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Pediatric pneumomediastinum: Symptom-based management

  • Danielle Dougherty
    Correspondence
    Corresponding author at: Fetal Surgery Research Fellow, C.S. Mott Children's Hospital, 1540 E. Hospital Dr. Ann Arbor, MI 48109-4211, United States.
    Affiliations
    University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, 1540 E. Hospital Dr. Ann Arbor, MI 48109-4211, United States
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  • Kayla M. Meyer
    Affiliations
    University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-4211, United States
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  • Allison R. Thompson
    Affiliations
    University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-4211, United States

    University of Michigan School of Public Health, Department of Health Behavior and Health Education, 1415 Washington Heights, Ann Arbor, MI 48109-4211, United States
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  • K. Elizabeth Speck
    Affiliations
    University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, 1540 E. Hospital Dr. Ann Arbor, MI 48109-4211, United States
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      Highlights

      • Despite the known benign course of pediatric spontaneous pneumomediastinum, there is no consensus on workup and management.
      • Patients with similar presentations undergo a variety of imaging studies.
      • Presenting symptoms should be the main determinant of evaluation and management.
      • There is an opportunity to decrease unnecessary radiation exposure in this patient population.

      Abstract

      Background

      Pediatric spontaneous pneumomediastinum is known to have a benign course. Despite this, there is no consensus or standardization for the workup and management. There are often a variety of imaging studies performed for patients with similar presentations.

      Methods

      This is a retrospective chart review evaluating the presentation, workup, and management of all pediatric patients with a primary diagnosis of spontaneous pneumomediastinum over a 5-year period at a children's hospital.

      Results

      Of the 62 patients, the initial workup consisted of either a chest x-ray (CXR) only (n = 31, 50%), a chest computed tomography scan only (n = 11, 18%) or both (n = 14, 23%); additionally, some patients came with ‘other’ imaging only (n = 3, 5%) or no imaging (n = 3, 5%). Twenty-seven patients (44%) underwent an additional CXR and 19 (31%) underwent an esophagram. All esophagrams were negative for an esophageal leak. A presenting symptom of pain was associated with a hospital stay of less than 24 h (p = 0.008) while shortness of breath (p = 0.0005) and emesis (p = 0.0006) were associated with a hospital stay of greater than 24 h. Associated diagnoses of respiratory infections (p = 0.02) and gastrointestinal issues (p = 0.006), such as hyperemesis, were associated with inpatient admission.

      Conclusion

      Pediatric patients with spontaneous pneumomediastinum benefit from evaluation, management, and treatment based on their presenting symptoms. There is an opportunity to decrease unnecessary radiation exposure in this patient population with fewer CXRs and avoidance of esophagrams, neither of which alter management.

      Level of Evidence

      Level III.

      Keywords

      Abbreviations:

      CXR (Chest x-ray), CT (computed tomography), ED (emergency department), EGD (esophagogastroduodenoscopy)
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