Clinical Spectrum of Spontaneous Pneumomediastinum in Children
摘要
Spontaneous pneumomediastinum (SPM) is a rare condition in children and probably underdiagnosed in pediatric patients visiting the pediatric emergent unit complaining of acute chest pain, dyspnea or neck discomfort. To evaluate the clinical features of SPM in children, we retrospectively analyzed 19 patients under the age of 18 with a diagnosis of SPM at the Changhua Christian Hospital from June 1994 to June 2003. The diagnosis of SPM was made on frontal chest radiography, including the cervical region. Lateral views were useful if there was a doubt in the diagnosis. In our series. SPM was most commonly associated with infections (42%) followed by asthma (21%) and idiopathic factor (21%). In addition, the most common clinical symptom was chest pain (58%) followed by dyspnea (53%), and the most common specific physical finding was subcutaneous emphysema (79%) followed by Hamman’s sign (21%). All of our cases admitted to the hospital, but six patients (32%) required intensive care treatment due to severe respiratory distress. The mean hospital length of stay for all cases was 4.5±2.6 days (±SD) with a range of 2 to 11 days. All patients had complete or nearly complete resolution of findings on chest radiography before discharge. No recurrence was found in our cases in the past 10 years. In conclusion, SPM is a rare condition but benign in itself in children. If pediatric patients, especially with a history of respiratory infectious disorder or asthma exacerbation, suffer from chest pain, dyspnea or neck discomfort in pediatric emergent unit, the diagnosis of SPM should be considered and chest radiography should be performed. WE recommend children with SPM may require short hospitalization for observation and management of possible complication associated with respiratory compromise, such as accompanying pneumothorax.