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• W2004878834 abstract "To the Editor: Although first reported by Hamman in 1939,1Hamman L. Spontaneous mediastinal emphysema.Bull John Hopkins Hosp. 1961; 54: 46-56Google Scholar spontaneous pneumomediastinum (SP) is still considered a rare entity. In recent years, as awareness of SP has grown, the syndrome seems to be much more prevalent than previously believed.2McMahon DJ. Spontaneous pneumomediastinum.Am J Surg. 1976; 131: 550-551Abstract Full Text PDF PubMed Scopus (47) Google Scholar,3Millard CE. Pneumomediastinum.Chest. 1969; 56: 297-300Abstract Full Text Full Text PDF Scopus (35) Google Scholar We have encountered 14 cases of SP over a four-year period,4Yellin A Gapani-Gapanavicius M Lieberman Y. Spontaneous pneumomediastinum; is it indeed a rare entity? Thorax (in press)Google Scholar all of which occurred in young and healthy individuals. One of the patients in this series suffered from a recurrent episode of SP, a phenomenon that has not been reported to date. A 19-year-old soldier was admitted for severe retrosternal pain that occurred after running 5 kilometers. His past history was unremarkable, and he was accustomed to participating in intensive athletic activity. On admission, subcutaneous emphysema was palpated and Hamman's sign (mediastinal crunch) was heard. Chest x-ray film revealed mediastinal and cervical emphysema. The patient was hospitalized, and after four days of bed rest the mediastinal air resolved completely. Four months later, he underwent resection of a benign tibial tumor under general anesthesia. Chest x-ray examination on that occasion was within normal limits. Fourteen months following the first episode of SP, the patient was readmitted with a second episode of retrosternal pain that again occurred after running. The diagnosis of recurrent SP was confirmed by chest x-ray film. He was submitted to bed rest at home and a repeated chest roentgenogram performed a week later showed no residual mediastinal air. Although only about 300 cases of SP have been reported in the literature, we believe there have been more. Regarding the incidence of 1:7,115 admissions reported by Munsell5Munsell WP. Pneumomediastinum.JAMA. 1967; 202: 689-693Crossref PubMed Scopus (135) Google Scholar and the incidence of 1:12,850 admissions found in our series, it can be calculated that a few thousand cases should occur every year. We have observed that SP is second to spontaneous pneumothorax as a cause for admissions in young (under 30 years old), healthy individuals experiencing sudden chest pain or shortness of breath. Most authors accept Macklin and Macklin's theory6Macklin MT Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: Interpretation of the clinical literature in light of laboratory experiment.Medicine. 1944; 23 (2nd ed): 281-358Crossref Scopus (642) Google Scholar of alveolar hyperpressure with rupture of marginal alveoli and dissection of air along interstitial planes to the mediastinum as the pathogenic basis for SP. This is usually caused by a sudden elevation in bronchiolar pressure, a mechanism shared by many cases of spontaneous pneumothorax. Although both situations affect a similar age group and have almost the same preference to males, spontaneous pneumothorax is notorious for its high recurrence rate.7Baum LG. Textbook of pulmonary disease. Little, Brown and Company, Boston1974: 987Google Scholar It is therefore believed that the majority of patients suffering from spontaneous pneumothorax have some underlying pulmonary parenchymal pathology. Judging from the lack of recurrences of SP, one can assume that lung architecture is preserved in the latter condition. It is possible that episodes of recurrent SP have occurred, but have not been reported or have passed unrecognized, and thus, spontaneous pneumothorax and SP may be two presentations of the pulmonary air leak differing only in anatomic location of the alveolar rupture. Nevertheless, evidence so far favors the acceptance of SP as a separate entity, and as such, a recurrent episode is exceptional." @default.
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• W2004878834 date "1983-06-01" @default.
• W2004878834 modified "2023-10-17" @default.
• W2004878834 title "Recurrent Spontaneous Pneumomediastinum" @default.
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• W2004878834 doi "https://doi.org/10.1378/chest.83.6.935a" @default.
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