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 Table of Contents  
COMMENTARY
Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 11

Traumatic pneumomediastinum: High alert


1 Ibn Sina Hospital, Kuwait
2 Trauma, Neuro and Spine Surgeon, NMCH, Nellore, Andhra Pradesh, India

Date of Web Publication21-Jun-2013

Correspondence Address:
Suryapratap Tomar
Trauma, Neuro and Spine Surgeon, NMCH, Nellore, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Parwez A, Tomar S. Traumatic pneumomediastinum: High alert. Int J Stud Res 2013;3:11

How to cite this URL:
Parwez A, Tomar S. Traumatic pneumomediastinum: High alert. Int J Stud Res [serial online] 2013 [cited 2023 Jan 31];3:11. Available from: http://www.ijsronline.net/text.asp?2013/3/1/11/113807

Traumatic Pneumomediastinum occurs in up to 10 - 15% of the cases of blunt chest trauma. [1] Pneumomediastinum may result from either intrathoracic or extra-thoracic causes. Intrathoracic etiology includes a narrowed or plugged airway, straining against a closed glottis, blunt chest trauma or alveolar rupture. Extra-thoracic causes are mainly sinus fracture, iatrogenic manipulation in dental extraction or perforation of a hollow viscus. [2] Although, they are rare in daily life, whenever they occur they can be life-threatening, requiring immediate diagnosis and treatment. [3]

In pneumomediastinum, the radiographic signs depend on the changes of normal anatomic structures that are outlined by the air as it leaves the mediastinum, for example, the thymic sail sign, 'ring-around-the-artery' sign, tubular artery sign, double bronchial wall sign, continuous diaphragm sign, and extrapleural sign. During a caudal end esophageal rupture, air migrates from the mediastinum into the pulmonary region and creates pneumomediastinum. This condition may be difficult to differentiate from medial pneumothorax and pneumopericardium. [4] Diagnosis can be confirmed using a computed tomography (CT) scan or transthoracic and transesophageal echocardiography, if available, although no imaging technique is entirely reliable. An empty pericardium, a pericardial defect, cardiac shift, and pneumopericardium are all consistent with the diagnosis. [5],[6],[7],[8],[9] At times, normal anatomic structures (e.g., major fissure, anterior junction line) may simulate air within the mediastinum. Iatrogenic entities that may complicate as pneumomediastinum include helium in the balloon of an intra-aortic assist device. [4]

Treatment is directed toward the factors responsible for the leakage of air, with symptomatic treatment and chest tube as per requirement, in the Emergency Room. In an emergency, tension pneumomediastinum or hemo-thorax with uncontrolled bleeding require a red alert and most of the time invasive procedures like thoracotomy or thoracostomy are performed.

On behalf of the experience and research article studies, we advocate that strict intensive care and conservative therapy can provide successful recovery in most patients. In 9 - 16% of the patients, the evolution of the process is dramatic and requires cervical mediastinotomy after Tiegel or thoracotomy, with wide mediastinotomy. [10]

 
  References Top

1.Yellin A, Gapany-Gapanavicius M, Lieberman Y. Spontaneous pneumomediastinum: Is it a rare cause of chest pain? Thorax 1983;38:383-5.  Back to cited text no. 1
[PUBMED]    
2.Beg MH, Reyazuddin, Ansari MM. Traumatic tension pneumomediastinum mimicking cardiac tamponade. Thorax 1988;43:576-7  Back to cited text no. 2
    
3.Putukian M. Pneumothorax and pneumomediastinum. Clin Sports Med 2004;23:443-54. x.  Back to cited text no. 3
    
4.Zylak CM, Standen JR, Barnes GR, Zylak CJ. Pneumomediastinum Revisited. Radiographics 2000;20:1043-57.  Back to cited text no. 4
    
5.Galindo Gallego M, Lopez-Cambra MJ, Fernandez-Acenero MJ, Alvarez Perez TL, Tadeo Ruiz G, Vazquez Santos P, et al. Traumatic rupture of the pericardium. Case report and literature review. J Cardiovasc Surg 1996;37:187-91.  Back to cited text no. 5
    
6.Matsuda S, Hatta T, Kurisu S, Ohyabu H, Koyama T, Kita Y. Traumatic cardiac herniation diagnosed by echocardiography and chest CT scanning: Report of a case. Jpn J Surg 1999;29:1221-4.  Back to cited text no. 6
    
7.Clark DE, Wiles CS 3rd, Lim MK, Dunham CM, Rodriguez A. Traumatic rupture of the pericardium. Surgery 1983;93:495-503.  Back to cited text no. 7
    
8.Schir F, Thony F, Chavanon O, Perez-Moreira I, Blin D, Coulomb M. Blunt traumatic rupture of the pericardium with cardiac herniation: Two cases diagnosed using computed tomography. Eur Radiol 2001;11:995-9.  Back to cited text no. 8
    
9.Place RJ, Cavanaugh DG. Computed tomography to diagnose pericardial rupture. J Trauma 1995;38:822-3.  Back to cited text no. 9
    
10.Platov II, Moiseev VS. Spontaneous pneumomediastinum. Probl Tuberk 1998;61-2.  Back to cited text no. 10
    




 

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