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Çocukluk Çağında Spontan Pnömomediastinum: Antalya’ daki Üçüncü Basamak bir Merkezin Deneyimi

Year 2022, , 55 - 60, 01.01.2022
https://doi.org/10.53394/akd.1037553

Abstract

ÖZ
Amaç: Spontan pnömomediastinumlu çocuk olguların demografik verilerini, klinik bulgularını, komplikasyonlarını ve prognozlarını değerlendirmek.
Gereç ve Yöntemler: Ocak 2009- Ağustos 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesinden pnömomediastinum tanısıyla taburcu edilen 15 çocuk olgunun demografik özellikleri, tetikleyici faktörleri, altta yatan hastalıkları, semptomları, bulguları, hastanede kalış süreleri, komplikasyonları, tedavileri ve sonuçları içeren verileri geriye dönük incelendi.
Bulgular: Spontan pnömomediastinumu olan 12 erkek (% 80) ve üç kızın (% 20) ortalama yaşları 11.33 ± 7 yıldı (4ay-17 yıl). En sık tetikleyici faktör solunum yolu enfeksiyonuna bağlı şiddetli öksürük ve / veya bronkospazmdı. Sekiz olguya akciğer grafisinde pnömomediastinum saptanmasına rağmen toraks bilgisayarlı tomografi de çekilmişti. Üç (% 20) olgunun toraks bilgisayarlı tomografisinde pnömoraşisi mevcuttu. Yedi (% 46.6) olguda pnömomediastinuma pnömotoraks eşlik etmekteydi. Ortalama hastanede kalış süreleri 8.4 ± 4.5 (3-18) gündü. Bir hasta dışında tümü iyileşerek taburcu edildi ve 1-72 ay boyunca takip edildi. Takip süresi boyunca olgularda nüks saptanmadı.
Sonuçlar: Spontan pnömomediastinum çocukluk çağında nadir görülen, kendi kendini sınırlandıran bir durumdur ve prognozu altta yatan hastalığa bağlıdır. Spontan pnömomediastinumlu çocuk olgulara rutin akciğer tomografisi çekilip çekilmeyeceği henüz net değildir. Tüm spontan pnömomediastinumlu olgulara akciğer tomografisi çekilirse pnömoraşi daha sık tespit edilebilir.

Anahtar Sözcükler: Spontan pnömomediastinum, Pnömoraşi, Pnömomediastinum, Pnömotoraks

References

  • 1- Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939; 64:1–21.
  • 2- Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001; 31:67–75.
  • 3- Tortajada M, Moreno P, Laguna D et al. Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review. Ther Adv Respir Dis 2016;10(5):402-9.
  • 4- Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med 1939; 64:913–26.
  • 5- Dekel B, Paret G, Szeinberg A, et al. Spontaneous pneumomediastinum in children: clinical and natural history. Eur J Pediatr 1996; 155:695-697.
  • 6- Perna V, Vilà E, Guelbenzu JJ, et al. Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 2010; 37: 573–5.
  • 7- Bakhos CT, Pupovac SS, Ata A, et al. Spontaneous pneumomediastinum: an extensive workup is not required. J Am Coll Surg 2014;219: 713–7.
  • 8- Roe PF, Kulkarni BN. Pneumomediastinum in children with cough. Br J Dis Chest 1967; 61:147-150.
  • 9- Balachandran S, Guinto FC, Goodman P, Cavallo FM. Epidural pneumatosis associated with spontaneous pneumomediastinum. AJNR Am. J. Neuroradiol 1993; 14: 271 – 2.
  • 10- Yaginuma K, Watanabe M, Saito Y, et al. Pneumorrhachis in children: A report of two cases and review of the literature. Radiology Case Reports 2019; 14:1325–1329.
  • 11- Kono T, Kuwashima S, Fujioka M, et al. Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication? Pediatrics International 2007; 49: 923–927.
  • 12- Lee CY, Wu CC, Lin CY. Etiologies of Spontaneous Pneumomediastinum in Children in Middle Taiwan Pediatr Pulmonol 2010; 45: 869-73.
  • 13- Zylak CM, Standen JR, Barnes GR, et al. Pneumomediastinum revisited. Radiographics 2000; 20: 1043–1057.
  • 14- Ho AS, Ahmed A, Jessica S, et al. Multidetector computed tomography of spontaneous versus secondary pneumomediastinum in 89 patients. J Thorac Imaging 2012; 27: 85-92.
  • 15- Noorbakhsh KA, Williams AE, Langham JW et al. Management and Outcomes of Spontaneous Pneumomediastinum in Children. Pediatr Emerg Care; 2019. Online ahead of print.
  • 16- Abbas PI, Akinkuotu AC, Peterson ML, et al. Spontaneous pneumomediastinum in the pediatric patient. The American Journal of Surgery 2015; 210: 1031-1036.
  • 17- Panacek EA, Singer AJ, Sherman BW, et al. Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med 1992; 21:1222–7.
  • 18- Yellin A. Spontaneous pneumomediastinum. Chest 1992; 101:1742–3.
  • 19- Chen C, Tseng CM, Hsu JH, et al. Spontaneous Pneumomediastinum in Adolescents and Children. Kaohsiung J Med Sci 2010; 26 :84-8.
  • 20- Gasser C, Pellaton R, Rochat CP. Pediatric Spontaneous Pneumomediastinum: Narrative Literature Review. Pediatr Emerg Care 2017; 33: 370-374.

Spontaneous Pneumomediastinum in Children: The Experience of a Pediatric Tertiary Center in Antalya

Year 2022, , 55 - 60, 01.01.2022
https://doi.org/10.53394/akd.1037553

Abstract

Objective: To evaluate the demographic data, clinical findings, complications and prognosis of children with spontaneous pneumomediasinum.
Material and Methods: This was a retrospective chart review including demographic characteristics, trigger factors, underlying diseases, symptoms, signs, length of hospital stay, complications, treatments, and outcomes of 15 children aged <18 years with a discharge diagnosis of pneumomediastinum, between January 2009 and August 2019, at the University of Health Sciences Antalya Training and Research Hospital.
Results: The mean age of the 12 boys (80%) and three girls (20%) with spontaneous pneumomediastinum was 11.33 ± 7 years, with a range of 4 months to 17 years. The most common trigger factor was severe cough and/or bronchospasm due to respiratory tract infection. In 8 patients with pneumomediastinum seen radiologically on the chest X-ray, thoracic computed tomography was also taken. Pneumorrhachis was determined on the thoracic computed tomography of 3 (20%) patients. Pneumomediastinum was accompanied by pneumothorax in 7 (46.6%) cases. The mean length of hospital stay was 8.4 ± 4.5 days (3-18 days). All patients except one recovered and were discharged and followed up for 1-72 months. Hospital records showed no recurrence during the follow-up period.
Conclusions: Spontaneous pneumomediastinum is a rare, self-limiting condition in childhood and the prognosis depends on the underlying disease. The problem of whether or not routine chest computed tomography scanning should be performed in children with spontaneous pneumomediastinum has not yet been resolved, but if chest computed tomography scanning is performed in every patient with spontaneous pneumomediastinum, pneumorrachis might be detected more frequently.
Key Words: Spontaneous pneumomediastinum, Pneumorrhachis, Pneumomediastinum, Pneumothorax

References

  • 1- Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939; 64:1–21.
  • 2- Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001; 31:67–75.
  • 3- Tortajada M, Moreno P, Laguna D et al. Spontaneous pneumomediastinum and subcutaneous emphysema as a complication of asthma in children: case report and literature review. Ther Adv Respir Dis 2016;10(5):402-9.
  • 4- Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med 1939; 64:913–26.
  • 5- Dekel B, Paret G, Szeinberg A, et al. Spontaneous pneumomediastinum in children: clinical and natural history. Eur J Pediatr 1996; 155:695-697.
  • 6- Perna V, Vilà E, Guelbenzu JJ, et al. Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients. Eur J Cardiothorac Surg 2010; 37: 573–5.
  • 7- Bakhos CT, Pupovac SS, Ata A, et al. Spontaneous pneumomediastinum: an extensive workup is not required. J Am Coll Surg 2014;219: 713–7.
  • 8- Roe PF, Kulkarni BN. Pneumomediastinum in children with cough. Br J Dis Chest 1967; 61:147-150.
  • 9- Balachandran S, Guinto FC, Goodman P, Cavallo FM. Epidural pneumatosis associated with spontaneous pneumomediastinum. AJNR Am. J. Neuroradiol 1993; 14: 271 – 2.
  • 10- Yaginuma K, Watanabe M, Saito Y, et al. Pneumorrhachis in children: A report of two cases and review of the literature. Radiology Case Reports 2019; 14:1325–1329.
  • 11- Kono T, Kuwashima S, Fujioka M, et al. Epidural air associated with spontaneous pneumomediastinum in children: Uncommon complication? Pediatrics International 2007; 49: 923–927.
  • 12- Lee CY, Wu CC, Lin CY. Etiologies of Spontaneous Pneumomediastinum in Children in Middle Taiwan Pediatr Pulmonol 2010; 45: 869-73.
  • 13- Zylak CM, Standen JR, Barnes GR, et al. Pneumomediastinum revisited. Radiographics 2000; 20: 1043–1057.
  • 14- Ho AS, Ahmed A, Jessica S, et al. Multidetector computed tomography of spontaneous versus secondary pneumomediastinum in 89 patients. J Thorac Imaging 2012; 27: 85-92.
  • 15- Noorbakhsh KA, Williams AE, Langham JW et al. Management and Outcomes of Spontaneous Pneumomediastinum in Children. Pediatr Emerg Care; 2019. Online ahead of print.
  • 16- Abbas PI, Akinkuotu AC, Peterson ML, et al. Spontaneous pneumomediastinum in the pediatric patient. The American Journal of Surgery 2015; 210: 1031-1036.
  • 17- Panacek EA, Singer AJ, Sherman BW, et al. Spontaneous pneumomediastinum: clinical and natural history. Ann Emerg Med 1992; 21:1222–7.
  • 18- Yellin A. Spontaneous pneumomediastinum. Chest 1992; 101:1742–3.
  • 19- Chen C, Tseng CM, Hsu JH, et al. Spontaneous Pneumomediastinum in Adolescents and Children. Kaohsiung J Med Sci 2010; 26 :84-8.
  • 20- Gasser C, Pellaton R, Rochat CP. Pediatric Spontaneous Pneumomediastinum: Narrative Literature Review. Pediatr Emerg Care 2017; 33: 370-374.
There are 20 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Abdurrahman Erdem Basaran This is me 0000-0002-9092-6936

Hasan Serdar Kıhtır This is me 0000-0003-0120-8711

Mahir Cevizoğlu This is me 0000-0001-9791-8587

Publication Date January 1, 2022
Submission Date December 28, 2020
Published in Issue Year 2022

Cite

APA Basaran, A. E., Kıhtır, H. S., & Cevizoğlu, M. (2022). Spontaneous Pneumomediastinum in Children: The Experience of a Pediatric Tertiary Center in Antalya. Akdeniz Tıp Dergisi, 8(1), 55-60. https://doi.org/10.53394/akd.1037553