Open Access, Peer-reviewed
pISSN 2288-0402
eISSN 2288-0410
    Allergy Asthma Respir Dis. 2015 Mar;3(2):145-150. Korean.
    Published online Mar 24, 2015.
    https://doi.org/10.4168/aard.2015.3.2.145
    © 2015 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
    Original Article

    Characteristics of pediatric noniatrogenic pneumomediasinum

    Narae Lee,1 Seung Kook Son,1 Hyung Young Kim,1 Hye-Young Kim,2 and Hee Ju Park1
      • 1Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
      • 2Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
    • Correspondence to: Hee Ju Park. Department of Pediatrics, Pusan National University Children's Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-700, Korea. Tel: +82-55-360-3150, Fax: +82-55-360-2181, Email: phj7294@hanmail.net
    Received September 17, 2014; Revised November 06, 2014; Accepted November 28, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

    Abstract

    Purpose

    Pneumomediastinum is rare in children and adolescents, and its causes have not yet been clearly determined. We aimed to identify the causes, clinical manifestations and prognosis of noniatrogenic pneumomediastinum in children.

    Methods

    From February 2007 to June 2014, we retrospectively investigated 121 patients with pneumomediastinum under 18 years of age in 2 hospitals. Eighteen patients with pneumomediastinum after thoracotomy and 35 patients with iatrogenic pneumomediastinum were excluded.

    Results

    Sixty-eight patients were divided into 4 age groups: those under 1 year of age (n=9, 13.2%), those 1 to 5 years of age (n=9, 13.2%), those 6 to 10 years of age (n=17, 25.0%) and those over 11 years of age (n=33, 48.5%). Chest pain (n=43, 63.2%) was the most common initial complaint and subcutaneous emphysema was identified in 18 patients (26.5%). Chest x-ray was diagnostic in all except 9 patients (13.2%). Predisposing causes of pneumomediastinum were idiopathic (n=26, 38.2%), respiratory tract infection (n=23, 33.8%), asthma exacerbation (n=4, 5.9%), trauma (n=4, 5.9%), endobronchial foreign body (n=2, 2.9%), interstitial lung disease (n=5, 7.4%), and neonatal respiratory disease (n=4, 5.9%). Chest pain (P<0.001) and idiopathic cause (P=0.001) were shown to linearly increase with age. On the contrary, tachypnea (P<0.001), dyspnea (P=0.016), and interstitial lung disease (P=0.008) were shown to have a decreasing linear association with age. The length of hospital stay was significantly increased in patients with interstitial lung disease (P=0.042), those with pneumothorax (P=0.044), and those without chest pain (P=0.013).

    Conclusion

    According to age groups, there were significant differences in causes and clinical manifestations. In particular, pneumomediastinum that developed in younger patients with interstitial lung disease showed unfavorable outcomes, such as dyspnea, pneumothorax, and increased length of hospital stay. Therefore, precise evaluation of predisposing causes and careful management are needed for children with pneumomediastinum.

    Keywords
    Pneumomediastinum; Interstitial lung disease; Child

    Figures

    Fig. 1
    Selection of the patients and classification by predisposing causes. ILD, interstitial lung disease. *ILD included humidifier disinfectant-associated children's interstitial lung disease (n=4) and idiopathic pulmonary fibrosis (n=1).

    Tables

    Table 1
    General characteristics of the patients (n=68)

    Table 2
    Predisposing causes of pneumomediastinum

    Table 3
    Clinical differences of patients according to age

    Table 4
    Comparisons of length of hospital stay by sex, predisposing causes, symptoms/signs, and complication

    Notes

    This study was supported by academic research fund for free assignment of Pusan National University.

    References

      1. Okada M, Adachi H, Shibuya Y, Ishikawa S, Hamabe Y. Diagnosis and treatment of patients with spontaneous pneumomediastinum. Respir Investig 2014;52:36–40.
      1. Banki F, Estrera AL, Harrison RG, Miller CC 3rd, Leake SS, Mitchell KG, et al. Pneumomediastinum: etiology and a guide to diagnosis and treatment. Am J Surg 2013;206:1001–1006.
      1. Dotson K, Johnson LH. Pediatric spontaneous pneumothorax. Pediatr Emerg Care 2012;28:715–720.
      1. Stack AM, Caputo GL. Pneumomediastinum in childhood asthma. Pediatr Emerg Care 1996;12:98–101.
      1. Mumford AD, Ashkan K, Elborn S. Clinically significant pulmonary barotrauma after inflation of party balloons. BMJ 1996;313:1619.
      1. Grossman A, Romem A, Azaria B, Goldstein L, Barenboim E. Pneumomediastinum in student aviators: 10 cases with return to flying duty. Aviat Space Environ Med 2005;76:63–65.
      1. Karakaya Z, Demir S, Sagay SS, Karakaya O, Ozdinc S. Bilateral spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema: rare and fatal complications of asthma. Case Rep Emerg Med 2012;2012:242579.
      1. Jeng MJ, Lee YS, Tsao PC, Soong WJ. Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc 2012;75:551–559.
      1. Lim EJ, Park YB, Kim CH, Park DS, Kim MG, Kim CH, et al. A recurrent spontaneous pneumomediastinum. Tuberc Respir Dis 2005;59:696–699.
      1. Jung AY, Yang I, Go HS, Shin SM, Yoon HK, Woo JY, et al. Imaging neonatal spontaneous pneumomediastinum using ultrasound. J Med Ultrason (2001) 2014;41:45–49.
      1. Sahni S, Verma S, Grullon J, Esquire A, Patel P, Talwar A. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci 2013;5:460–464.
      1. Chalumeau M, Le Clainche L, Sayeg N, Sannier N, Michel JL, Marianowski R, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001;31:67–75.
      1. Kim HY, Kim KM, Kim SH, Son SK, Park HJ. Clinical manifestations of respiratory viruses in hospitalized children with acute viral lower respiratory tract infections from 2010 to 2011 in Busan and Gyeongsangnam-do, Korea. Pediatr Allergy Respir Dis 2012;22:265–272.
      1. Hatamabadi HR, Esmailnejad SS, Khazayi AR, Masjoudi B. A diagnostic challenge of an unusual presentation of pneumomediastinum. Chin J Traumatol 2014;17:44–47.
      1. Chiu CY, Wong KS, Yao TC, Huang JL. Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children. Asian Pac J Allergy Immunol 2005;23:19–22.
      1. McSweeney WJ, Stempel DA. Non-iatrogenic pneumomediastinum in infancy and childhood. Pediatr Radiol 1973;1:139–144.
      1. Kim KW, Ahn K, Yang HJ, Lee S, Park JD, Kim WK, et al. Humidifier disinfectant-associated children's interstitial lung disease. Am J Respir Crit Care Med 2014;189:48–56.
      1. Cheong HK, Ha M, Lee JH. Unrecognized bomb hidden in the babies' room: fatal pulmonary damage related with use of biocide in humidifiers. Environ Health Toxicol 2012;27:e2012001
      1. Lee E, Seo JH, Kim HY, Yu J, Jhang WK, Park SJ, et al. Toxic inhalational injury-associated interstitial lung disease in children. J Korean Med Sci 2013;28:915–923.
    MeSH Terms
    Adolescent
    Asthma
    Chest Pain
    Child
    Dyspnea
    Foreign Bodies
    Humans
    Length of Stay
    Lung Diseases, Interstitial
    Mediastinal Emphysema
    Pneumothorax
    Prognosis
    Respiratory Tract Infections
    Retrospective Studies
    Subcutaneous Emphysema
    Tachypnea
    Thoracotomy
    Thorax
    Metrics
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    Funding Information
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