SPONTANEOUS PNEUMOMEDIASTINUM: CLINICAL ANALYSIS OF 17 CASES

Yıl 2022, Cilt: 23 Sayı: 4, 457 - 462, 17.10.2022

Barış Hekimoğlu , Muhammet Ali Beyoglu

https://doi.org/10.18229/kocatepetip.1149904

Öz

OBJECTIVE: Spontaneous pneumomediastinum (SPM) is a rare disease caused by the accumulation of air in the mediastinum through the tracheobronchial tree neighborhood due to alveolar rupture, which occurs spontaneously or with the effect of precipitating factors. The aim of this study is to report our experience in the diagnosis and treatment of SPM.
MATERIAL AND METHODS: Seventeen patients treated with the diagnosis of SPM in a 3.5 year period were included in the study retrospectively. Age, gender, smoking, co-morbid disease status, clinical presentations, radiological imaging, treatment processes, and recurrence status were analyzed. Secondary pneumomediastinum cases were not included in the study.
RESULTS: Fourteen of the patients were male, and three were female. The mean age was 19.2 ±2.8, and the mean Body Mass Index (BMI) was 18.5 ±6.3 kg/m2. The precipitating factor for SPM was found in 13 (76.5%) cases. There was a diagnosis of asthma in 4 (23.5%) cases. 9 (52.9%) cases were smokers. The most common symptom was chest pain, with 14 cases (82.4%). Subcutaneous emphysema was present in 5 (29.4%) and Hamman's sign in 2 (11.8%) cases, and the Macklin effect was detected in 3 (17.6%) cases in thorax tomography. The mean hospital stay of the cases was 4.5 ±2 days. No interventional procedures were performed, such as fiberoptic bronchoscopy, upper gastrointestinal endoscopy, pretracheal fasciotomy, or mediastinal drainage catheterization. When the antibiotic therapy rates were examined, it was seen that 13 (76.5%) cases were not given antibiotics, and no advanced complications such as mediastinitis developed in any case.
CONCLUSIONS: SPM is a benign condition presenting with chest pain and dyspnea. Computed tomography is the gold standard in diagnosis, and SPM is usually treated conservatively. Although recurrence is rare, it is vital to determine the presence of an underlying secondary cause at the time of initial diagnosis.

Anahtar Kelimeler

Antibiotic prophylaxis, Mediastinal emphysema, Subcutaneous emphysema

SPONTAN PNÖMOMEDİASTİNUM: 17 OLGUNUN KLİNİK ANALİZİ

Öz

AMAÇ: Spontan Pnömomediastinum (SPM), kendiliğinden veya tetikleyici faktörlerin etkisi ile oluşan alveoler rüptür sonucu havanın trakeobronşial ağaç komşuluğu yolu ile mediastende birikimi ile oluşan nadir görülen bir hastalıktır. Bu çalışmanın amacı, spontan pnömomediasten tanı ve tedavisindeki deneyimlerimizi bildirmektir.
GEREÇ VE YÖNTEM: 3.5 yıllık süreçte SPM tanısı ile tedavi edilen 17 hasta retrospektif olarak çalışmaya alındı. Olguların; yaş, cinsiyet, sigara kullanımı, ek hastalık durumu, klinik prezentasyonları, radyolojik görüntüleme, tedavi süreçleri ve nüks durumları incelendi. Sekonder pnömomediasten olguları çalışmaya alınmadı.
BULGULAR: SPM olgularının 14'ü erkek ve 3'ü kadın hastaydı. Ortalama yaş 19.2 ±2.8 ve ortalama BMI 18.5 ±6.3 kg/m2 olarak bulundu. SPM oluşumu için tetikleyici faktör 13 (%76.5) olguda bulunmaktaydı. 4 (%23.5) olguda astım tanısı mevcuttu. 9 (%52.9) olgu sigara kullanmaktaydı. En sık görülen semptom 14 (%82.4) olguyla göğüs ağrısıydı. Subkutan amfizem 5 (%29.4) ve Hamman bulgusu 2 (%11.8) olguda vardı ve Toraks tomografisinde 3 (%17.6) olguda Macklin effect tespit edildi. Olguların hastanedeki yatış süresi ise ortalama 4.5 ±2 gündü. Olguların hiçbirisine fiberoptik bronkoskopi, üst GIS endoskopi ve pretrakeal fasya açılması yada mediastene drenaj katateri yerleştirilmesi gibi girişimsel işlem uygulanmadı. Antibiyoterapi oranları incelendiğinde ise 13 (%76.5) olguya antibiyoterapi verilmediği, ve hiçbir olguda mediastinit gibi ileri komplikasyon gelişmediği görüldü.
SONUÇ: SPM göğüs ağrısı ve dispne ile prezente olan benign bir durumdur. Tanıda bilgisayarlı tomografi altın standarttır ve genelde konservatif yollarla tedavi edilir. Nüks nadir olmakla birlikte tanı anında sekonder bir nedenin SPM’ye yol açıp açmadığının belirlenmesi hayati önem taşımaktadır.

Anahtar Kelimeler

Antibiyotik proflaksisi, Mediastinal amfizem, Subkütan amfizem

Kaynakça

• 1. Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp. 1939;64:1-21.
• 2. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respirotary diseases and other conditions: interpretation of the clinical literature in the light of laboratory experiment. Medicine (Baltimore). 1944;23:281-358.
• 3. Macia I, Moya J, Ramos R, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardio Thorac Surg. 2007;31:1110-4.
• 4. Caceres M, Ali SZ, Braud R, et al. Spontaneous pneumomediastinum: a comparative study and rewiev of the literature. Ann Thorac Surg. 2008;86:962-6.
• 5. Kim DH, Park JH, Chei CS, et al. Spontaneous pneumomediastinum: clinical investigation. Korean J Thorac Cardiovasc Surg. 2006;39:220-5.
• 6. Okada M, Adachi H, Shibuya Y. Diagnosis and treatment of patients with spontaneous pnemomediastinum. Respir Investig. 2014;52:36-40.
• 7. Ryoo JY. Clinical analysis of spontaneous pneumomediastinum. Tuberc Respir Dis (Seoul). 2012;73(3):169-73.
• 8. Yamairi K, Yoshimatsu Y, Shimazu H, et al. Clinical analysis of 71 spontaneous pneumomediastinum cases: an observational study from a tertiary care hospital in Japan. Respir Investig. 2021;59(4):530-4.
• 9. Çakmak M, Yüksel M, Kandemir MN. Analysis of Patients with Spontaneous Pneumomediastinum. Turk Thorac J. 2016;17(3):105-8.
• 10. Gunluoglu MZ, Cansever L, Demir A, et al. Diagnosis and treatment of spontaneous pneumomediastinum. Thorac Cardiovasc Surg. 2009;57(4):229-31.
• 11. Park SJ, Park JY, Jung J, Park SY. Clinical Manifestations of Spontaneous Pneumomediastinum. Korean J Thorac Cardiovasc Surg. 2016;49(4):287-91.
• 12. Sahni S, Verma S, Grullon J, et al. Spontaneous pneumomediastinum: time for consensus. N Am J Med Sci. 2013;5(8):460-4.
• 13. Dajer-Fadel WL, Argüero-Sánchez R, Ibarra-Pérez C, Navarro-Reynoso FP. Systematic review of spontaneous pneumomediastinum: a survey of 22 years' data. Asian Cardiovasc Thorac Ann. 2014;22(8):997-1002.
• 14. Göktekin MÇ. Acil serviste spontan pnömomediastinum tanılı hastaların değerlendirilmesi. Cukurova Medical Journal. 2019;44(4):1155-9.
• 15. Acar LN, Gülhan E, Biçakçioglu P, et al. The Comparison of Therapeutic Approaches for Spontaneous Pneumomediastinum/Spontan Pnömomediastinumda Tedavi Yaklasimlarinin Karsilastirilmasi. Türkiye Klinikleri. Tip Bilimleri Dergisi. 2016;36(1): 30.
• 16. Çetin M, Türk İ, Fındık G, et al. Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification. The Egyptian Journal of Bronchology. 2022;16(1): 1-7.
• 17. Song IH, Lee SY, Lee SJ, Choi WS. Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg. 2017;65(5): 280-4.
• 18. Sapmaz E, Işık H, Doğan D, et al. A comparative study of pneumomediastinums based on clinical experience. Pnömomediastinumların klinik deneyimlere dayalı olarak karşılaştırılması. Ulus Travma Acil Cerrahi Derg. 2019;25(5):497-502.
• 19. Ebina M, Inoue A, Takaba A, Ariyoshi K. Management of spontaneous pneumomediastinum: Are hospitalization and prophylactic antibiotics needed? Am J Emerg Med. 2017;35(8):1150-3.
• 20. Takada K, Matsumoto S, Hiramatsu T, et al. Management of spontaneous pneumomediastinum based on clinical experience of 25 cases. Respir Med. 2008;102(9):1329-34.
• 21. Murayama S, Gibo S. Spontaneous pneumomediastinum and Macklin effect: Overview and appearance on computed tomography. World J Radiol. 2014;6(11):850-4.
• 22. Kumeda H, Saito G. Spontaneous pneumomediastinum diagnosed by the Macklin effect. J Surg Case Rep. 2022;(1):1-3.