Pneumomediastinum history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:  Trusha Tank, M.D.[2], Jacquelyne DiTroia

## Overview

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Most common symptoms seen in pneumomediastinum are sudden onset of pain in the chest and subcutaneous emphysema. In most cases, pain follows the signs of causative or underlying pathology such as exacerbation of asthma. Spontaneous pneumomediastinum in most cases presents without any symptoms. Besides chest pain, other frequent symptoms are cough, dyspnea or pain in the neck. Most specific finding on physical exam is Hamman's sign, which is a mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heartbeat.

## History and Symptoms

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### History

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There are several causative and/or precipitating factors associated with pneumomediastinum. Specific history should be focused on:[1][2][3]

* Asthma
* COPD
* Pneumonia
* ARDS
* Interstitial lung disease
* Mediastinitis
* Procedures
* Endoscopy

### Symptoms

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The clinical presentation of pneumomediastinum depends on the causative or precipitating factor. Common symptoms of pneumomediastinum include:[4][5][6][7][8]

* Severe, acute pain in the chest (pain may radiate to the shoulders or back)
* Shortness of breath
* Fever
* Cervical pain (Subcutaneous emphysema)
* Jaw pain (Subcutaneous emphysema)
* Swelling of neck, face, chest, abdomen, shoulder (subcutaneous emphysema)
* Dysphonia
* Dysphagia
* Emesis

## References

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1. ↑ Agut A, Talavera J, Buendia A, Anson A, Santarelli G, Gomez S (2015). "IMAGING DIAGNOSIS-SPONTANEOUS PNEUMOMEDIASTINUM SECONDARY TO PRIMARY PULMONARY PATHOLOGY IN A DALMATIAN DOG". Vet Radiol Ultrasound. 56 (5): E54–7. doi:10.1111/vru.12223. PMID 25388364.
2. ↑ Chiu CY, Wong KS, Yao TC, Huang JL (March 2005). "Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children". Asian Pac. J. Allergy Immunol. 23 (1): 19–22. PMID 15997870.
3. ↑ Iyer VN, Joshi AY, Ryu JH (May 2009). "Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients". Mayo Clin. Proc. 84 (5): 417–21. doi:10.1016/S0025-6196(11)60560-0. PMC 2676124. PMID 19411438.
4. ↑ name="pmid18721592">Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE (September 2008). "Spontaneous pneumomediastinum: a comparative study and review of the literature". Ann. Thorac. Surg. 86 (3): 962–6. doi:10.1016/j.athoracsur.2008.04.067. PMID 18721592.
5. ↑ Nakagawa, Hideki, Yamauchi, Miwa, Kusuyama, Toshiyuki, Fukuda, Hiroyuki, & Ogawa, Kaoru. "Cervical emphysema secondary to pneumomediastinum as a complication of childbirth". Ear, Nose and Throat Journal. 82(12): 948–51. Vancouver style error: initials (help); Check date values in: `|access-date=` (help); `|access-date=` requires `|url=` (help)
6. ↑ Riccio, John C.; Abbott, Jean (1990). "A simple sore throat?: Retropharyngeal emphysema secondary to free-basing cocaine". The Journal of Emergency Medicine. 8 (6): 709–712. doi:10.1016/0736-4679(90)90283-2. ISSN 0736-4679.
7. ↑ Abbas, Paulette I.; Akinkuotu, Adesola C.; Peterson, Michelle L.; Mazziotti, Mark V. (2015). "Spontaneous pneumomediastinum in the pediatric patient". The American Journal of Surgery. 210 (6): 1031–1036. doi:10.1016/j.amjsurg.2015.08.002. ISSN 0002-9610.
8. ↑ Andrade Semedo, Flávia Helena Monteiro; Silva, Rosário Santos; Pereira, Sónia; Alfaiate, Teresa; Costa, Teresa; Fernandez, Pilar; Pereira, Amélia (2012). "Pneumomediastino espontâneo: relato de um caso". Revista da Associação Médica Brasileira. 58 (3): 355–357. doi:10.1590/S0104-42302012000300017. ISSN 0104-4230.

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