B. A. Potz1, L. Chao1, T. T. Ng1, I. C. Okereke1 1Brown University,Surgery/Cardiothoracic Surgery/ Warren Alpert Medical School,Providence, RHODE ISLAND, USA
Introduction: Spontaneous pneumomediastinum (SPM) is classified as the presence of free air in the mediastinum in the absence of any precipitating cause. SPM is relatively uncommon, and the clinical significance and risk associated with SPM is not well understood and has not been widely documented in the literature. Our goals were to determine the outcomes of patients who presented with SPM and to determine predictors of severe pathology associated with SPM.
Methods: From 2004 through 2013, a retrospective review was conducted of all patients who were discovered to have SPM during presentation to our institution. Patient demographics, co-morbidities, laboratory values and presence of esophageal perforation were recorded.
Results: Over the 10 year span of the study 249 patients who presented to our institution were discovered to have spontaneous pneumomediastinum on chest x-ray or computerized tomography (CT) scan. Mean age was 38.7 years (1—93). Sixty-one percent (151/249) of patients were male. Subcutaneous emphysema was appreciated in 16 percent (39/249) of patients. Ten percent (24/249) of all patients were ultimately discovered to have esophageal perforation, determined by upper endoscopy, upper gastrointestinal series or intraoperatively during emergent surgery. Age (p <0.01), presence of pleural effusion (p < 0.01) and elevated white blood count (p < 0.01) were the only significant risk factors for presence of esophageal perforation (Table 1). Other variables, such as subcutaneous emphysema, elevated creatinine level and oxygen saturation were not associated with esophageal perforation.
Conclusions: SPM is usually associated with a benign clinical course. Risk factors for presence of esophageal perforation in these patients include age, elevated white blood count and presence of a pleural effusion. In the absence of abnormal laboratory values or associated radiologic findings, the majority of patients with SPM can be safely observed without the need for further diagnostic testing.
