II. Pathophysiology

  1. Spontaneous rupture of alveolus or bleb
  2. Results from increased pressure gradient
    1. Negative (Inhalation)
    2. Positive (Valsalva)
  3. Air tracks along vessels and Bronchi
  4. Air coalesces in mediastinum

III. Causes

  1. Inhalation Drug Use (e.g. Huffing)
  2. Asthma
  3. Coughing
  4. Vomiting
  5. Weight lifting
  6. Parturition

IV. Symptoms

  1. Sore Throat
  2. Dyspnea
  3. Pleuritic Chest Pain
    1. Worse with lying
    2. Better with sitting

V. Signs

  1. Subcutaneous Emphysema
  2. Hamman's Crunch (50%)

VI. Differential Diagnosis

  1. Esophageal Perforation
  2. Tension Pneumomediastinum
  3. Pneumothorax

VII. Radiology: Chest XRay

  1. As many as 50% Pneumomediastinum cases missed on PA
  2. Review Lateral Chest XRay carefully

VIII. Disposition

  1. Intensive Care Unit Admission

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Ontology: Mediastinal Emphysema (C0025062)

Definition (NCI_NICHD) Mediastinal emphysema is a condition in which air is present in the mediastinum. It can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity.
Definition (NCI) The presence of air in the mediastinum. It is caused by injury, most often esophageal or intestinal perforation.
Definition (MSH) Presence of air in the mediastinal tissues due to leakage of air from the tracheobronchial tree, usually as a result of trauma.
Concepts Pathologic Function (T046)
MSH D008478
ICD10 J98.2
SnomedCT 155627006, 390899006, 196144009, 266411000, 16838000
English Emphysema, Mediastinal, Emphysemas, Mediastinal, Mediastinal Emphysema, Mediastinal Emphysemas, Pneumomediastinum, mediastinal emphysema (diagnosis), mediastinal emphysema, Mediastinal Emphysema [Disease/Finding], pneumomediastinum, Pmeumomediastinum, Mediastinal emphysema, Mediastinal emphysema (disorder), emphysema; mediastinal, mediastinal; emphysema, Mediastinal emphysema [Ambiguous]
Dutch mediastinaal emfyseem, emfyseem; mediastinaal, mediastinaal; emfyseem, pneumomediastinum, Emfyseem, mediastinum-, Mediastinumemfyseem, Pneumomediastinum
German mediastinales Emphysem, Emphysem, Mediastinal-, Mediastinalemphysem, Pneumomediastinum
Italian Enfisema del mediastino, Pneumomediastino, Enfisema mediastinico
Portuguese Enfisema do mediastino, Pneumomediastino, Enfisema Mediastínico
Spanish Enfisema mediastínico, enfisema mediastinal, neumomediastino, enfisema del mediastino (trastorno), enfisema del mediastino, enfisema mediastínico, Pneumomediastino, Enfisema Mediastínico, Neumomediastino
Japanese 気縦隔症, ジュウカクキシュ, キジュウカクショウ, 気腫-縦隔, 縦隔気腫
Swedish Mediastinalt emfysem
Czech mediastinum - emfyzém, pneumomediastinum, Pneumomediastinum, Mediastinální emfyzém
Finnish Välikarsinan ilmapöhö
Russian PNEVMOMEDIASTINUM, EMFIZEMA MEDIASTINAL'NAIA, SREDOSTENIIA EMFIZEMA, ПНЕВМОМЕДИАСТИНУМ, СРЕДОСТЕНИЯ ЭМФИЗЕМА, ЭМФИЗЕМА МЕДИАСТИНАЛЬНАЯ
Croatian SREDOPRSJE, EMFIZEM, EMFIZEM MEDIJASTINUMA, MEDIJASTINUM, EMFIZEM
Polish Odma śródpiersiowa
Hungarian Mediastinalis emphysema, Pneumomediastinum
Norwegian Mediastinalemfysem, Pneumomediastinum, Mediastinumemfysem, Emfysem, mediastinalt, Mediastinalt emfysem
French Pneumomédiastin, Emphysème du médiastin, Emphysème médiastinal