Chest
Volume 100, Issue 1, July 1991, Pages 93-95
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Clinical Investigations
Spontaneous Pneumomediastinum: A Report of 25 Cases

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Spontaneous pneumomediastinum (SPM) is a relatively uncommon, infrequently reported entity. To determine the clinical presentation and sequelae of SPM, data were obtained from 25 patients: 14 from Hadassah University Hospital, and 11 from other medical institutions. The mean age was 18.8 ±5.2 years (±SD), with a range of 8 to 31 years. The most common presenting complaint was retrosternal pain in 22 patients (88 percent), dyspnea in 15 (60 percent), dysphagia in 10 (40 percent), and weakness in 10 (40 percent). Predisposing factors for the development of SPM could be identified in 18 patients (72 percent). Information on the sequelae of SPM during a mean period of 87.4 ±38.0 months following the initial SPM episode was obtained from 23 patients. Recurrent SPM occurred in 1 patient at 18 months, and another patient experienced 4 episodes of recurrent spontaneous pneumothorax. No other long-term sequelae were reported. We conclude that SPM is a benign self-limited disease with diverse clinical manifestations. Although uncommon, recurrences of SPM may be observed.

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Materials and Methods

To determine the incidence of hospital admissions with SPM, we performed a computerized retrospective study of discharge diagnoses in 460,544 patients hospitalized at Hadassah University Hospital in Jerusalem between June 1, 1978 and May 31, 1989. Fourteen patients with SPM were identified.

Clinical data on SPM were obtained from 25 patients: 14 admitted to Hadassah University Hospital; and 11 patients admitted to other medical institutions, but followed in Hadassah's outpatient clinic. Data

Results

The incidence of SPM at Hadassah University Hospital was 1:32,896 hospital admissions. In young patients (5 to 34 years), the incidence was 1:24,945.

The mean age of the 25 patients with SPM was 18.8 ±5.2 years (± SD), with a range of 8 to 31 years. There were 21 male and 4 female patients. Body build and smoking habits were not significantly different from the general population (data not shown).

The patients' complaints on admission are summarized in the following tabulation, showing numbers of

Discussion

The present study confirms that SPM is a relatively uncommon disorder which occurs primarily in young adults. It is usually a self-limited benign condition, which may recur.

Spontaneous pneumomediastinum was first reported in 1939 by Hamman.8 It results from the rupture of marginal pulmonary alveoli, allowing bubbles of air to dissect along the vascular sheaths and connective tissue planes to the mediastinum.9 In our study, 36 percent (nine) of the episodes of SPM were preceded by cough, and 24

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Manuscript received July 23; revision accepted November 30.

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