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Pneumomediastinum on a surgical service
D E Sands1, A M Ledgerwood, C E Lucas
1Department of Surgery, Wayne State University, Detroit, Michigan 48201.
The American Surgeon
|July 1, 1988
Summary
Mediastinal emphysema, or pneumomediastinum, has diverse causes including trauma and medical procedures. Treatment focuses on underlying issues, with expectant management for the emphysema itself.
Area of Science:
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Pneumomediastinum, or air in the mediastinum, is a condition with varied underlying causes.
- Surgical services manage patients with mediastinal emphysema, necessitating a review of its etiologies and outcomes.
Observation:
- A 6-year review of 25 patients with pneumomediastinum revealed common causes: Valsalva maneuvers (10 patients), trauma (7), central venous access attempts (4), and cardiopulmonary resuscitation (4).
- Air from pneumomediastinum can extend to the peritoneal cavity, pericardium, and subcutaneous tissues.
- Associated conditions like hydrothorax may indicate severe underlying pathology, such as esophageal perforation.
Findings:
- Expectant management is the standard treatment for pneumomediastinum; patient outcomes depend on addressing the primary cause.
- Mortality was observed in patients following cardiopulmonary resuscitation and severe chest trauma.
- In uncomplicated cases without pleural effusion, chest X-rays are sufficient for monitoring, with resolution typically within 72 hours.
Implications:
- Understanding the diverse etiologies of pneumomediastinum is crucial for effective clinical management.
- Prompt identification and treatment of associated conditions are paramount for improving patient prognosis.
- Non-invasive monitoring with serial chest X-rays is adequate for uncomplicated pneumomediastinum, simplifying diagnostic pathways.
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