Spontaneous pneumomediastinum: analysis of 87 pediatric patients.

OBJECTIVES: Early reports on pneumomediastinum studied the adult population, and recent analyses of pneumomediastinum in pediatric patients contain small numbers of patients. We aimed to summarize the experience of a larger number of pediatric patients with spontaneous pneumomediastinum (SPM) in a tertiary children's facility in northern Taiwan.

METHODS: We performed a retrospective chart review of clinical manifestations and outcome of SPM on pediatric patients who were admitted to our hospital during a 10-year period.

RESULTS: Forty-three patients (49.4%) had primary SPM, with a male predominance in adolescents. None of the 16 patients younger than 6 years had primary SPM; 43 of 71 patients older than 6 years had secondary SPM (0% vs 60.6%, P < 0.05). The common causes of secondary SPM were asthmatic exacerbation, pneumonia or lower respiratory tract infections, or choking. Ten patients had normal frontal chest radiograph finding (sensitivity, 89.1%); the lateral neck radiographs clearly demonstrated subcutaneous emphysema in 9 of these 10 patients.

CONCLUSIONS: All patients younger than 6 years with SPM were secondary; therefore, they should be vigilantly examined for predisposing causes. For adolescent patients with SPM with no catastrophic events, asthma with exacerbation should be considered first, and extensive or invasive diagnostic examinations are not needed. Primary SPM usually requires conservative treatment only with no sequel or recurrence. Lateral neck radiograph has a higher sensitivity for the demonstration of subcutaneous emphysema in doubtful cases.