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Medical causes of pneumomediastinum in children
1Pediatric Emergency Medicine, Children's Hospital Medical Center of Akron, Ohio, USA.
Insights
Pneumomediastinum in children is uncommon, often caused by asthma or infections. Key signs include subcutaneous emphysema and sore throat, with pneumothorax as a potential complication.
Area of Science:
- Pediatric Medicine
- Pulmonology
- Medical Diagnostics
Background:
- Pneumomediastinum, the presence of air in the mediastinum, can occur in children due to various medical conditions.
- Understanding its causes, clinical presentation, and complications is crucial for appropriate management.
Purpose of the Study:
- To investigate the medical causes, clinical findings, and associated complications of pneumomediastinum in pediatric patients.
- To analyze the prevalence of pneumomediastinum in relation to specific conditions like asthma and foreign body ingestions.
Main Methods:
- Retrospective review of medical records (1985-1994) at a children's hospital.
- Inclusion criteria focused on non-traumatic, non-iatrogenic medical causes, excluding neonates and patients with procedures.
- International Classification of Diseases, ninth revision (ICD-9) codes were used to identify cases.
Main Results:
- Twenty-nine pediatric cases of pneumomediastinum were identified, with asthma exacerbations (59%) and infections (28%) being the most common causes.
- Subcutaneous emphysema (76%), sore throat/neck pain (38%), and Hamman's crunch (10%) were the most frequent clinical findings.
- Pneumothorax was the primary complication, observed in 7% of patients, including one tension pneumothorax in a recurrent case.
Conclusions:
- Pneumomediastinum is an infrequent condition in children, predominantly linked to asthma and infections.
- Clinical presentation commonly involves subcutaneous emphysema and neck pain; pneumothorax is the main complication.
- The clinical significance lies in identifying underlying causes and potential severe complications, impacting hospital stay duration.
Abstract:
The purpose of this study was to determine the possible causes, clinical findings, and associated complications of pneumomediastinum in children. Medical records from January 1985 to December 1994 were retrospectively reviewed at Children's Hospital Medical Center of Akron using International Classification of Diseases, ninth revision, codes to identify cases of pneumomediastinum. The medical causes, nontraumatic and noniatrogenic, of pneumomediastinum were studied; intubated or trauma patients and patients having undergone procedures were excluded. Neonates were also excluded. Twenty-nine cases of pneumomediastinum were identified. Two patients (7%) had recurrent pneumomediastinum. Only the first episode of pneumomediastinum was included in the data analysis. Twenty males (69%) and nine females (31%) were affected. The most common medical causes of pneumomediastinum were asthma exacerbations (17/59%) and infections (8/28%). Over the 10-year period, the prevalence of pneumomediastinum in children with asthma exacerbations was 0.2% (21/10,472); 1% (1/126) in children with airway foreign bodies and 0.2% (1/351) in children with esophageal foreign bodies. The most common signs and symptoms were subcutaneous emphysema (22/76%), sore throat or neck pain (11/38%), and Hamman's crunch (3/10%). The most common complication was pneumothorax with small pneumothoraces in 2 patients (7%) and a tension pneumothorax in 1 asthmatic with recurrent pneumomediastinum. Patients without sore throat or neck pain and patients admitted to the intensive care unit had greater hospital lengths of stay. Pneumomediastinum appears to be uncommon in children. The most common medical causes were asthma and infections. The most common signs and symptoms were subcutaneous emphysema, sore throat or neck pain, and Hamman's crunch. The most common complication was pneumothorax. The clinical significance of pneumomediastinum is its cause and association with significant complications.