Introduction:
The space located in between the two lungs is called the mediastinum. Pneumomediastinum is a condition in which this space is occupied by air. It occurs due to an injury in the lungs or is associated with lung diseases like pneumothorax, asthma, and chronic obstructive pulmonary disorder. The increase in pressure ruptures the airways.
What Are the Types of Pneumomediastinum?
There are two types of pneumomediastinum - primary and secondary pneumomediastinum.
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Primary Pneumomediastinum - It is also known as the spontaneous mediastinum. The air in the mediastinal space is due to actions like heavy workouts, frequent vomiting, recurrent asthmatic episodes, and difficulty during labor.
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Secondary Pneumomediastinum - Trauma is the major reason for secondary mediastinum. The mediastinum comprises the heart, part of the airway, and part of the digestive system. The injury to the digestive tract (esophagus) or lungs leaks air into the mediastinum.
What Are the Causes of Pneumomediastinum?
The pressure in the lungs increases due to the stress in the adjacent vital organs. The various causes of pneumomediastinum are as follows;
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Vigorous coughing and sneezing due to respiratory infections increase the pressure in the airways.
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The abdominal pressure increases in a pregnant woman if there is any difficulty in pushing the baby during delivery.
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Involving in high-altitude sports like paragliding or hiking in the mountains produces stress on the chest.
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Deep neck infections and inflammation in the airways cause primary pneumomediastinum.
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Excess use of respiratory supporting machines like ventilators increases the pressure in the space between the lungs.
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Using recreational drugs like cocaine can cause intoxication.
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Injury to the chest occurs during any surgical procedures involving the lungs, like a lung biopsy.
What Are the Symptoms of Pneumomediastinum?
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Referred pain in the shoulder, neck, and chest is the most common symptom.
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The patient gasps for breath even after a short physical activity. There is a shortness of breath.
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The patient experiences difficulty breathing with tightness in the chest.
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The patient is unable to swallow or drink liquids, called dysphagia. Due to the unusual bowel movements, vomiting sensations may arise.
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The dryness in the voice box makes the voice hoarse.
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Due to strain, the excess pressure gets distributed to the face and neck. The patient has swelling in the face and neck, along with discomfort and pain.
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Injury to the food pipe is called esophageal perforation. This causes leakage of liquids into the mediastinum. The patient has continuous vomiting. The perforation can be healed with the help of surgery.
Will Pneumomediastinum Affect Newborns?
Primary pneumomediastinum is more common in newborns. Mild pneumomediastinum shows no symptoms in babies and recovers itself. The reasons for pneumomediastinum in babies are as follows:
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Premature babies kept in ventilators to assist breathing are affected by pneumomediastinum.
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Stress experienced by the baby to pass meconium stools (stools produced in the intestine before birth) causes pneumomediastinum.
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Babies born in cesarean delivery with lung infection are more prone to pneumomediastinum.
The symptoms in babies are,
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Groaning with faster breathing.
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The nostrils flare out during breathing.
Oxygen supply is provided for the babies by the medical professional to help them breathe. The infection in the lungs is treated with antibiotics. The babies are kept under observation until the air inside the mediastinum dissipates completely.
What Are the Risk Factors for Pneumomediastinum?
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Males are the most commonly affected gender than females.
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Using smokeless tobacco or smoking affects the functional capacity of the lungs.
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The risk of pneumomediastinum is more in people who already have other respiratory diseases like asthma and pneumothorax.
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If the air in the mediastinum leaks into the space surrounding the heart, it causes pneumopericardium. It creates a strain on the heart and blood vessels and diminishes its working capacity.
What Are the Diagnostic Procedures for Pneumomediastinum?
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Auscultation - The doctor uses a stethoscope to observe the heart sounds. A crunching heart sound is heard in the stethoscope. This condition is referred to as "mediastinal crunch."
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Physical Examination - During the physical inspection, the doctor finds tiny swellings in the skin over the neck and chest areas.
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CT (Computed Tomography) Scan - The scanner takes around 30 seconds to one minute to give images of the chest in cross-section. It gives a detailed view of the soft tissue structures around the chest. It helps to analyze the size and shape of the lungs. Any fluid retention in the space between the lungs can be identified using a CT scan.
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X-Rays - The radiographic impressions show the picture of the chest to see the changes in the shape of the lungs and ribs. The radiographic image also covers other parts like the heart, diaphragm, and blood vessels.
What Are the Various Treatment Methods for Pneumomediastinum?
If the air inside the mediastinum is minimal, it drains out due to the immune mechanism of the body.
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The patient with severe pneumomediastinum is monitored in the hospital. The symptoms are treated initially, followed by bed rest. There should not be any physical activity.
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Painkillers and anti-anxiety drugs are given by medical professionals to subside pain and anxiety, respectively. Antitussive drugs are given to suppress excessive cough in respiratory infections.
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Delivering oxygen at a high concentration can dissipate the air in the body.
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A chest tube is inserted inside the chest between the ribs. An X-ray is taken after tube insertion to investigate the abnormal fluid or air inside the mediastinal space. Suction is used to drain the air or fluid. The lungs re-expand when the air is completely removed. A suture is placed to keep the chest tube in position.
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The injury in the food pipe leaks the contents into the mediastinum and increases the risk of pneumomediastinum. Esophagoscope is passed through the nose or mouth to visualize the injury in the esophagus. Esophagogram is also used to observe the condition of the esophagus. Barium is swallowed before taking the X-ray of the esophagus. Esophagoscopy is a procedure used to repair the injury in the food pipe. This surgery reduces the risk of pneumomediastinum.
Conclusion:
The recovery rate of pneumomediastinum depends on the underlying cause and other systemic diseases. So take the necessary steps to treat the medical conditions. Long-term complications are very rare in pneumomediastinum. The patient should not smoke as it increases the risk of lung diseases. If you have any symptoms or discomfort in the chest area, get help from medical professionals immediately.
