Primary pneumomediastinum in pediatric patients: are hospitalizations and control x-rays necessary?
A C Moore Olalla1, Y P Álvarez Marchán1, J Jiménez Gómez2
1Hospital Universitari Parc Taulí. Sabadell, Barcelona (Spain).
Insights
Primary pneumomediastinum (PP) in children is typically benign and manageable with conservative treatment. Hospitalization and extra imaging are often unnecessary unless other health issues are present.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Pediatric Emergency Medicine
Background:
- Primary pneumomediastinum (PP) is a rare pediatric condition lacking standardized management protocols.
- Understanding the clinical course and optimal treatment strategies for pediatric PP is crucial.
Purpose of the Study:
- To report institutional experience with pediatric primary pneumomediastinum.
- To analyze the necessity and impact of hospitalizations and radiological investigations in pediatric PP cases.
Main Methods:
- Retrospective study of pediatric patients diagnosed with PP between 2013 and 2023.
- Collection and analysis of demographic, clinical presentation, hospitalization details, and radiological data.
Main Results:
- 24 pediatric patients (median age 9.5 years) were analyzed; common symptoms included dyspnea, chest pain, and odynophagia.
- 79% of patients required hospitalization, with longer stays and more frequent aerosol use in those with concomitant pathologies.
- Conservative management was universally successful, with no complications or 30-day rehospitalizations; additional imaging provided no change in patient management.
Conclusions:
- Primary pneumomediastinum in children is a benign condition amenable to conservative treatment.
- Hospitalization may be avoidable for pediatric PP patients without concurrent medical conditions.
- Routine use of additional ionizing imaging tests offers limited clinical benefit and increases radiation exposure.
Objective:
Primary pneumomediastinum (PP) is an infrequent condition in pediatrics with no standardized management. The objective of this paper was to report our experience with PP and analyze the role of hospitalizations and radiological tests.
Material And Methods:
A retrospective study of pediatric patients with PP from 2013 to 2023 was carried out. Demographic, clinical, and radiological data was collected.
Results:
24 patients (54% of whom male) with a median age of 9.5 years (3.9-15.2) and a median weight of 32 kg (14.8-49.3) were included. The most frequent reasons for consultation were dyspnea (46%), chest pain (29%), and odynophagia (13%). Patients < 5 years old reported less chest pain (12.5% vs. 75%, p= 0.008) and had more respiratory infections (p= 0.032), with lower SpO2 (95% vs. 98.5%, p= 0.05). 19 (79%) patients required hospitalization, 9 of whom exclusively as a result of PP. Hospitalization was longer (5.5 vs. 3 days, p= 0.017) and aerosol treatment was more frequent (p= 0.005) in patients admitted due to concomitant pathologies. They all received conservative treatment. Early (< 24 h) pain control was achieved with oral analgesia, without complications or rehospitalizations in the first 30 days following discharge. Additional radiological tests, aside from the diagnostic chest X-ray, were carried out in 95.8% of the cases (95.8% X-rays, 12.5% chest CT-scan), with no changes in terms of patient management whatsoever. Subcutaneous emphysema was not significantly associated with more X-rays (3 vs. 1.5, p= 0.235). Median added radiation was 0.05 mSv (0.02-0.1) or 2.5 X-rays.
Conclusions:
PP is a benign condition that can be conservatively treated. In the absence of intercurrent pathologies, hospitalization might prove unnecessary. Additional ionizing tests increase radiation while not adding a clear clinical benefit.
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