Mediastinal emphysema is classified into three types according to the mechanism of causation: (1) spontaneous, in the absence of any underlying respiratory disease; (2) symptomatic, secondary to other pulmonary diseases, such as pneumonitis, asthma, and pulmonary emphysema; (3) traumatic, following a traffic accident, blunt trauma, or surgical procedure. This study was conducted to clarify the characteristics of the three types of mediastinal emphysema.
We conducted a retrospective review of all patients presenting with mediastinal emphysema who were treated on an inpatient basis in any unit of our hospital from March 2006 to July 2017. We analyzed the following data: number of patients, age, gender, classification, clinical symptoms, extent of emphysema on CT images, presence/absence of subcutaneous emphysema, treatment methods (antibiotics, fasting and antibiotics, or only rest), number of days to complete resolution of the mediastinal emphysema, and relationship between the treatment employed and the time to complete resolution of the emphysema.
Data of a total of 59 patients (43 males/16 females; mean age, 0–94 years) were included in the study. Ten patients (6, spontaneous; 4, traumatic) were treated at our department. Results revealed that patients classified as having spontaneous emphysema were younger and left the hospital earlier. As for patients with traumatic emphysema, association with subcutaneous emphysema was more frequent and resolution of complications took longer. Patients with traumatic emphysema often had comorbid conditions, such as bone fractures and pneumothorax, and their general condition was generally more serious. The severity of mediastinal emphysema, however, covers the spectrum from mild to severe. Preventive antibiotic therapy may not be needed for patients who are at a low risk for mediastinitis, such as those without esophageal rupture or subcutaneous emphysema. Hospital care may not be needed in milder cases of mediastinal emphysema. We might be able to reduce unnecessary treatment by selecting the appropriate intervention according to the severity of presentation.
