Back
 SS  Vol.3 No.4 , April 2012
Usefulness of Chest Computed Tomography for Diagnosis of Idiopathic Pneumomediastinum with Negative Findings on Plain X-Ray
Abstract: Idiopathic pneumomediastinum is rare in children. Few cases of patients with pneumomediastinum show negative findings on X-ray examination. Chest computed tomography (CT) was very useful for the diagnosis and evaluation of the extent of pneumomediastinum. We report here a case of idiopathic pneumomediastinum in a 15-year-old boy who exhibited no significant chest X-ray finding. The patient was referred to our institute for the further evaluation of pre-cordial pain and breathing difficulty. Precordial pain suddenly developed, when he was carrying a portable shrine on his shoulder (day of onset). He was admitted to another institute 3 days after onset because of worsening precordial pain. On admission, he presented with 98% saturation of hemoglobin in the peripheral blood under room air. Plain chest X-ray also revealed no abnormal findings. A half-dissolved gastrographin swallow showed no leakage of gastrographin from the pharynx and esophagus to the mediastinum, and no diverticulum within the esophagus. Plain chest CT revealed extensive emphysema around the trachea from the neck to the portion inferior to the carina of trachea. The patient was diagnosed with idiopathic pneumomediastinum because the cause was unclear. We decided to admit him to our institute under fasting conditions and rest. His symptoms improved 3 days after onset. The lesion had disap-peared 8 days after onset on chest CT. When young people experience precordial pain which increases on inspiration, we must consider pneumomediastinum in a differential diagnosis, and it is important to perform chest CT.
Cite this paper: K. Mino, T. Okada, S. Honda, H. Miyagi and A. Taketomi, "Usefulness of Chest Computed Tomography for Diagnosis of Idiopathic Pneumomediastinum with Negative Findings on Plain X-Ray," Surgical Science, Vol. 3 No. 4, 2012, pp. 216-219. doi: 10.4236/ss.2012.34042.
References

[1]   C. Joyaube, B. Mona, D. Patrick, B. Denis, B. Andreana, O. Alain, et al., “Spontaneous Pneumomediastinum: Are We Over-Investigating?” Journal of Pediatric Surgery, Vol. 39, No. 5, 2004, pp. 681-684. doi:10.1016/j.jpedsurg.2004.01.045

[2]   I. Abolnik, I. S. Lossos and R. Breuer, “Spontaneous Pneumomediastinum: A Report of 25 Cases,” Chest, Vol. 100, No. 1, 1991, pp. 93-95. doi:10.1378/chest.100.1.93

[3]   M. Chalumeau, L. L. Clainche, N. Sayeg, N. Sannier, J. L. Michel, R. Marianowski, et al., “Spontaneous Pneumomediastinum in Children,” Pediatricic Pulmonology Vol. 31, No. 1, 2001, pp. 67-75. doi:10.1002/1099-0496(200101)31:1<67::AID-PPUL1009>3.0.CO;2-J

[4]   A. Yellin, M. Gapany and Y. Lieberman, “Spontaneous Pneumomediastinum,” Chest, Vol. 101, No. 6, 1992, 1742-1743. doi:10.1378/chest.101.6.1742b

[5]   W. P. Munsell, “Pneumomediastinum. A Report of 28 Cases and Review of the Literature,” Journal of the American Medical Association, Vol. 202, No. 8, 1967, pp. 689-693. doi:10.1001/jama.1967.03130210063009

[6]   D. J. McMahon, “Spontaneous Pneumomediastinum,” American Journal of Surgery, Vol. 131, No. 5, 1976, pp. 550-551. doi:10.1016/0002-9610(76)90008-8

[7]   M. Aisner and J. E. Franco, “Mediastinal Emphysema,” New England Journal of Medicine, Vol. 241, No. 11, 1949, pp. 818-825. doi:10.1056/NEJM194911242412105

 
 
Top