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Pneumomediastinum

Pneumomediastinum is air in the mediastinum. The mediastinum is the space in the middle of the chest, between the lungs.

Alternative Names

Mediastinal emphysema

Causes

Pneumomediastinum is uncommon. The condition can be caused by injury or disease. Most often, it occurs when air leaks from any part of the lung or airways into the mediastinum.

Increased pressure in the lungs or airways may be caused by:

  • Too much coughing
  • Repeated bearing down to increase abdominal pressure (such as pushing during childbirth or a bowel movement)
  • Sneezing
  • Vomiting

It may also happen after:

  • An infection in the neck or center of the chest
  • Rapid rises in altitude, scuba diving
  • Tearing of the esophagus (the tube that connects the mouth and stomach)
  • Tearing of the trachea (windpipe)
  • Use of a breathing machine
  • Use of inhaled recreational drugs, such as crack cocaine

Pneumomediastinum also can occur with pneumothorax or other diseases.

Symptoms

There may be no symptoms. The condition usually causes chest pain behind the breastbone, which may spread to the neck or arms. The pain may be worse when you take a breath or swallow.

Exams and Tests

During a physical examination, the doctor may feel small bubbles of air under the skin of the chest, arms, or neck. A chest x-ray or CT scan of the chest may be done. This is to confirm that air is in the mediastinum, and to help diagnose a hole in the trachea or esophagus.

Treatment

Often, no treatment is needed because the body will gradually absorb the air. Breathing high concentrations of oxygen may speed this process.

The doctor may put in a chest tube if you also have a collapsed lung (pneumothorax). You may also need treatment for the cause of the problem. A hole in the trachea or esophagus needs to be repaired with surgery.

Outlook (Prognosis)

The outlook depends on the disease or events that caused the pneumomediastinum.

Possible Complications

The air may build up and enter the space around the lungs (pleural space), causing the lung to collapse.

In rare cases, air may enter the area between the heart and the thin sac that surrounds the heart. This condition is called a pneumopericardium.

In other rare cases, so much air builds up in the middle of the chest that it pushes on the heart and the great blood vessels, so they cannot work properly.

All of these complications require urgent attention because they can be life threatening.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have severe chest pain or difficulty breathing.

References

Park DR, Vallieres E. Pneumomediastinum and mediastinitis. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Saunders Elsevier; 2010: chap 77.

Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 99.

Updated: 8/25/2014

Denis Hadjiliadis, MD, Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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