Spontaneous pneumomediastinum: case series and literature review

Spontaneous pneumomediastinum (SPM) is a condition characterised by presence of air in the mediastinum that is not iatrogenic or secondary to trauma. We conducted a retrospective review of 4 cases, treated at our hospital for SPM in 2023. The mean age of the patients was 35 years (range, 28-58 years), with 3 male (75%). Only one of the patients (25%) had precipitating projectile vomiting followed by hematemesis. Chest pain was by far the most common symptom (75%). One patient presented with haematemesis, raised inflammatory markers and fever. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In all cases a computed tomography (CT) scan of the chest with on table contrast was performed with half of the patients needing fluoroscopy swallow later in the admission. Half of the patients were treated for suspected oesophageal perforation and received antibiotics and kept nil by mouth, the other two patients only required supportive care. The mean length of hospital stay was 3.4 days (range, 1.2-4.7 days). SPM is a benign process primarily affecting young otherwise healthy males. There is a growing body of evidence to suggest that CT of the chest with on table contrast should be reserved for patients presenting with red flags such as abdominal pain, hematemesis, fever and raised inflammatory markers.