dyspnea. They died from large PM and bilateral pneumothorax, respectively, despite of aggressive interventions in our hospital.


CONCLUSIONS
PM secondary to FBA could be life-threatening in some patients. The degree of dyspnea should be evaluated immediately, and patients in different dyspnea should be treated accordingly. For patients in Grade I dyspnea, simple bronchoscopic FBs removals could promise a good outcome. For patients in Grade II dyspnea, emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Xiao-Jian
XJ
Yang
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Jie
J
Zhang
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, Beijing 100020, China.
Ping
P
Chu
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, Beijing 100020, China.
Yong-Li
YL
Guo
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Jun
J
Tai
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Ya-Mei
YM
Zhang
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Li-Xing
LX
Tang
Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing 100045; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology.Head and Neck Surgery, Beijing Pediatric Research Institute, Capital Medical University, Beijing 100020, China.
Xin
X
Ni
D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis*; D011030:Pneumothorax / Q000175:diagnosis; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000175:diagnosis