We characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest
series to date and propose a management pathway.
All patients at our institution with ICD-9 code 518.1 confirmed to have isolated radiographic
findings of spontaneous pneumomediastinum between January 2003 and February 2014 were
retrospectively reviewed for admission, intensive care unit (ICU) stay, complications,
We identified 96 children with 99 episodes, median age 14.1 years (IQR: 8.7–16.4). Primary symptoms were chest pain, cough, and dyspnea. Most
were hospitalized (n = 91, 91.9%), with 20 (20.2%) admitted to ICU. Median lengths of stay (LOS) were 1 day (IQR: 1–2) for non-ICU admissions and 3 days (IQR: 2–3) for ICU admissions. The surgical service discharged non-ICU patients
0.94 days earlier than medical services (95% CI 0.38–1.50, p = 0.0014). Asthma affected neither LOS nor ICU admission rates. Follow-up imaging, when
obtained (n = 81, 81.8%), did not alter management. Recurrences occurred in three asthmatics, all
after one year. Each was rehospitalized and discharged uneventfully. No patient developed
pneumomediastinum-related complications (e.g., pneumothorax, pneumopericardium, or
Spontaneous pneumomediastinum without associated comorbidities can be managed with
expectant outpatient observation without further imaging. Children with asthma should
be treated independent of spontaneous pneumomediastinum.