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      A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Young Adult

      case-report

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          Abstract

          Spontaneous medialstinal emphysema (pneumomediastinum) and pneumopericardium may be defined as the presence of free air or gas in the mediastinal structures and in the pericardial sac without an apparent precipitating cause. It most frequently occurs in young healthy adults without serious underlying pulmonary disease.

          Although pneumomediastinum and pneumopericardium is often asymptomatic, it may cause pain in the neck and chest, dysphonia and shortness of breath. Treatment is supportive unless the patient has a history of trauma from foreign body aspiration. The course of spontaneous pneumomediastinum and pneumopericardium is usually benign and self-limited.

          A case of spontaneous pneumomediastinum, pneumopericardium and subcutaneous emphysema in a 20-year-old male is reported in this paper.

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          Most cited references20

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          Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management.

          Subcutaneous emphysema and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating trauma, soft-tissue infections, or any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. A continuum of fascial planes connects cervical soft tissues with the medlastinum and retroperitoneum, permitting aberrant air arising in any one of these areas to spread elsewhere. Diagnosis is made in the appropriate clinical setting by careful physical examination and inspection of the chest roentgenogram. While the presence of air in subcutaneous or mediastinal tissue is not dangerous in itself, prompt recognition of the underlying cause is essential. Certain trauma-related causes may require surgical intervention, but the routine use of chest tubes tracheostomy, or mediastinal drains is not recommended.
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            Pneumomediastinum: old signs and new signs.

            Pneumomediastinum, also known as mediastinal emphysema, represents extraluminal gas in the mediastinum. Pneumomediastinum can lead to pneumothorax, pneumopericardium, pneumoperitoneum, or pneumoretroperitoneum. There are many causes of pneumomediastinum (Table 1) and several radiographic signs: pneumopericardium, continuous diaphragm sign, continuous left hemidiaphragm sign, Naclerio's V sign, V sign at confluence of brachiocephalic veins, ring-around-the-artery sign, thymic spinnaker-sail sign, and extrapleural air sign. We review the common and uncommon signs of pneumomediastinum and present some new signs. We also address the problem of distinguishing pneumomediastinum from pneumothorax and pneumopericardium.
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              Spontaneous pneumomediastinum: is it a rare cause of chest pain?

              A policy of obtaining a routine chest radiograph in every young patient with unexplained chest pain or dyspnoea led to the diagnosis of 14 cases of spontaneous pneumomediastinum within four years, whereas only two cases from former years could be found retrospectively. One patient had recurrent spontaneous pneumomediastinum, the first case so far reported. Analysis of admission data suggested that this entity may be much more common than is generally believed, and may be second only to spontaneous pneumothorax as a cause of admission of young, healthy individuals experiencing sudden chest pain or shortness of breath. After reviewing the published reports we propose the following definition of spontaneous mediastinal emphysema: the non-traumatic presence of free air in the mediastinum in a patient with no known underlying lung disease. When it occurs without associated pneumothorax it is benign. The incidence of spontaneous pneumomediastinum for the four-year period under study was 1 per 12 850 admissions.
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                Author and article information

                Journal
                Korean J Intern Med
                Korean J. Intern. Med
                KJIM
                The Korean Journal of Internal Medicine
                Korean Association of Internal Medicine
                1226-3303
                2005-6648
                September 2001
                : 16
                : 3
                : 205-209
                Affiliations
                Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Author notes
                Address reprint requests to : Seung-Won Jin, M.D., Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 520-2 Daehung2-dong, Chung-gu, Daejeon 301-723, Korea
                Article
                kjim-16-3-205-10
                10.3904/kjim.2001.16.3.205
                4531731
                11769580
                18c87caa-1171-4323-b338-fe470238e029
                Copyright © 2001 The Korean Association of Internal Medicine

                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/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Internal medicine
                mediastinal emphysema (pneumomediastinum),pneumopericardium
                Internal medicine
                mediastinal emphysema (pneumomediastinum), pneumopericardium

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