Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Spontaneous pneumomediastinum is a rare clinical entity defined as the presence of free air in the mediastinal structures without an apparent cause such as trauma. Spontaneous pneumomediastinum is rare in children and most frequently occurs in young male patients. It usually develops after alveolar rupture and air penetration into the pulmonary interstice, followed by air penetration towards the hila and into the mediastinum. Alveolar ruptures may be caused by various pathological and physiological processes, in children most frequently by asthma. Clinical diagnosis is based on the symptom triad including chest pain, dyspnea and subcutaneous emphysema. The diagnosis is confirmed by radiography. On differential diagnosis, esophageal perforation should be considered first, and if suspected, contrast esophagogram should be performed. Spontaneous pneumomediastinum usually resolves spontaneously in several days of treatment, which includes identification of the underlying cause (if possible), rest, analgesics and clinical monitoring. Complications involving spontaneous pneumomediastinum, such as tension pneumomediastinum and tension pneumothorax, are quite rare. A case is presented of pneumomediastinum in a 17-year-old male adolescent with no relevant history but with a clinical picture of intense retrosternal pain and subcutaneous emphysema of the neck and supraclavicular region. Thorough examinations including chest x-ray, chest computed tomography, bronchoscopy and esophagoscopy failed to identify the cause of pneumomediastinum. After eight days of conservative treatment, the pneumomediastinum symptoms completely disappeared and x-ray showed resolution of pneumomediastinum.Spontani pneumomedijastinum (SPM) je rijedak klinički entitet obilježen prisutnošću slobodnog zraka oko medijastinalnih struktura bez jasnog uzroka kao što je trauma. SPM je rijedak u djece i javlja se uglavnom u muških adolescenata. Obično se pojavljuje sekundarno nakon rupture alveola i prodora zraka u plućni intersticij, a potom slijedi prodor zraka prema hilusima i u medijastinum. Različiti patološki i fiziološki događaji mogu dovesti do rupture alveola, a u djece je najčešći uzrok astma. Klinička dijagnoza se temelji na trijasu simptoma, a to su bol u prsištu, dispneja i supkutani emfizem. Dijagnoza se potvrđuje rendgenskom snimkom. U diferencijalnoj dijagnozi treba prvenstveno misliti na perforaciju jednjaka, a postoji li sumnja na perforaciju treba učiniti ezofagogram s kontrastom. SPM se obično spontano povlači nakon nekoliko dana liječenja koje uključuje pronalaženje osnovnog uzroka (ako je moguće), odmor, analgetike i kliničko praćenje. Rijetke su komplikacije spontanog pneumomedijastinuma kao što je tenzijski pneumomedijastinum i tenzijski pneumotoraks. Ovdje se prikazuje slučaj pneumomedijastinuma u 17-godišnjeg mladića bez značajne medicinske anamneze, s kliničkom slikom intenzivnih retrosternalnih bolova te supkutanim emfizemom vrata i supraklavikularnih područja. Intenzivnim pretragama uključujući rendgensku snimku pluća, kompjutoriziranu tomografiju prsnog kosa, bronhoskopiju i ezofagoskopiju nije se pronašao uzrok pneumomedijastinuma. Nakon osam dana konzervativnog liječenja došlo je do potpunog nestanka simptoma i povlačenja pneumomedijastinuma na rendgenskoj snimci
