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Pediatric pneumomediastinum: Symptom-based management
Danielle Dougherty1, Kayla M Meyer2, Allison R Thompson3
1University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, 1540 E. Hospital Dr. Ann Arbor, MI 48109-4211, United States.
Insights
Pediatric spontaneous pneumomediastinum has a benign course. Reducing imaging like chest X-rays (CXRs) and esophagrams can decrease radiation exposure without affecting management.
Area of Science:
- Pediatric Pulmonology
- Pediatric Radiology
Background:
- Spontaneous pneumomediastinum in children typically follows a benign clinical course.
- Current diagnostic workup and management lack standardization, leading to varied imaging practices.
- This variability can result in unnecessary radiation exposure for pediatric patients.
Purpose of the Study:
- To evaluate the presentation, diagnostic workup, and management strategies for pediatric spontaneous pneumomediastinum.
- To identify factors influencing hospital stay duration and admission decisions.
- To assess the utility of common imaging modalities in the management of this condition.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with spontaneous pneumomediastinum over a 5-year period.
- Analysis of initial imaging studies, including chest X-ray (CXR) and chest computed tomography (CT) scans.
- Review of subsequent imaging, such as esophagrams, and correlation with presenting symptoms and diagnoses.
Main Results:
- Initial imaging varied, with chest X-ray (CXR) alone in 50%, chest CT alone in 18%, and both in 23% of patients.
- Esophagrams were performed in 31% of patients and were consistently negative for esophageal leaks.
- Presenting symptoms like shortness of breath and emesis were associated with longer hospital stays (>24 hours), while pain was associated with shorter stays (<24 hours).
- Respiratory infections and gastrointestinal issues were linked to inpatient admission.
Conclusions:
- Pediatric spontaneous pneumomediastinum management should be guided by presenting symptoms.
- Routine esophagrams are not indicated as they do not alter management and can be avoided.
- Reducing the frequency of chest X-rays (CXRs) can decrease radiation exposure in this pediatric population without compromising care.
Background:
Pediatric spontaneous pneumomediastinum is known to have a benign course. Despite this, there is no consensus or standardization for the workup and management. There are often a variety of imaging studies performed for patients with similar presentations.
Methods:
This is a retrospective chart review evaluating the presentation, workup, and management of all pediatric patients with a primary diagnosis of spontaneous pneumomediastinum over a 5-year period at a children's hospital.
Results:
Of the 62 patients, the initial workup consisted of either a chest x-ray (CXR) only (n = 31, 50%), a chest computed tomography scan only (n = 11, 18%) or both (n = 14, 23%); additionally, some patients came with 'other' imaging only (n = 3, 5%) or no imaging (n = 3, 5%). Twenty-seven patients (44%) underwent an additional CXR and 19 (31%) underwent an esophagram. All esophagrams were negative for an esophageal leak. A presenting symptom of pain was associated with a hospital stay of less than 24 h (p = 0.008) while shortness of breath (p = 0.0005) and emesis (p = 0.0006) were associated with a hospital stay of greater than 24 h. Associated diagnoses of respiratory infections (p = 0.02) and gastrointestinal issues (p = 0.006), such as hyperemesis, were associated with inpatient admission.
Conclusion:
Pediatric patients with spontaneous pneumomediastinum benefit from evaluation, management, and treatment based on their presenting symptoms. There is an opportunity to decrease unnecessary radiation exposure in this patient population with fewer CXRs and avoidance of esophagrams, neither of which alter management.
Level Of Evidence:
Level III.
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