Spontaneous Pneumomediastinum in a Pediatric Patient After a 1600-m Run: Case Report and Literature Review

Abstract

Pneumomediastinum occurs as a result of traumatic or iatrogenic causes or in patients with preexisting lung conditions such as interstitial lung disease, asthma, and chronic obstructive pulmonary disease. Spontaneous pneumomedi-astinum (SPM), however, is rarely seen in clinical practice. The authors report the case of a 14-year-old boy who presented to the emergency department with chest discomfort and shortness of breath after a 1600-m run as part of a physical education class. The patient was found to have SPM, was admitted to the pediatric service for monitoring and pain control, and made a full recovery within 24 hours. This case is notable because SPM occurred in the absence of identifable organic causes and as the result of sustained noncontact physical activity. A review of the literature provides background information and highlights pathophysiologic processes of SPM and suggested treatment. Physicians should consider pneu-momediastinum in young patients or runners presenting with chest pain even in the absence of any known inciting event.

Mediastinal emphysema after long‐distance flight with ketoacidosis and underlying diabetes mellitus type 1

“…As such, increased intra-alveolar pressure (relative to the interstitium surrounding peripheral alveoli), during coughing, vomiting, and cocaine sniffing, and barotrauma during diving or gas inhalation present characteristic triggers of SPM [9][10][11][12][13][14]. Similarly, activities associated with alveolar over-inflation such as pronounced physical activity have been associated with SPM [15]. It is thus little surprising that multiple reports have found a co-existence of SPM and ketoacidosis [11,[16][17][18][19], which has been attributed to diabetic hyperventilation (Kussmaul's respiration) triggered by increased respiratory drive at low arterial pH [11,[16][17][18][19].…”

Exercise-induced pneumomediastinum

“…Most patients are male adolescents [ 2 ], and preexisting bronchial asthma primarily causes SPM. However, an exertional increase in airway pressure induced by daily activities (weightlifting or sports) often causes alveolar rupture, leading to SPM, even in the absence of underlying lung disease [ 3 , 4 ]. Although most patients require hospitalization for observation or treatment (92 %), almost all are discharged within a few days, without further complications [ 5 , 6 ].…”

Neumomediastino espontáneo de reentrada en la altitud: reporte de dos casos

“…La administración de oxígeno suplementario reduce la presión parcial de nitrógeno en los capilares, por lo que aumenta la velocidad de reabsorción del gas. Es habitual que el síndrome se resuelva de manera espontánea después de dos a ocho días, sin secuelas, como en el caso de nuestros pacientes, y la recurrencia es rara (28)(29)(30) . En conclusión, se recomienda la evaluación de los pacientes con mal de altitud agudo de reascenso con rayos X para evaluar la posibilidad del NME asociado.…”