featured

What causes a pneumomediastinum_

Introduction

Pneumo is a Greek word which means air while mediastinum is the area between our lungs, with chest wall at the front and spine at the back. This area consists of the windpipe, food pipe, blood vessel, heart and thymus gland. In short, pneumomediastinum refers to the abnormal presence of air in mediastinum. Pneumomediastinum is rare, but it is potentially life-threatening. In this article, we will look into detail on what causes a pneumomediastinum. If you experience any of the symptoms suggestive of pneumomediastinum, kindly make an appointment klinik kesihatan (appointment doctor) for further investigation. 

Who is prone to getting pneumomediastinum?

Children and babies are more commonly affected due to looser tissue structure. Apart from that, males are more inclined to be affected than females. Patients with respiratory illness such as asthma have a greater risk in contracting this condition.

What causes a pneumomediastinum?

Air can get into mediastinum through an external injury, leakage from the surrounding organs such as lung, windpipe, bowel or esophagus, or air sac rupture due to increased lung pressure. Below are the factors in further detail:

  • Organ injury
    • Penetrating injury to the lung might lead to air leaking into the mediastinum
    • Perforation of bowel
    • Rupture of esophagus
  • Respiratory illness
    • Asthma might lead to rupture of air sac
    • Lung infection
    • Lung scarring
  • Elevated lung pressure
    • Forceful coughing, vomiting, crying, shouting, childbirth and weight lifting might increase the lung pressure
    • Use of ventilator
  • Rapid change in air pressure (barotrauma) during scuba diving

Signs and symptoms

The main symptom experienced will be sudden severe chest pain which might radiate to the neck or the back. In patients with underlying asthma, they might experience an exacerbation of the disease.

Other symptoms such as shortness of breath, coughing, fever, voice distortion, mouth or throat pain are also frequently experienced.

Complications

Leakage of air might occur in other areas such as lung and soft tissue. Pneumomediastinum, although rare, might compress the surrounding structures such as blood vessels causing low blood pressure. Depending on the causes, pneumomediastinum due to vomiting might induce infection of the mediastinum. In certain cases, pneumothorax is present as a complication. It is a condition when air leaks into space between lung and chest wall which leads to lung collapse. It is a medical emergency requiring immediate treatment.

Diagnosis

A chest-X Ray (CXR) or CT-Scan of chest might reveal the presence of air within the mediastinum which is suggestive of the condition.

Your doctor might also perform a blood test to evaluate your lung and heart function and the causes of your pneumomediastinum.

Treatment

Patients will be admitted to hospital for monitoring. Most of the patients recover spontaneously as the air is reabsorbed by the surrounding tissues. However, treatment might be needed for the underlying cause such as asthma or lung infection and to provide relief to the symptoms.

A ventilator might be needed to provide adequate oxygenation and removal of carbon dioxide for the patient. 

Pain reliever, anti-anxiety medication, antibiotic for infection and cough medicine might be prescribed based on the symptoms.

In the case of pneumomediastinum due to a food pipe or windpipe rupture, a surgical repair might be performed.

Conclusion

Pneumomediastinum is a condition where air is present in the mediastinum. It is a rare but potentially life-threatening condition. Treatment is needed if a patient is affected with symptoms such as chest pain and shortness of breath