2020 Volume 56 Issue 7 Pages 1082-1087
Purpose: Pneumomediastinum is an uncommon disorder and usually benign and self-limiting. However, it sometimes requires invasive workup of suspected esophageal perforation and prophylactic antibiotics to prevent sequential mediastinitis. The purpose of this study is to review our experience and propose a management pathway for this rare condition.
Methods: The cases of all children over one year of age treated at our hospital with pneumomediastinum between September 2005 and November 2018 were retrospectively reviewed.
Result: We identified nine patients: eight males and one female. Their age range was from four to fourteen years (median, seven years). The primary symptoms were chest pain, back pain and sore throat. Asthma was the most common cause (five patients), followed by trauma (two patients). The remaining two patients were considered to have idiopathic pneumomediastinum. All patients were diagnosed on the basis of chest radiography findings. Computed tomography (CT) was performed in six patients and contrast-enhanced CT was performed to exclude gastrointestinal perforation in a patient with trauma. A boy with dysphagia underwent esophagography. Eight of the patients were admitted to our hospital: one patient with trauma and one with severe asthma were initially admitted to the pediatric intensive care unit. The length of hospital stay was three to eight days (median, four days). All patients improved with rest, and four patients were administered prophylactic antibiotics. No mediastinitis occurred and pneumomediastinum did not recur.
Conclusions: Most pediatric patients with pneumomediastinum need only supportive care and treatment for the underlying causes. We propose a management algorithm for pediatric pneumomediastinum based on the vital signs and underlying causes.
